On March 7, 2019, The Centers for Medicare and Medicaid Services (CMS) announced the final product categories and timeline for the Medicare DMEPOS Competitive Bidding Program that will begin for dates of service on or after January 1, 2021.
As expected, certain off-the-shelf (OTS) knee orthoses and spinal orthoses will be included in the 2021 competitive bidding program. A total of 16 OTS spinal orthosis codes and 7 OTS knee orthosis codes will be included in the program. The specific codes that have been identified by CMS are listed below.
OTS Spinal Orthosis Codes Included in Competitive Bidding 2021
L0450, L0455, L0457, L0467, L0469, L0621, L0623, L0625, L0628, L0641, L0642, L0643, L0648, L0649, L0650, L0651
OTS Knee Orthosis Codes Included in Competitive Bidding 2021
L1812, L1830, L1833, L1836, L1850, L1851, L1852
One knee orthosis code (L1848) has been removed from the list as it represents an orthosis that policy states is never medically necessary.
While DMEPOS competitive bidding is in a temporary “gap” period until 2021, the process of soliciting, analyzing, and awarding bids, as well as implementing the program takes approximately 18 months. The CMS announcement on March 7, 2019 sets the following timeline to assure that Competitive Bidding 2021 will begin on time.
March 7, 2019
- CMS begins pre-bidding supplier awareness program
- CMS announces dates for registration and bidding
- CMS begins bidder education program
- Bidder registration period begins
- Bid windows open
AOPA will be developing several resources to educate its members about the competitive bidding program. In the meantime, general information regarding Competitive Bidding 2021 may be found by clicking here or here.