Fee Schedules
CMS sets the DMEPOS Fee Schedule. The fee schedules list the highest amount Medicare will pay per unit for the associated HCPCS code. Keep in mind that just because an item has a price listed doesn’t mean Medicare will cover it.
Find more information on the following resources:
- CMS DMEPOS Fee Schedule Files
- CMS information about updates to the Durable Medical Equipment, Prosthetics/Orthotics & Supplies Fee Schedule
- 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
The Supplier Manual includes helpful information about pricing and fee schedules in Chapter 5 – DMEPOS Fee Schedule Categories and Chapter 10 – Pricing
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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