CMS releases zip codes, fee schedule format

Tuesday, October 6, 2015

WASHINGTON – CMS has released a revised fee schedule format and a preliminary list of rural zip codes for the national roll out of competitive bidding.

The agency had previously announced plans to apply bid pricing in non-bid areas on Jan. 1, 2016, by using regional prices limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices). Pricing will be slightly higher in rural areas.

While industry stakeholders were still digging through the new info at press time on Tuesday morning, during a recent webcast, Andrea Stark, a reimbursement consultant with MiraVista, used Bartlesville, Okla., as an example and calculated that, once fully phased in, the cut for oxygen concentrators would be $86.36 per month, representing a 47% reduction, if the town is considered a standard MSA, and $77.94, a 43% reduction, if it’s considered a rural area.

CMS plans to phase in the national roll out this way: On Jan. 1, it will use pricing comprised of 50% of the new fee schedule and 50% of the original fee schedule; on July 1, it will transition to 100% of the new fee schedule.

Using Bartlesville and oxygen concentrators again as an example, pricing would be $137.74 in non-rural areas on Jan. 1, and $94.56 on July 1; in rural areas, it would be $141.95 on Jan. 1 and $102.98 on July 1, according to Stark.