Fee Schedules - JA DME

A fee schedule is a complete listing of fees used by Medicare to pay suppliers. This comprehensive listing of fee maximums is used to reimburse a supplier for an item or service. To access the most current fee schedules, select the appropriate Noridian or CMS link(s) below.

DMEPOS Fees - View Medicare DMEPOS Fee Schedules

• Sequestration
• Sequestration History
• Rural Zip Code File

Drug, Pharmacy Supply and Dispensing Fees - View ASP, pharmacy supply and dispensing fees

Fee Schedule Lookup Tool - Find DMEPOS, Drug or PEN fees. Select applicable state and enter HCPCS to view

Former Competitive Bidding Area (CBA) Fee Schedule

Adjusted fees for former Competitive Bidding Areas (CBAs) during a gap period in the DMEPOS Competitive Bidding Program (CBP) are determined by CMS. These items have been paid based on the Former CBA Fee Schedules since 2019 (see MM11064).

To view the Former CBA Fee Schedule, visit the CMS DMEPOS Fee Schedule page

• Select the applicable file for the date of service
  • Under "File Name." Download that ZIP file, and you can open the files for CBA information, which are labeled
    • Former CBA Fee schedule
    • Former CBA National Mail Order diabetic testing supply fee schedule
    • Former CBA ZIP Code

Jurisdiction List - The jurisdiction list will assist suppliers in determining which Medicare contractor to bill for certain HCPCS codes. This list is a yearly list created by CMS. All HCPCS code listed have DME or joint MAC Jurisdiction. Any other codes not listed as DME MAC only or dual DME MAC/Part B MAC jurisdiction shall be A/B MAC (Part B) only jurisdiction.

Labor Payment Rates - View allowed payment amounts for HCPCS K0739, L4205 and L7520

Medically Unlikely Edit (MUE) Lookup Tool - Helps to determine the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service

Oral Anti-Cancer Drug Fees - View oral anti-cancer drug fees

Parenteral and Enteral Nutrition (PEN) Fees - View fees for PEN Items and Services

PrEP HIV - Effective September 30, 2024, CMS will cover pre-exposure prophylaxis (PrEP) using antiretroviral drugs approved by the U.S. Food and Drug Administration (FDA) to prevent HIV in individuals at increased risk of HIV acquisition.

Pricing - View the three DMEPOS payment methodologies, Gap Filling, Reasonable Charges, Customary Charges, Prevailing Charges, Individual Consideration, Not Otherwise Classified (NOC) Miscellaneous Codes

Rural Zip Code File - Check the Zip Code to determine if it is a rural zip code for the date of service you are billing

Resources and Updates

• CMS - DMEPOS Fee Schedules (Previous Releases)
• CMS - ASP Drug Pricing Files
• CMS - Zip Code to Carrier Locality File

Note: Every effort is made to ensure the accuracy of this information up to our publication; however, Noridian is not responsible for any errors or subsequent changes. Inclusion or exclusion of a fee schedule amount for an item or service does not imply coverage. Noridian does not guarantee eligibility for reimbursement based on using this information. Reimbursement is based on factors, including, but not limited to diagnosis, medical necessity for the DMEPOS item and the Medicare program coverage guidelines.

Noridian does not guarantee eligibility for reimbursement based on using this information. Reimbursement is based on factors including, but not limited to disease diagnosis, medical necessity for the DMEPOS item and the Medicare program coverage guidelines.

Quarter 1 = January 1 - March 31
Quarter 2 = April 1 - June 30
Quarter 3 = July 1 - September 30
Quarter 4 = October 1 - December 31