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March 30, 2021

April Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule

CMS issued a new MLN Matters® Article MM12193 on April Quarterly Update for 2021 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule.External PDF

Below are the key points outlined in the MLN article:

  • Consolidated Appropriations Act of 2021 Changes to the Oxygen and Oxygen Equipment Fee Schedule Amounts
    Effective for claims with dates of service on or after April 1, 2021, CMS is adjusting the fee schedule amounts for HCPCS codes E0424, E0431, E0433, E0434, E0439, E0441, E0442, E0443, E0444, E0447, E1390, E1391, E1392, E1405, E1406, and K0738 to remove a percentage reduction necessary to meet the budget neutrality requirement previously that Section 1834(a)(9)(D)(ii) of the Act required.

  • New Codes Added
    DMEPOS HCPCS codes K1013, K1014, K1015, K1016, K1017, K1018, K1019, and K1020 will be added effective April 1, 2021. As part of this update, there will not be any added fee schedules to the DMEPOS fee schedule file for new HCPCS codes effective April 1, 2021. Until national Medicare coverage and payment guidelines are established for these codes, the Medicare coverage and payment determinations for these items are based on the discretion of the DME MACs processing claims for these items.

  • 2021 DMEPOS Fee Schedule Amounts
    The April 2021 update to the DMEPOS fee schedule includes a revision to the fee schedule amounts for HCPCS code A4563, effective January 1, 2021.

Learn about these announcements and other changes to codes and payment policy at MLN Matters® Number: MM12193.External PDF

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