CMS Releases Updated Fee Schedule For Non-Bid, Non-Rural Areas

The reimbursement rates reflect relief measures for HME providers included in the CARES Act, which went into effect in late March.

• By Haley Samsel
• May 07, 2020

As a result of the CARES Act, which went into effect in late March, CMS has released an adjusted fee schedule with new rates for non-rural and non-bid areas.

The legislation provided reimbursement relief to HME suppliers billing Medicare beneficiaries in non-rural areas that are not part of the bidding program. Now, the reimbursement rate for items that have been receiving 100 percent of the adjusted fee schedule are getting a blended rate of 75 percent adjusted and 25 percent unadjusted rates based on the 2015 fee schedule.

These rates will apply to claims with dates of service beginning on March 6 and will last until the end of the COVID-19 pandemic, according to the American Association for Homecare.

“Across the board, we see a 32% increase for suppliers in non-rural, non-bid areas for the top DME items vs. the former 2020 rates,” AAHomecare wrote in a Monday update to members. “Our original analysis just after the legislation was passed had estimated a 30% overall increase.”

The new rates released by CMS show an estimated 39 percent increase for oxygen concentrators, a 41 percent increase for CPAP machines and a 9 percent increase for portable oxygen concentrators. AAHomecare has also released a region-by-region analysis comparing the new rates for former rates for the top 25 HCPCS codes.

The agency has not indicated when HME suppliers will begin to receive retroactive payments. AAHomecare will continue to monitor this process and “work with CMS and DME MACs to ensure the new payments will be implemented as soon as possible,” according to the Monday update.