Fee Schedule Column Descriptors

The DMEPOS fee schedule contains fee schedule amounts, floors, and ceilings for each procedure code subject to the DMEPOS fee schedule payment methodology. Although these fee schedule amounts are contained in a single file, their calculations have been mandated by three separate payment methodologies: DME, prosthetic and orthotic, and surgical dressings.

Column Number and Name Comment
1 - HCPCS CODE All current year active codes subject to DMEPOS floors and ceilings.
2 - 1ST MODIFIER
  • NU - Purchased, New
  • RR - Rented
  • UE - Purchased, Used
  • KM - Replacement of Facial Prosthesis including new impression/moulage
  • KN - Replacement of Facial Prosthesis using previous master mold
  • AU - Urological, ostomy or trach item
  • AV - Item with prosthetic/orthotic device
  • AW - Item with a surgical dressing
  • KE - Bid Under Round I of the DMEPOS Competitive Bid Program For Use With Non-Competitive Bid Base Equipment KF--Class III device
  • KL - DMEPOS Item Delivered Via Mail
  • KC - Replacement of Special Power Wheelchair Interface
3 - 2ND MODIFIER Reserved for future use.
4 - JURISDICTION
  • D - DMEMAC jurisdiction
  • L - Local Part B Carrier jurisdiction
  • J - Joint DMEMAC/Local Carrier jurisdiction
5 - CATEGORY
  • IN - Inexpensive and Other Routinely Purchased Items
  • FS - Frequently Serviced Items
  • CR - Capped Rental Items
  • OX - Oxygen and Oxygen Equipment
  • OS - Ostomy, Tracheostomy & Urological Items
  • SD - Surgical Dressings
  • PO - Prosthetics & Orthotics
  • SU - Supplies
  • TE - Transcutaneous Electrical Nerve Stimulators
  • TS - Therapeutic Shoes
6 - CEILING
  • Maximum fee schedule amount.
  • Please note that since E0607 is priced via national Inherent Reasonableness, it is not priced using floors and ceilings. For E0607, this field will be filled with zeros.
  • Since pricing amounts for E1405 and E1406 were developed by summing pricing amounts from source codes, they are not subject to ceilings and floors.
  • Those items which are priced using special payment rules do not have floors and ceilings; these fields will be filled with zeros. Please note that the payment amounts for E0935 represent a daily rather than a monthly payment amount.
7 - FLOOR
  • Minimum fee schedule amount.
  • Please note that since E0607 is priced via national Inherent Reasonableness, it is not priced using floors and ceilings. For E0607, this field will be filled with zeros.
  • Since pricing amounts for E1405 and E1406 were developed by summing pricing amounts from source codes, they are not subject to ceilings and floors.
  • Those items which are priced using special payment rules do not have floors and ceilings; these fields will be filled with zeros. Please note that the payment amounts for E0935 represent a daily rather than a monthly payment amount.

 

Last Updated Wed, 10 Jan 2018 15:04:25 +0000