DMEPOS Fee Schedule Changes for 2016
This is a transitional time for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Adjustments to DMEPOS fee schedule amounts (finalized in 79 FR 66223) are being phased in for claims with dates of service from January 1, 2016, through June 31, 2016. As such, fee schedule amounts for many codes have changed.
Each fee schedule amount is based on a 50/50 blend of the fee schedule amount that would have gone into effect on January 1, 2016, if not adjusted based on information from the Competitive Bidding Program (CBP), and the adjusted fee schedule amount.
For claims with dates of service on or after July 1, 2016, the fee schedule amounts will be based on 100 percent of the adjusted fee schedule amounts.
Coding DMEPOS in 2016
Along with the DMEPOS fee schedule adjustments are several coding changes.
The following new HCPCS Level II codes are effective January 1, 2016:
A4337 Incontinence supply, rectal insert, any type, each
E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type
E0465 Home ventilator, any type, used with invasive interface (e.g., tracheostomy tube)
E0466 Home ventilator, any type, used with non-invasive interface (e.g., mask, chest shell)
L8607 Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies
HCPCS Level II codes deleted from the DMEPOS fee schedule, effective January 1, 2016, are: E0450, E0460, E0461, E0463, and E0464.
Code E0465 replaces E0450 and E0463 and code E0466 replaces E0460, E0461 and E0464.
Billing DMEPOS in 2016
For gap-filling pricing purposes, the 2015 deflation factors by payment category are:
Oxygen – 0.459
Capped Rental – 0.462
Prosthetics and Orthotics – 0.463
Surgical Dressings – 0.588
Parental and Enteral Nutrition – 0.639
Splints and Casts – 0.978
Intraocular Lenses – 0.962
The 2016 fee schedule update factor is -0.4 percent. For example, the maintenance and servicing fee is adjusted by the -0.4 percent to yield a maintenance and servicing fee of $69.48 for oxygen concentrators and transfilling equipment in 2016.
See MLN Matters® article MM8999 Revised for the 2016 update to labor payment rates, effective for claims submitted using HCPCS Level II codes K0739, L4205, and L7520, with dates of service from January 1, 2016, through December 31, 2016.