The Round 2021 Competitive Bidding window has closed, and CMS has announced the contract suppliers and single pricing amounts.Implementation of the Round 2021 contracts and prices began on January 1, 2021.
Update on Competitive Bidding 2021
Medicare competitive bidding of OTS orthoses is limited to 16 spinal orthosis codes (L0650, L0450, L0455, L0457, L0467, L0469, L0621, L0623, L0625, L0628, L0641, L0642, L0643, L0648, L0649, and L0651) and 7 knee orthosis codes (L1833, L1812, L1830, L1836, L1850, L1851, and L1852. Competitive Bidding Round 2021 initially included all DMEPOS product categories previously included in Medicare competitive bidding as well as the 23 OTS orthosis codes not previously included in competitive bidding.
After the bidding process was completed, CMS determined that additional savings would not be achieved by continuing competitive bidding for the previous product categories as Medicare fees had already been adjusted based on the single payment amounts (SPAs) established through previous rounds of Medicare competitive bidding. As a result of the lack of additional savings through continuation of competitive bidding, CMS elected to remove all the previous product categories from future competitive bidding except for the selected OTS orthoses which had not had their Medicare fee schedules adjusted based on previous rounds of competitive bidding.
After extensive bid submission process, on October 27, 2020 CMS announced the SPAs for the 23 OTS orthosis codes in each of the Medicare competitive bidding areas (CBAs). This was followed by the announcement of contracted suppliers for each CBA on November 20, 2020. The Medicare competitive bidding program for the 23 OTS orthoses began on January 1, 2021.
Effective for dates of service on or after January 1, 2021, unless you were selected as a contracted supplier through the Medicare competitive bidding program, you will no longer be able to provide OTS orthoses described by the 23 OTS orthosis codes included in competitive bidding Round 2021. Non-contracted suppliers who bill Medicare for one of the 23 OTS orthosis codes will have their claims denied. Medicare beneficiaries may only be held responsible for payment if they elect to sign an Advanced Beneficiary Notice (ABN) prior to receiving the orthosis.