Fee Schedules
Fee schedules are lists of the maximum allowable amount per unit for the associated HCPCS codes. Pricing for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is based on the fee schedules and payment methodologies provided by CMS. Inclusion or exclusion of a fee schedule amount for an item or service does not imply any health insurance coverage.
Find more information on the following resources:
- DMEPOS Fee Schedule & Parenteral and Enteral Nutrition (PEN) Jurisdiction C Fee Schedule
- Former Competitive Bidding Area (CBA) Fee Schedule (Adjusted fees for former CBAs during a gap period in the DMEPOS Competitive Bidding Program (CBP))
- Single Payment Amounts (SPAs) from Competitive Bidding Programs (CBPs)
- Drug Fees, Pharmacy Dispensing Fees, and Pharmacy Supply Fees
- Labor Payment Amounts for Repairs & Service Codes
- CMS information about updates to the Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule
The Supplier Manual includes helpful information about pricing and fee schedules in Chapter 5 – DMEPOS Fee Schedule Categories and Chapter 10 – Pricing.
The Advanced Modifier Engine (AME) helps suppliers bill proper HCPCS codes and modifier combinations for common DMEPOS billing scenarios. Enter a specific HCPCS code and the billing scenario, and the tool will recommend modifiers for claim submission