CMS Updates DMEPOS Fee Schedule

Citing errors in the December 2020 schedule, this new release includes adjustments to more than 900 HCPCS codes.

CMS has published a revised January 2021 DMEPOS Fee Schedule that adjusts 919 HCPCS codes.

The agency aid the revision was necessary due to errors it found in its previous release.

Claims submitted before Jan. 26 with dates of service on or after Jan. 1 might have been processed and paid using the incorrect fee schedule amounts, according to CMS.

DMEPOS suppliers that submitted claims prior to Jan. 26 that were paid at the incorrect amount can provide their PTAN to the DME MAC and request the DME MAC reprocess the claims.

Mostly ‘Minor’ Corrections

CMS reports most of the fee schedule corrections were minor, resulting in the application of a missing update factor and an increase in the 2021 fee schedule amount of less than 1 percent. However, in roughly 8 percent of the cases, the corrections were significant, according to CMS.

That said, CMS said it found multiple calculation errors, and the corrections to them range from a 2021 fee schedule amount decrease of 30 percent to a 2021 fee schedule amount increase of 57 percent.

Most of the significant fee schedule corrections were for claims that included a KE modifier, with the greatest fee schedule amount increases in the non-contiguous areas of the country.

Industry Analysis

The American Association for Homecare reviewed the adjusted schedule stating it found “on average non-rural areas will be receiving 0.9 percent more and rural areas will receive 0.5 percent more than the original published 2021 fee schedule.”

This seems to indicate that CMS recognized AAHomecare’s previous analysis of the first 2021 fee schedule, which found that the rates in rural and non-rural areas on average were slightly lower than the 2020 rates.

“AAHomecare was able to communicate our concerns to CMS directly, and we are pleased CMS reviewed this input and adjusted the rates as appropriate,” AAHomecare noted in a public statement.

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