2010 DME Reasonable Charge Update is Status Quo

The 2010 payment limits for splints and casts will be based on 2009 payment limits. Due to a -1.41 percent change in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending June 2009, the inflation indexed charge (IIC) update factor for 2010 is 0 percent.

When supplies are indicated for cast and splint purposes, HCPCS Level II Q codes are to be used. This payment is in addition to the payment made under the physician fee schedule for the splint or cast application procedure.

For a complete list of the applicable HCPCS Level II codes and 2010 payment limits for splints and casts, refer to Centers for Medicare & Medicaid Services (CMS) transmittal 1834, Attachment A.

CMS issued transmittal 1834, Oct. 23, to provide instructions regarding the calculation of reasonable charges for payment of claims for splints and casts, as well as dialysis supplies and equipment, and intraocular lenses furnished in the calendar year 2010.

Part A and Part B Medicare Administrative Contractors (A/B MACs) and carriers shall base 2010 customary and prevailing charges using actual charge data from July 1, 2008 through June 30, 2009 for intraocular lenses implanted in a physician’s office:

  • V2630 Anterior chamber intraocular lens
  • V2631 Iris supported intraocular lens
  • V2632 Posterior chamber intraocular lens

Durable medical equipment (DME) MACs shall also base 2010 customary and prevailing charges using actual change data from the aforementioned dates for dialysis supplies and equipment billed with or without modifier AX. Refer to transmittal 1834 for the list of applicable A and E codes.

Instructions for calculating reasonable charges, customary and prevailing charges, and the IIC are located in the Medicare Claims Processing Manual, Pub. 100-04, chap. 23, secs. 80, 80.2, and 80.6, respectively.


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