CMS rethinks miscellaneous DME codes

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Thursday, June 25, 2015

WASHINGTON – CMS is proposing new codes for miscellaneous DME to reflect more accurate payment of Medicare claims.

HCPCS codes E1399 and K0108 are currently used to bill for inexpensive items; however, the agency proposes to replace them with new codes effective Jan. 1, 2016.

The public is invited to submit electronic comments on the proposal until July 9, 2015.

The proposed codes are:

·      KXXX1: Durable medical equipment, miscellaneous, the purchase price does not exceed $150. Based on the average reasonable charges for items that could be included in this code, CMS calculates that the 2015 fee schedule amount would be $97.94; this amount will be updated by the 2016 covered item update.

·      KXXX2: Durable medical equipment, miscellaneous, the purchase price exceeds $150. Based on the average reasonable charges for all items covered by this code, CMS determines that the 2015 capped rental fee schedule amounts would be $80.60 for rental months 1 thru 3 and $60.45 for months 4 thru 13; these amounts will be updated by the 2016 covered item update.

·      KXXX3: Wheelchair component or accessory, miscellaneous, the purchase price does not exceed $150. The 2015 fee schedule amount generated based on CMS calculations would be $72.56; this amount will be updated by the 2016 covered item update.

·      KXXX4: Wheelchair component or accessory, miscellaneous, the purchase price exceeds $150. CMS calculates that the 2015 fee schedule amounts for items in this code would be $53.41 for months 1 thru 3 and $40.06 for months 4 thru 13; these amounts will be updated by the 2016 covered item update.

·      KXXX5: Repair part for use with beneficiary owned durable medical equipment, other than wheelchair, not covered under supplier or manufacturer warranty, not otherwise specified.  Payment will be made on a lump sum purchase basis, per the contractor's individual consideration of the item.

·      KXXX6: Repair part for use with beneficiary owned wheelchair, not covered under supplier or manufacturer warranty, not otherwise specified. Payment will be made on a lump sum purchase basis, per the contractor's individual consideration of the item.