CMS releases July 1 Medicare DME fee schedules at 11th hour- what’s next?

On June 23, 2016, at the 11th hour, CMS released its new rates for the fee schedules that will affect all of our patients and operations.

This last minute consideration of our industry and ploy that has come to be common practice with CMS has dramatic cuts to our CRT industry. These substantial cuts will limit patients’ options for medically needed products for their aids to daily living. This is the rationing of health care products that CMS is implementing to reduce the number of providers and limit the amount of voices for the industry’s most vulnerable patient population.

As feared, the payment reductions due to the full application of the Competitive Bidding program, including new data from the recent Round 2 Recompete, are major.

Here are the average fees for 2015 and 2016 along with the % change from the Rural and Urban areas.  This fact sheet gives the average reduction from the contiguous United States to be applied in July 1 of this year.

Selected DMEPOS Items: Fees and Percentage Change from 2015 to 2016
DMEPOS Item HCPCS¹ 2015 Fee 2016 Urban Fee-July Percent Change Urban 2016 Rural Fee-July Percent Change Rural
Oxygen Concentrator (monthly) E1390 $180.92 $78.74 -56% $86.61 -52%
CPAP (rental) E0601 $101.94 $40.60 -60% $44.66 -56%
Hospital Bed (rental) E0260 $134.38 $60.50 -55% $66.55 -50%
NPWT Pump (rental) E2402 $1,642.09 $646.98 -61% $711.68 -57%
Manual Wheelchair (rental) K0001 $57.06 $22.79 -60% $24.97 -56%
Power Wheelchair (rental) K0823 $577.42 $272.45 -53% $299.69 -48%
Walker (purchase) E0143 $110.92 $46.57 -58% $51.23 -54%
Commode Chair (purchase) E0163 $117.62 $52.15 -56% $57.36 -51%
TENS (purchase) E0730 $399.67 $71.51 -82% $78.93 -80%
Nebulizer (rental) E0570 $17.87 $5.80 -68% $6.35 -64%
Powered Mattress (rental) E0277 $662.42 $190.94 -71% $206.55 -69%
Insulin Pump (rental)² E0784 $463.44 $418.23 -10% $418.23 -10%
Enteral Pump (rental) B9002 $121.70 $61.06 -50% $67.90 -44%
Enteral Supplies (daily) B4035 $11.95 $5.31 -56% $5.84 -51%
Enteral Nutrients (per 100 calories) B4150-B4154 $1.12 $0.63 -44% $0.70 -38%

¹ HCPCS = Healthcare Common Procedure Coding System; codes used to identify items for billing purposes
² Item included in 10 or fewer CBAs

The table below lists average 2015 fees and average 2016 fees for Alaska, Hawaii, Puerto Rico, and the U.S. Virgin Islands for select items with the percentage change from 2015 to 2016:

DMEPOS Item HCPCS 2015 Fee 2016 Fee-July Percent Change
Oxygen Concentrator (monthly) E1390 $180.92 $86.87 -52%
CPAP (rental) E0601 $107.41 $44.74 -58%
Hospital Bed (rental) E0260 $134.38 $66.55 -50%
NPWT Pump (rental) E2402 $1,724.18 $722.85 -58%
Manual Wheelchair (rental) K0001 $58.64 $24.96 -57%
Power Wheelchair (rental) K0823 $591.86 $299.94 -49%
Walker (purchase) E0143 $121.13 $51.07 -58%
Commode Chair (purchase) E0163 $136.55 $57.36 -58%
TENS (purchase) E0730 $439.89 $81.01 -82%
Nebulizer (rental) E0570 $17.72 $6.43 -64%
Powered Mattress (rental) E0277 $673.00 $206.55 -69%
Insulin Pump (rental) E0784 $486.60 $418.23 -14%
Enteral Pump (rental) B9002 $121.70 $71.00 -42%
Enteral Supplies (daily) B4035 $11.95 $6.31 -47%
Enteral Nutrients (per 100 calories) B4150-B4154 $1.12 $0.76 -32%

Click here for additional information about the adjustments to Fee Schedule Amounts.

CMS’s detailed July Fee schedule can be located here.

This information gives us a better understanding that CMS is in no way being held accountable for their inappropriate actions. The implementation of these adjustments will limit access and reduce the levels of service provided to patients while shifting cost from one silo to another.

So, what’s next?

As an industry, we must continue to push for passage of H.R. 3229 and S. 2196 to protect accessories used on complex rehab power and manual wheelchairs.

Through our outcomes programs and aggressive lobbying efforts we are doing all we can to keep you informed and protect your interest but we need you to participate to strengthen our efforts. The outcomes program we have are voluntary and your data is needed to be able to show CMS that certain CRT equipment is the appropriate equipment to provide for certain disease states. Click here for additional information about our rehab outcomes program.

If you have any questions about how you can help advocate for H.R. 3229 and S.2196, please feel free to call or email.

Sincerely,

Greg Packer
President of U.S. Rehab
The VGM Group
Employee Owned
Phone: 800-987-7342
Greg.Packer@vgm.com