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Tag: Co-Insurance Cap

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CMS details process for new insulin cap  

February 20, 2023HME News Staff

WASHINGTON – Part B co-insurance for a month’s supply of insulin used in an insulin pump covered under the DME benefit can’t exceed $35 starting on July 1, 2023, according to an MLN facet sheet. CMS will adjust payments to suppliers and pharmacies to account for the balance of the reduced co-insurance. Suppliers will continue to get the Medicare payment amount for the insulin (average sales price plus 6%), minus any applicable co-insurance, which, again, is now capped at $35. “Don’t...

Co-Insurance Cap, Insulin pump

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