July 2019

CMS Issues DMEPOS Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule containing updates to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) regulations. CMS also published a fact sheet outlining several major provisions in the rule, which are summarized below:

  • This rule proposes to establish a gap-filling methodology in regulations for pricing new items and services for durable medical equipment, prosthetic devices, orthotics, surgical dressings, and custom molded shoes, extra-depth shoes, and inserts, and for parental and enteral nutrients (PEN) and medical supplies, including splints and casts and intraocular lenses inserted in a physician’s office. A one-time adjustment to the gap-filled fee schedule amounts will be made if such prices decrease within 5 years of establishing the initial fee schedule amounts.
  • This proposed rule would streamline the requirements for ordering DMEPOS items. It would also develop one Master List of DMEPOS items potentially subject to a face-to-face encounter, written orders prior to delivery, and/or prior authorization requirements. According to several sources, the current Master List includes 82 L-codes that are subject to prior authorization, and with this proposed rule, that list would expand to include 144 new L-codes.

Comments on the proposed rule are due September 27, 2019, and can be submitted electronically at regulations.gov/document?D=CMS-2019-0110-0001 or by visiting regulations.gov and searching for CMS-1713-P.

To read the full text of the rule, visit s3.amazonaws.com/public-inspection.federalregister.gov/2019-16369.pdf. To read the CMS fact sheet summarizing major provisions in the rule, visit cms.gov/newsroom/fact-sheets/end-stage-renal-disease-esrd-and-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos.

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