2014 Medicare DMEPOS Fee Schedule Released


2014 Medicare DMEPOS Fee Schedule Released

The Centers for Medicare and Medicaid Services (CMS) has released the 2014 Medicare DMEPOS Fee Schedule.  The updated fee schedule will be implemented for claims with a date of service on or after January 1, 2014.

Existing Medicare fees for HCPCS codes that describe orthotic and prosthetic devices have been increased by 1.0%, reflecting the 1.8% CPI-U annual update minus the annual productivity adjustment which has been set at .08% for 2014.

Of particular interest is the establishment of fee schedule amounts for the 23 new HCPCS codes created to describe off the shelf (OTS) orthoses as well as the HCPCS codes whose descriptors were changed to indicate that they are either off the shelf or are required to be “trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.”  The fee schedule for these codes are the same regardless of whether they are classified as OTS or require specific fitting and are consistent with the fee schedule amounts for 2013 subject to the 1% increase.

While the fee schedule is subject to change, the current fee schedule does not appear to include a reimbursement reduction for HCPCS codes that describe OTS orthoses.

AOPA is monitoring this situation closely  and will communicate any additional information as soon as it is available.

Questions regarding this issue may be directed to Joe McTernan at  jmcternan@aopanet.org  or Devon Bernard at  dbernard@aopanet.org .