CMS Updates DMEPOS Competitive Bidding Program Files

The Centers for Medicare & Medicaid Services (CMS) is updating Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program files to implement a number of changes that go into effect Jan. 1, 2011.

DMEPOS suppliers should be aware of quarterly updates CMS is making to the Competitive Bidding Program HCPCS Level II, ZIP code, Single Payment Amount and Supplier files. The Round One Rebid is scheduled to begin Jan. 1, 2011 in competitive bidding areas (CBAs), which are defined by ZIP codes in nine of the statistically largest U.S. metropolitan areas.

DME Medicare administrative contractors (MACs) will begin using all four Competitive Bidding Program files to pay claims furnished between Jan. 1, 2011 and Dec. 31. 2013 for the following competitive bidding product categories:

001  Oxygen supplies and equipment
002  Standard power wheelchairs
003  Complex rehabilitative power wheelchairs
005  Enteral nutrients, equipment and supplies
006  CPAP and RAD devices and related supplies
009  Walkers and related supplies
010  Support surfaces (in Miami only)

For specific DME payment policies, visit the DMEPOS Competitive Bidding Program website for suppliers.

HCPCS Level II Code Changes

The following HCPCS Level II codes are changing from K codes to E codes in the HCPCS Level II file, effective Jan. 1, 2011.

HCPCS Level II Code Crosswalked to HCPCS Level II Code and Short Description
K0734 E2622 Adj skin pro w/c cus wd<22in
K0735 E2623 Adj skin pro wc cus wd>=22in
K0736 E2624 Adj skin pro/pos cus<22in
K0737 E2625 Adj skin pro/pos wc cus>=22

A list of the HCPCS Level II codes that are included in each of the Round One Rebid product categories can be found on the DMEPOS Competitive Bidding Implementation Contractor’s (CBIC) website.

Competitive Bidding Modifiers

Suppliers, including grandfathered suppliers, should submit claims for competitive bid items for Medicare patients residing in a CBA using the competitive bidding modifiers: KG, KK, KU, KW, and KY. Modifiers KG and KK are treated as pricing modifiers in the Round One Rebid of the Competitive Bidding Program and modifiers KU, KW, and KY are reserved for future program use.

Note: Non-contract suppliers that are renting competitively bid DME or oxygen and oxygen equipment at the time the DMEPOS Competitive Bidding Program is implemented may choose to become grandfathered suppliers for these items.

For diabetic supplies delivered through the mail, contract suppliers should use the pricing modifier KL DMEPOS item delivered via mail when billing the HCPCS Level II codes A4233, A4234, A4235, A4236, A4253, A4256, A4258, and A4259 for beneficiaries with a permanent residence in a CBA.

Modifier KV DMEPOS item subject to DMEPOS competitive bidding program that is furnished as part of a professional service should not be used when submitting competitive bidding claims for items in product category 9 (walkers and related accessories).

Suppliers should submit claims with modifier KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item for non-mail order DMEPOS competitive bid items that are furnished to patients who have traveled outside the CBA in which they reside.

The competitive bidding modifiers are listed in the single payment amount public use charts found under the supplier page on the CBIC website.

Source: CMS Transmittal 2088, Change Request (CR) 7181, issued Nov. 5.

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