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When completing the DME MAC Reopening Request Form on or after July 1, 2020, suppliers should: The DME MACs will identify and adjust the claims to ensure appropriate payment at the unadjusted fee schedule amount. However, the changes that CMS is making to the Medicare claims processing system will facilitate the use of the KU modifier with claims for accessories furnished in conjunction with complex rehabilitative manual wheelchairs. As aforementioned, these system changes will be implemented on July 1, 2020. Suppliers should use the KU modifier for claims with dates of service on or after July 1, 2020 through June 30, 2021 for Attachment A codes that are furnished in conjunction with complex rehabilitative manual wheelchairs or certain manual wheelchairs. Additionally, the deadline for suppliers bidding in Round 2021 of the DMEPOS Competitive Bidding Program to upload their required financial documents in Connexion, the program’s secure portal, to be included in the process for reviewing covered documents and be notified of any missing required financial documents, has passed. Bidders that rely on this information in the preparation or submission of their bids could be at risk of submitting a non-compliant bid. Visit the CBIC website for valuable resources and tools and to subscribe to Email Updates. Hours are extended until 9 p.m. prevailing Eastern Time during the last two weeks of the bid window. More information on this important milestone in cancer treatment can be found at the DME MAC websites: Payment for the TTFT system will be made using monthly rental fee schedule amounts that include payment for the entire system (electromagnetic field generator, transducer arrays, and all related accessories) as well as all services furnished in providing the TTFT system, including frequent and substantial servicing of the device.

Background information and a list of the applicable KE HCPCS codes was issued in Appendix B (ZIP) of Transmittal 1630, Change Request (CR) 6270, dated November 7, 2008.CMS is currently working to implement the retroactive payments required by section 3712(b) of CARES for dates of service back to March 6, 2020. We will be providing instructions for reprocessing the applicable claims in the near future. There is no action required by suppliers at this time. Please note that the fee schedule changes made in relation to section 3712(b) of the CARES Act have no impact on the wheelchair accessory KU fee schedule amounts that are calculated based on unadjusted fee schedule amounts. Section 106 of the Further Consolidated Appropriations Act, 2020 mandates the non-application of fee schedule adjustments based on information from competitive bidding programs for wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with complex rehabilitative manual wheelchairs (HCPCS codes E1161, E1231, E1232, E1233, E1234 and K0005) and certain manual wheelchairs currently described by HCPCS codes E1235, E1236, E1237, E1238, and K0008 during the period beginning on January 1, 2020 and ending June 30, 2021. CMS is on track to modify its Medicare claims processing system to begin paying claims for the impacted HCPCS codes at the unadjusted rates beginning on July 1, 2020. Until these changes to the Medicare claims processing system are implemented, payment for claims submitted for these items is based on the adjusted fee schedule amounts. To support suppliers with their reprocessing requests, the DME MACs have implemented a streamlined approach to adjust previously processed claims with dates of service from January 1, 2020 through June 30, 2020 for the manual wheelchair accessories referenced in Attachment A.

Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service January 1, 2017 through June 30, 2017. The law requires that adjustments be made to the fee schedule amounts for certain items furnished on or after January 1, 2016 in areas that are not competitive bid areas, based on information from competitive bidding programs (CBPs). The fee schedule adjustments were phased in for claims with dates of service January 1, 2016 through June 30, 2016, so that each fee schedule amount was based on a blend of 50 percent of the fee schedule amount that would have gone into effect on January 1, 2016, if not adjusted based on information from the CBP, and 50 percent of the adjusted fee schedule amount. Section 16007 of the Cures Act extends this transition period from June 30, 2016 to December 31,2016 with the full implementation of the 100 percent adjusted fee schedule amounts applying on or after January 1, 2017. CMS is currently working to implement this section and will be providing contractor instructions for re-processing the applicable claims. There is no action required for the suppliers at this time. Formal instructions will be issued in the near future. The data has been updated using claims processed through August 2, 2016. The data will continue to be updated as more claims are processed. CMS identified errors in the fee schedule amounts for some items and has released revised DMEPOS public use fee schedule files on August 31, 2016. The corrections do not impact the PEN public use file. One of the corrections identifies E2378 as a code subject to Section 2 of the Patient Access and Medicare Protection Act (PAMPA) and adds unadjusted fee schedule amounts for this code to the July 2016 fee schedule file.

In addition, errors were identified in the E1012RR fees in the July DMEPOS text file and these fees have been corrected. Subscribe to your MAC’s email list to learn about these opportunities. For the purpose of processing claims for replacement of essential accessories for this equipment, the medical necessity for the beneficiary-owned base CPAP device or RAD is assumed to have been established.As long as no other information is uncovered or reviewed that would result in a determination that the equipment furnished and paid for by Medicare was not medically necessary, then all that is necessary for the purpose of processing claims for replacement of essential accessories used with a beneficiary-owned CPAP device or RAD purchased by Medicare following 13 months of continuous use is a determination that the medical need for the equipment continues, and that the claims for the accessories themselves are reasonable and necessary. In that regard, CMS will ensure that the supplier's documentation records support the need to replace the accessory to maintain the equipment's functionality and meet the beneficiary's medical need. In the event that certain accessories are furnished for the first time, such as a heated humidifier or heated tubing, CMS will ensure that the accessories are medically necessary. In these cases, all medical necessity documentation needed for the initial use of the CPAP device or RAD must be furnished, but the 120 day grace period above would apply for transitions to contract suppliers at the start of the Round 2 Recompete. The DMEPOS and PEN public use files contain fee schedules for certain items that were fully adjusted based on information from the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program in accordance with Section 1834(a)(1)(F) and 1842(s)(3)(B) of the Act.

The innovative aspects of this change in the pricing methodology for DME are intended to ensure that Medicare is expeditious and responsive to providing reimbursement and access to new technology and devices for beneficiaries. These changes are consistent with the Agency’s approach of putting patients first and incentivizing innovation and use of e-technology. In January 2017, CMS issued a ruling providing for Medicare coverage of therapeutic CGMs. The ruling was followed by a policy article issued by the Durable Medical Equipment Medicare Administrative Contractors on March 23, 2017 to provide coverage guidance for these devices. This allows Medicare to establish a price that aligns with the statutory requirements for the DMEPOS fee schedule. For example, the exclusive payment rule for DME items requiring frequent and substantial servicing indicates that the fee schedule amounts must be based on the average reasonable charge in the state for the rental of the item or device for the 12-month period ending with June 1987. In establishing fees for newly covered DMEPOS, Medicare first looks to identify a comparable DMEPOS item for which a fee schedule amount already exists, as existing fee schedule amounts are based on average reasonable charges for items paid during the base year. CMS determines whether a comparable item exists based on the purpose and features of the device, nature of the technology, and other factors, and then applies that fee to the new item. Going forward, potential appropriate sources for such commercial pricing information can also include verifiable information from supplier invoices and non-Medicare payer data (e.g., fee schedule amounts comprised of the median of the commercial pricing information adjusted as described below). CMS then inflates that amount to the payment year using the update factors required by law. This allows Medicare to establish a fee for the newly covered item consistent with the law.

Section 16005 of the 21 st Century Cures Act currently allows higher payments for these items but is set to expire after June 30, 2017. By continuing these higher payments, this new action will help to protect access to complex rehabilitative power wheelchair accessories on which people with significant disabilities depend. This provision excludes certain complex rehabilitative power wheelchairs recognized by the Secretary as classified within group 3 or higher (and related accessories when furnished in connection with such wheelchairs). CMS has reconsidered its policy on adjusting fee schedule amounts using information from the competitive bidding program for these items under 1834(a)(1)(F) of the Social Security Act to take into consideration the exclusion at section 1847(a)(2)(A). As a result, effective July 1, 2017, payment for these items will be based on the standard unadjusted fee schedule amounts. No additional action will be required by suppliers. Section 2 of PAMPA mandates that adjustments to the 2016 Medicare fee schedule amounts for certain durable medical equipment (DME) based on information from competitive bidding programs not be applied to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. CMS welcomes public input on this list. The list should only include codes for wheelchair accessories that can be used with Group 3 complex rehabilitative power wheelchairs and had revised fee schedule amounts calculated for 2016 based on information from competitive bidding programs. Please note, since posted, the list has been revised to include codes E1012 and E2378. To implement the extension, the 2016 KU fee schedule amounts have been updated by the 2017 0.7 percent covered item update and will be added to the 2017 DMEPOS fee schedule file.

To ensure beneficiary access to these accessories particularly for these vulnerable populations, advance payment may be available for suppliers. Prior to July 1, suppliers will be paid the adjusted fee schedule rates. The average reduction during this period for these items is approximately 10%. During this time, CMS has announced that suppliers are able to submit a single advance payment request for multiple claims if the conditions described in CMS regulations at 42 CFR Section 421.214 are met. Additional information is below. Beginning January 1, 2016, the DME fee schedule rates are adjusted to reflect information from the DMEPOS competitive bidding program as required by section 1834(a)(1)(F)(ii) of the Social Security Act. Section 2 of PAMPA mandates that adjustments to the 2016 Medicare fee schedule amounts for certain durable medical equipment (DME) based on information from competitive bidding programs not be applied to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. Group 3 complex rehabilitative power wheelchair bases are currently described by codes K0848 through K0864 of the Healthcare Common Procedure Coding System (HCPCS). Until these changes are implemented, payment for these items will be based on the adjusted fee schedule amounts. Suppliers can submit claims for these items with dates of service on or after January 1, 2016, but payment will be based on the adjusted fee schedule amounts. On or after July 1, 2016, suppliers can adjust previously paid claims with dates of service on or after January 1, 2016, to receive the full fee schedule amount. For these items, the average adjustments to the 2016 rates in the transition period is about a reduction of 10 percent. Suppliers are able to submit a single advance payment request for multiple claims for an eligible period of time.

Note an advance payment is a conditional partial payment, which requires repayment, and may be issued when the conditions described in CMS regulations at 42 CFR Section 421.214 are met. CMS will not make advance payments in the case where a supplier is unable to submit a valid claim for services rendered. The DMEPOS and PEN public use files contain fee schedules for certain items that were adjusted based on information from the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program in accordance with Section 1834(a)(1)(F) and 1842(s)(3)(B) of the Act. CMS identified errors in the fee schedule amounts for some items and has therefore released revised fee schedule files on December 8, 2015. A list of the codes affected by the revisions is included as a separate public use file along with the revised 2016 fee schedule public use files. In addition, errors were identified in the Fact Sheet under the “Examples of New Payment Rates for January” chart for the contiguous United States. Under the 2016 blended urban fee column, the average 2016 blended fees for codes E0163, E0730 and E0784 have been revised.The DMEPOS and PEN public use files contain fee schedules for certain items that were adjusted based on information from the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program in accordance with Section 1834(a)(1)(F) and 1842(s)(3)(B) of the Act. Also released is a preliminary DMEPOS rural ZIP Code file containing Quarter 4 2015 rural ZIP codes. Beginning January 1, 2016, fee schedule amounts for certain items will be adjusted based on information from the DMEPOS competitive bidding program, and for some items, the adjusted fee schedule amounts for items furnished in rural areas within the state will be different than the adjusted fee schedule amounts in other areas of the state. The ZIP codes for areas defined as rural areas per regulations at 42 CFR 414.

202 are based on current ZIP code boundaries. Changes to the ZIP code public use file will be made, as needed, based on future changes to ZIP codes by the United States Postal Service. The public use files for the DMEPOS and PEN fee schedules do not contain fee schedule amounts, but are being posted to show what changes are being planned for the file formats to accommodate the fee schedule amounts for rural areas, as well as statewide fee schedule amounts for enteral nutrition. Please be aware that effective October 21, 2015, revised 2016 DME and PEN TEXT file formats were made available as part of an updated DMEREADLAYOUTS16 document. The law requires that a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME. As such, CMS expects that during the next several months, suppliers and physicians who order certain DME items will continue to collaborate and establish internal processes to ensure compliance with the face-to-face requirement. CMS expects durable medical equipment suppliers to have fully established such internal processes and have appropriate documentation of required encounters by October 1, 2013. CMS and its contractors will also use other communication channels to ensure that the provider community is properly informed of this announcement. Changes in section 20.3, Publication 100-04 of the Claims Processing Manual are reflected in the recurring update notification. Please upgrade your browser to improve your experience. Choose your own Simply present your Cigna ID card when you visit aIt’s an easy-to-use discount savings program. ThereMembers are responsible for paying all applicable fees and charges directly to the dentist at the time of visit. Charges may vary from the sample listed above.

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