CMS Releases Rural Relief Adjustments

Agency adjusts reimbursement as mandated by the recently released IFR.

CMS has released revised reimbursement rates for rural and non-bid areas in non-contiguous areas, per the Interim Final Rule (IFR) it issued earlier this month.

The IFR resumes the 50/50 blended rate schedule from June 1 through Dec. 31 and will affect rural areas and non-contiguous areas (Alaska, Hawaii and U.S. territories) that are non-bid areas. However, the IFR doesn’t apply to non-bid areas in the contiguous United States. The full text of the IFR can be read here.

A fact sheet from CMS breaks down the increased fee schedule amounts, and the full rates are available at go.cms.gov/2xwR7rB.

CMS also provided a table of the state averages for the rural fee schedule amounts:

DMEPOS Item

HCPCS

Unadjusted Fee

Rural Fee - Jan

Rural Blended Fee

Percent Increase

Oxygen Concentrator (monthly)

E1390

$182.43

$72.33

$121.46

68%

CPAP (rental)

E0601

$103.78

$43.95

$73.86

68%

Hospital Bed (rental)

E0260

$136.78

$65.40

$100.83

54%

NPWT Pump (rental)

E2402

$1,665,09

$703.16

$1,184.12

68%

Manual Wheelchair (rental)

K0001

$57.86

$24.50

$41.18

68%

Power Wheelchair (rental)

K0823

$585.51

$294.71

$440.11

49%

Walker (purchase)

E0143

$112.47

$50.61

$81.54

61%

Commode Chair (purchase)

E0163

$119.27

$56.30

$87.79

56%

TENS (purchase)

E0730

$405.26

$72.11

$238.69

231%

Nebulizer (rental)

E0570

$18.12

$6.12

$12.15

99%

Powered Mattress (rental)

E0277

$671.70

$205.41

$438.55

113%

Insulin Pump (rental)1

E0784

$469.93

n/a

n/a

n/a

Enteral Pump (rental)

B9002

$123.40

$67.64

$95.57

41%

Enteral Supplies (daily)

B4035

$12.12

$5.79

$8.95

55%

Enteral Nutrients (100 calories)

B4150-
B4154

$1.14

$0.70

$0.91

30%

n/a: Item included in 10 or fewer CBAs and therefore has one national adjusted rate with no rural rates

Source: CMS

About the Author

David Kopf is the Editor of HME Business.

Comments

Mon, Jun 4, 2018 KEVIN HILL Tyler

Question at this time is "WHEN" - Does CMS have the payers flip a switch and start paying us the new rate starting with claims filed now for dates of service - 6/1/18 and beyond? (which would be inexpensive and logical) OR - Do we have to wait for the Wheels of Government to have hearings, etc.... Then get around to reprocessing claims with monies not showing up until November or December? Just Asking !

Fri, Jun 1, 2018 wallace g. whiten Sky Vallley

6/01/18 This may be the same scheme that happened in 2016. If it turns out to be, then the USA has a serious injustice to our elderly, uneducated, and poor areas in the Rural districts. What is wrong with this system when all other areas of the markets are booming. It is getting very disheartening to say the least. How could this great country do such an embarrassing thing to our elderly? Wallace G. Whiten, R.Ph..

Fri, Jun 1, 2018 Editor

The IFR only runs until Dec. 31, and CMS has offered no guidance on what happens in 2019 and beyond. This is why industry advocates are calling on providers to help them secure more permanent fixes via H.R. 4229. A couple stories worth reading for further info: https://hme-business.com/articles/2018/05/24/hill.aspx https://hme-business.com/articles/2018/05/17/ifranalysis.aspx

Fri, Jun 1, 2018 Editor

If you go to CMS's collection of files regarding the adjustments, you'll find an Excel file that lists the zip codes: http://go.cms.gov/2xwR7rB.

Fri, Jun 1, 2018 Diane Bomback Pondera Medical Center DME Conrad MT

This may sound silly but is there a list of zip codes that are in the ruling areas. I'm confused as to the wording on who is effected by this change. thanks

Fri, Jun 1, 2018 Paul Reses Pleasantville

I have a question. Is the rural relief adjustment going to continue after December 31, 2018 or does the fee revert back to the pre July 2018 fee schedule?

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