CHA News

CMS Issues CY 2021 DMEPOS Proposed Rule and Competitive Bidding Program Information

For CEOs, CFOs, finance & reimbursement staff, post-acute care staff, and case managers

This post has been archived and contains information that may be out of date.

The Centers for Medicare & Medicaid Services (CMS) has issued its proposed rule updating payment methodologies for the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule for calendar year (CY) 2021. In addition, CMS announced changes to the DMEPOS competitive bidding program (CBP) for 2021, which will be limited to off-the-shelf knee and back braces.  

CMS proposes policies to permanently pay higher amounts for DMEPOS furnished in rural and non-contiguous non-bid areas. This policy – which is currently in effect for the duration of the COVID-19 public health emergency – would be made permanent April 1, 2021, or at the end of the public health emergency, whichever is sooner. CMS also proposes to expand coverage of continuous glucose monitors, codify procedures for determining pay for new durable medical equipment, and expand coverage of external infusion pumps for certain drugs. Comments on the proposed rule are due Jan. 4, 2021. 

CMS notes that stakeholders have called on the agency to delay Round 2021 of the CBP due to the COVID-19 public health emergency. CMS notes that it has already removed the product category for non-invasive ventilators from the CBP due to the public health emergency. In addition, CMS will not include 13 additional product categories for Round 2021 that were previously competed because the payment amounts did not achieve expected savings. CMS will continue with the CBP for off-the-shelf knee and back braces, which have been competitively bid for the first time in Round 2021.