The Centers for Medicare & Medicaid Services (CMS) announced that the single payment amounts and contracts for select off-the-shelf knee and spinal orthosis codes are scheduled for implementation on January 1, 2021, and that it has begun sending contract offers to bidders.
Several off-the-shelf knee and spinal orthosis codes were included in the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program for 2021. CMS said it heard from a range of stakeholders requesting that the agency delay or cancel the Round 2021 competitive bidding program for DMEPOS due to the COVID-19 public health emergency, and that it considered that feedback while moving forward.
Contract offers have been made in 127 competitive bid areas for the back and knee brace product categories, as Medicare expects to save $600 million over the three-year contract performance period. Contracts for the orthoses are not being awarded in certain competitive bid areas where savings would not be achieved.
Payment for the items where contracts will not be awarded will be based on adjusted fee schedule amounts in accordance with regulations in CFR 414.210(g).
O&P practitioners who chose to participate in the competitive bidding program will either be offered a contract effective for claims with a date of service on or after January 1, 2021, or will receive a disqualification notice indicating that no contract will be offered. If offered a contract, participating practitioners must accept or decline the offer by November 10. Declining the offer will result in loss of the bid surety bond.