Bid under round one of the DMEPOS Competitive Bidding Program for use with non-competitive bid base equipment

Correct Use

• Append to accessory code for contract and non-contract suppliers when beneficiary resides in a competitive bidding area (CBA)
  • Scenario: wheelchair accessory code is competitively bid in Round 1 and Round 2. The base code that accessory is being billed for was not bid in Round 1 or Round 2 (HCPCS codes K0005, K0009, K0898, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, and E1239)

Medicare will reimburse fee schedule amount (5%) for wheelchair accessory code

• Beginning June 1, 2018, append to accessory code not included in the CBA when beneficiaries reside in rural or non-contiguous, non-competitive bid areas (Alaska, Hawaii, United States territories) furnished June 1 - December 31, 2018.
  • Rural and non-contiguous KE fee schedule amounts will be based on a blend of 50 percent of adjusted fee schedule amount and 50 percent of unadjusted KE fee schedule amount by covered item

Resource

• CMS Medicare Learning Network (MLN) Matters (MM)8181
• CMS Medicare Learning Network (MLN) Matters (MM)10707