Reimbursement Issues


2021 Medicare Fee Schedule Update

The Centers for Medicare and Medicaid Services (CMS) has released the 2021 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2021.  The 2021 Medicare fee schedule will be increased by 0.2% . The 0.2% increase is a net reflection of the 0.6% increase in the Consumer Pricing Index for Urban Areas (CPI-U) from June 2019 through June 2020, combined with the annual Multi-Factor Productivity Adjustment (MFP) of -0.4% . Click here to view and download the complete 2021 Medicare DMEPOS fee schedule

CMS Announces the Resumption of Medicare Audits

The Centers for Medicare and Medicaid Services (CMS) has authorized its Medicare contractors (e.g. DME MACs, RACS, SMRCs, etc.) to once again perform pre-payment and post-payment audits as part of their medical review responsibilities, startin on August 3, 2020.  CMS had suspended most audits as of March 30, 2020 due to the COVID-19 Public Health Emergency (PHE).  CMS indicates that if individual providers are selected for medical review believe that responding to a request for documentation will create a hardship situation, they should discuss response options with the contractor performing the review. Click here for more information.

CGS and/or Noridian are currently conducting post payment reviews for claims with the following codes:l0457, L0631, L0650, L1833, L1851, L1902, L1906, L1940, L1970, L1971, L4360, L4361, L4396, and L4397

Medicare Medical Policies

Lower Limb Prostheses

Ankle-Foot/Knee-Ankle-Foot-Orthosis

Spinal Orthoses: TLSO and LSO

Knee Orthosis

External Breast Prostheses

Diabetic Shoes/Inserts
The policy has been updated to include information on NPs and PAs acting as the Certifying Physician.

Orthopedic Shoes/Inserts