DME MACs move custom items to set allowables

Wednesday, April 19, 2017

WATERLOO, Iowa – Custom cushions and backs—codes E2609 and E2617—now have set allowables in jurisdictions B and C, VGM Group reports. Previously, the custom items were individually priced and were averaging about 70% of MSRP/supplier price. Now E2609 has a set price of $450 and E2617 $550, VGM reports. “We are hearing that the new established allowables will not even cover acquisition cost for any of the products that are coded as custom fabricated,” it stated in a bulletin to members. Stakeholders are also concerned with the way the DME MACs in the two jurisdictions made the change—internally and without notice to the provider community. “There are many issues that are unsettling with how this came about and all are being addressed with CMS and the DME MACs,” VGM stated. “All industry advocates are aware of these issues and are reaching out to get answers and request that this change be rescinded.” Jurisdictions A and D have not implemented the change, VGM says.