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CMS Announces Single Payment Amounts for Medicare Competitive Bidding of OTS Knee and OTS Spinal Orthoses

On October 27, 2020, the Centers for Medicare and Medicaid Services (CMS) announced the Single Payment Amounts (SPAs) for select Off-the-Shelf (OTS) knee and OTS spinal orthosis codes included in the Medicare DMEPOS competitive bidding program scheduled for implementation on January 1, 2021.

AOPA has continually expressed a need for CMS to delay implementation of Round 2021of the Medicare DMEPOS competitive bidding program due to the COVID-19 Public Health Emergency (PHE). These efforts include but are not limited to multiple communications with high ranking CMS officials, coordination of advocacy efforts with AOPA partner organizations both within and outside of O&P, vocal support of congressional efforts, including a letter to CMS signed by more than 100 members of Congress requesting consideration of a program delay, and comprehensive discussions with key legislators on the importance of ensuring Medicare beneficiaries have access to high quality, clinically appropriate care, delivered by properly credentialed and accredited providers.

2021 Medicare O&P Fee Schedule Update

The Centers for Medicare and Medicaid Services (CMS) has published an update on the economic factors that are used to calculate the Medicare O&P fee schedule.  The annual Medicare fee schedule increase for O&P services is based on a combination of change in the Consumer Pricing Index for Urban Areas (CPI-U) from June to June of the previous year combined with the annual Multi-Factor Productivity Adjustment (MFP).

CMS recently announced that the CPI-U for June 2019 through June 2020 is 0.6% and the annual MFP adjustment is -0.4% for a net increase of 0.2%.  While CMS has not officially announced the 2021 update to the Medicare O&P fee schedule, the announcement of the CPI-U and MFP adjustment lead to relative confidence in the 2021 increase of 0.2%.