2012 DMEPOS Pay Rates on the Increase

The most recent update to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule is now available. The changes, effective Jan. 1, 2012, will affect all providers and suppliers submitting claims to Medicare contractors for DMEPOS items and services.

The big news is a 2.4 percent overall increase to the 2011 payment rate, as well as a 3.6 percent increase in the labor rate for services described by K0739 (repair/service oxygen equipment), L4205 (repair orthotic device), and L7520 (repair prosthetic device).

Also announced is an updated national monthly payment amount for stationary oxygen equipment codes (E0424, E0439, E1390 and E1391) of $176.06. The maintenance and servicing fee for oxygen concentrators and transfilling equipment will be $67.51. Payment for maintenance and servicing of certain oxygen equipment can occur every six months, beginning six months after the end of the 36th month of continuous use, or the end of the supplier’s or manufacturer’s warranty, whichever is later. For more information, see MLN Matters® articles MM6792 and MM6990.

New supply codes include HCPCS Level II A9272 for the SNaP™ Wound Care for negative pressure wound therapy (NPWT), A5056 and A5057 for the Premier One Piece Ostomy pouch (with extended wear barrier and filter), and E0988 to describe lever-driven wheelchair drive wheels, marketed as the Wijit® Tetra™ and Voyager™ Driving and Braking Systems (DBS®). Also new are three codes for prosthetics and orthotics (L5312, L6715, and L6880) and 10 new E codes for wheelchair accessories (for instance, E2358 and E2359 for power wheelchair, group 34 batteries).

Wheelchair accessory codes L3964-L3974 are deleted, to be replaced by new codes E2626-E2633 for various arm supports. Ten other orthotic/prosthetic L codes (e.g., L1500-L1520) have also been deleted.

Other changes include lowered reimbursement for shoe modification codes A5503-A5507, and new instruction for modifier application with HCPCS Level II codes E0776 IV pole and E2373 Power wheelchair accessory, hand or chin control interface, compact remote joystick.

For additional information on the updated DMEPOS fee schedule, see Centers for Medicare & Medicaid Services (CMS) CR 7635.

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