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

For beneficiaries residing in non-rural areas, in cases where accessories included in the 2008 Original Round One CBP are furnished for use with base equipment that was not included in the 2008 CBP (for example, manual wheelchairs where the KU modifier does not apply, canes, and aspirators), suppliers should submit a request for reopening if their claim for dates of service between March 6, 2020, and April 22, 2020, should have been processed with the KE modifier. For claims that the KE modifier would have been applicable to, the supplier may adjust the claim or notify the MACs to adjust the claims after the mass adjustments for the 75/25 fee blend are completed.

Resource

• CMS Change Request (CR) 8181
• CMS Medicare Learning Network (MLN) Matters (MM) 11784
• CMS MM 10707