Medicare Establishes Set Fees for Custom Cushions (E2609) and Backs (E2617)….and it DOESN’T Sit Well!

This is a heads up to those who provide custom cushions (E2609) and backs (E2617) to Medicare beneficiaries! The Jurisdiction B and C DME MAC has decided to develop set fees for these custom items and did this internally without notice to the provider community. As of today, DME A and D has NOT implemented this change. This came to light when providers noticed the allowed amounts for these items dropped by approximately 70% overnight and brought this to our attention. Since these are custom items (miscellaneous), they were individually priced prior to this blind change and were averaging approximately 70% OF MSRP / Supplier Price. The allowed amount varied significantly since, well, they are custom fabricated and not prefabricated.

Please be aware that as of today, the set allowable for these codes are approximately $450 for E2609 and $550 for E2617 regardless of MSRP/Supplier Price or your cost of the item. We are hearing that the new established allowables will not even cover acquisition cost for any of the products that are coded as custom fabricated.

There are many issues that are unsettling with how this came about and all are being addressed with CMS and the DME MACs as you read this article. All industry advocates are aware of these issues and are reaching out to get answers and request that this change be rescinded so not to impact access to these custom medically necessary products.

The take away for now is knowing that the allowed amount as of today is approximately  $450 for E2609 and $550 for E2617. We want providers to have this information to be able to make an informed decision before providing these items.

More information will be forthcoming as there are Council meetings on Apr 19 for DME MAC C and Apr 20 for DME MAC B where we hope to obtain more information on how this was determined and why the provider community was not given advance notice of this change.

If you have any questions please contact me.

Dan Fedor
O: 844-794-8459
C: 570-499-8459
E: [email protected]