Round 2021 of the DMEPOS Competitive Bidding Program begins on January 1, 2021 and extends through December 31, 2023. Round 2021 consolidates the competitive bidding areas (CBAs) that were included in Round 1 2017 and Round 2 Recompete. Round 2021 includes 130 CBAs.

On April 9, 2020, the non-invasive ventilators product category was removed from Round 2021 due to the novel COVID-19 pandemic.

On October 27, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the single payment amounts and began offering contracts for the off-the-shelf (OTS) back braces and OTS knee braces product categories. All other product categories were removed from Round 2021. Please see the CMS announcement for additional information.

CMS is required by law to recompete contracts under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program at least once every three years. The contract periods for Round 1 2017, Round 2 Recompete, and the National Mail-Order Recompete expired on December 31, 2018.

To verify if beneficiary resides in a Competitive Bid Area, suppliers should:

1. Check eligibility in the Noridian Medicare Portal to obtain beneficiary’s permanent address on file with SS.
2. Utilize the Round 2021 CBA Zip Code Lookup Tool to verify if beneficiary’s address is in a Competitive Bid Area

Non-contracted suppliers submitting claims for beneficiaries that reside in a CBA and do not meet the definition of a traveling beneficiary, will need to obtain a properly executed ABN for off-the-shelf (OTS) back and knee braces. Suppliers that provide off-the-shelf (OTS) back and knees braces without a properly executed ABN cannot collect payment from the beneficiary.

Non-contract supplier exceptions Fact sheets

• Physicians and Other Treating Practitioners. Refer to Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists fact sheet on the CMS website.
• Hospitals. Refer to Hospitals That Are Not Contract Suppliers fact sheet on the CMS website.
• Medicare Secondary Payer. A non-contract supplier may receive a Medicare secondary payment for a competitively bid OTS back or knee brace furnished to a beneficiary residing in a CBA if the beneficiary is required to use that supplier under his or her primary insurance policy.
• Repairs and Replacements. Medicare allows for the repair of beneficiary owned items by any Medicare-enrolled supplier. Beneficiary owned competitively bid OTS back or knee braces that are replaced, rather than repaired, must be furnished by contract suppliers when beneficiaries obtain these items in a CBA. Refer to Repairs and Replacements of Off-the-Shelf Back and Knee Braces fact sheet on the CMS website.

Modifiers Physicians/Practitioners and Physical and Occupational Therapists only

KV Utilized by Physicians/Practitioners

J5 Utilized by Physical Therapists and Occupational Therapists.

• When providing brace as part of professional service in beneficiary’s CBA (must be same date of service)
• Beneficiary travels to non-CBA for procedure (surgery) and then goes home (KT not applicable)
• Beneficiary temporarily living in another CBA or non-CBA (KT not applicable)

The Traveling Beneficiary Fact Sheet is available on the Medicare Learning Network and provides guidance on the rules for traveling beneficiaries and the use of the KT modifier from January 1, 2021, thru December 31, 2023.

The permanent residence is the address on file with the Social Security Administration (SSA). It is the address to which the SSA mails checks and/or correspondence to the beneficiary.

Three important CBP rules to know when a beneficiary needs an OTS back or knee brace while traveling are:

• Medicare payment is always based on the beneficiary’s permanent residence.
• Which supplier may furnish the OTS back or knee brace is determined based on where the beneficiary purchases the item.
• The supplier that provides the OTS back or knee brace to the Medicare beneficiary must accept assignment (i.e., accept Medicare payment as payment in full) unless the beneficiary’s permanent residence is not in a CBA and the beneficiary travels to an area that is not a CBA.
• Suppliers must affix the HCPCS modifier "KT" to claims for OTS back or knee braces that are furnished to beneficiaries who permanently reside in a CBA and need a competitively bid item when they travel outside of the CBA where they reside.

The Healthcare Common Procedure Coding System (HCPCS) codes used to bill for OTS back braces: L0450, L0455, L0457, L0467, L0469, L0621, L0623, L0625, L0628, L0641, L0642, L0643, L0648, L0649, L0650, and L0651.

The HCPCS codes used to bill for OTS knee braces: L1812, L1830, L1833, L1836, L1850, L1851, and L1852.

• J5 - Physical therapists and occupational therapists furnishing DMEPOS item subject to DMEPOS Competitive Bidding Program as a non-contract supplier
• KE - Used to identify an accessory code that can be dually billed with either a competitive bid or non-competitive bid base item not subject to fee schedule reduction. Only for rural and non-contiguous states. Not appropriate for former competitive bid areas or non-rural locations.
• KY - Used to identify a formerly competitively bid wheelchair accessory code used with a base unit that was not bid for a beneficiary who resides in a former competitive bid area.
• KG - Used to identify supplies/accessories utilized across multiple former competitive bidding product categories or when same code can be used for both formerly competitively bid and non-competitively bid items.
• KU - Only for wheelchair accessories and seat back cushions used with Group 3 Complex Rehab Wheelchair bases.
• KL - Any DMEPOS item delivered by mail. This includes shipping services and supplier delivery services.
• KT - Beneficiary resides in a competitive bidding area and travels to a non-competitive bidding area and receives item from a non-contract supplier
• KV - DMEPOS item subject to DMEPOS Competitive Bidding Program that is furnished as part of a professional service (non-contract supplier, physicians and other treating practitioners)