Quarterly Update Schedule for DMEPOS Fee Schedule

60.2 - Quarterly Update Schedule for DMEPOS Fee Schedule (Rev. 2902, Issued: 03-11-14, Effective: 04-01-14, Implementation: 04-07-14) Following is an approximate schedule for making additions (for new HCPCS codes) and corrections to base- year amounts for the DMEPOS fee schedule. • The DME MACs identify instances where base year fees are incorrect and forward requests for revisions to their regional offices. The DME MACs also identify those instances where fee schedule amounts are replaced by inherent reasonableness (IR) limits/payment amounts, should the authority for making IR adjustments be restored. A/B MACs (B) and DME MACs must use the file layout in §60.1 above to submit all revisions. Regional offices will review those requests and, upon concurrence, forward them to the Division of Data Systems (DDS) and the Division of DMEPOS Policy (DDP) in CMS Central Office. Those transmissions must occur within the timeframes established by CMS. • Requests for revisions must be accompanied by a narrative description. • For inherent reasonableness (IR) changes, the effective date of the revised payment amount must be provided. The format provides a field for those dates. • DDS will recalculate the current year fee schedule amounts as appropriate. • DDS will transmit the entire DMEPOS file to the DME MACs, PDAC, and A/B MACs using the file layout described in §60.1 above. An indicator in the record field will identify those instances where pricing amounts have changed. These transmissions must occur within the dates specified each year by CMS. DDP must also receive a copy of the corrected fees. • Concurrently, DDP issues instructions for implementing the revised fee schedule amounts. • DME MACs and A/B MACs should give providers 30 days’ notice before revised payment amounts are implemented. Dates for implementation are provided by CMS. • DME MACs and A/B MACs should make adjustments on those claims that were processed incorrectly if brought to their attention. Adjustments may be made retroactively to January 1 unless otherwise specified. • CMS will furnish the revised payment amounts to RRB, Indian Health Service and United Mine Workers. DME MACs and A/B MACs (A), (B), and (HHH), shall provide the data to the State Medicaid Agencies. • Fee Schedule Disclaimer: Whenever the MACs publish the DMEPOS fee schedule in their bulletins/notices, a disclaimer must be added. The disclaimer is, “Inclusion or exclusion of a fee schedule amount for an item or service does not imply any health insurance coverage.” • CMS will release specific timeframes for quarterly changes for DMEPOS Fees.