2008 for Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fee Schedule Updates

Provider Action Needed
This article is based on Change Request (CR) 5803, which provides the annual update to the 2008 DMEPOS fee schedules in order to implement fee schedule amounts for new codes and to revise any fee schedule amounts for existing codes that were calculated in error. Be sure your billing staff is aware of these changes.

Background
This recurring update notification, CR 5803, provides specific instructions regarding the 2008 annual update for the DMEPOS fee schedule. Payment on a fee schedule basis is required for durable medical equipment (DME), prosthetic devices, orthotics, prosthetics, and surgical dressings by §1834(a), (h), and (i) of the Social Security Act. Payment on a fee schedule basis is required for parenteral and enteral nutrition (PEN) by regulations contained at 42 CFR 414.102.

The update process for the DMEPOS fee schedule is located in the Medicare Claims Processing Manual, Publication 100-04), Chapter 23, Section 60 (PDF, 1.28 KB). Other information on the fee schedule, including access to the DMEPOS fee schedules.

Key Points

• The following codes are being deleted from the HCPCS codes effective January 1, 2008, and are therefore being removed from the DMEPOS and PEN fee schedule files:

Deleted Codes
B4086 E2618 K0553 K0554 K0555 L0960 L1855 L1858 L1870 L1880	L3800 L3805 L3810 L3815 L3820 L3825 L3830 L3835 L3840 L3845	L3850 L3855 L3860 L3907 L3910 L3916 L3918 L3820 L3922 L3924	L3926 L3928 L3930 L3932 L3934 L3936 L3938 L3940 L3942 L3944	L3946 L3948 L3950 L3952 L3954 L3985 L3986

• The payment category for HCPCS code K0730 is revised to move the controlled dose inhalation drug delivery system from the DME payment category for capped rental items to the DME payment category for inexpensive and routinely purchased items, effective January 1, 2008. The total payment for inexpensive and/or routinely purchased items may not exceed the fee schedule amount for purchase of the equipment. In the case of controlled dose inhalation drug delivery systems furnished on a purchase basis on or after January 1, 2008, the allowed payment amount will be reduced by the total rental payments previously made for the item.

• The fee schedule amounts established for HCPCS codes K0553, K0554 and K0555 will directly crosswalk to new HCPCS codes A7027, A7028 and A7029, respectively

• As of the July 2007 HCPCS Quarterly Update, the following composite dressing HCPCS codes are non-covered by Medicare, effective July 1, 2007: A6200, A6201 and A6202. To reflect this change, the fee schedule amounts for HCPCS codes A6200, A6201 and A6202 will be removed from the fee schedule file as part of this update. Medicare Contractors will deny claims for HCPCS codes A6200, A6201 and A6202 with dates of service July 1, 2007, through December 31, 2007.

• CMS will establish fee schedule amounts for the following HCPCS codes: B4087, B4088, E2312 and E2312, and for HCPCS modifiers KC, E2373, E2313, L1846, L3808, L3923, L3764, L3763, L3925, L3929 and L3931. These fee schedule amounts will be added to the fee schedule file on January 1, 2008, and are effective for claims with dates of service on or after January 1, 2008. The existing fee schedule amounts for HCPCS code E2373 will become the full replacement E2373 with HCPCS modifier KC fees, effective January 1, 2008.

• Suppliers are to submit the HCPCS modifier KC when billing for the full replacement of HCPCS power wheelchair interface codes E2373 and E2312

• Note that HCPCS codes E0328 and E0329 are rarely appropriate for Medicare billings, payment for pediatric beds represented by these codes will be based on individual Medicare contractor consideration

• As part of this update, CMS is implementing the 2008 national monthly payment rates for stationary oxygen equipment, (HCPCS codes E0424, E0439, E1390 and E1391), effective for claims with dates of service on or after January 1, 2008. CMS is revising the fee schedule file to include the new 2008 monthly payment rate of $199.28 for stationary oxygen equipment. As required by statute, these payment rates are adjusted annually to assure budget neutrality on the addition of the new oxygen generating portable equipment class. Accordingly, a reduction to the national monthly payment amount for stationary oxygen equipment for 2008 that is necessary to offset payments under the new class will be slightly lower ($0.56) (from $199.84 to $199.28) than previously announced.

• As a result of the above adjustments, CMS is also revising the fee schedule amounts for HCPCS codes E1405 and E1406 as part of this update. Since 1989, the fees for HCPCS codes E1405 and E1406 have been established based on a combination of the Medicare payment amounts for stationary oxygen equipment and nebulizer HCPCS codes E0585 and E0570, respectively.

The following are the new HCPCS codes, effective January 1, 2008:

New HCPCS Codes
A4252 A5083 A6413 A7027 A7028 A7029 A9274	A9276 A9277 A9278 A9283 B4087 B4088 E0328	E0329 E0856 E2227 E2228 E2312 E2313 E2397	L3925 L3927 L3929 L3931 L7611 L7612 L7613	L7614 L7621 L7622 V2787

Additional Information
You may see the official instruction, CR 5803 (PDF, 236 KB), issued to your Medicare A/B MAC, FI, DMERC, DME/MAC, RHHI or carrier.

If you have questions, please contact our office at (866) 332-7025 for Ohio/West Virginia or (888) 828-2092 for South Carolina.

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