The Centers for Medicare & Medicaid Services (CMS) is proposing changes to Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) coverage and payment policies, including continuing to pay higher amounts for DMEPOS items and services in rural and non-contiguous areas. The proposed rule would also establish policies about Healthcare Common Procedure Coding System (HCPCS) Level II code applications and streamline the process for getting new technology approved for Medicare coverage, payment, and coding.
Continuing to pay higher amounts to suppliers for DMEPOS items and services furnished in rural and non-contiguous areas encourages suppliers to provide access and choices for beneficiaries living in those areas. CMS said it is making this proposal based on stakeholder feedback that indicate unique challenges and higher costs for providing for DMEPOS items for beneficiaries in rural and remote areas.
HCPCS Level II code applications for products paid separately include O&P devices. CMS is proposing to codify the more frequent coding cycles as implemented January 1, 2020, including timeframes for application submission and final decisions, and to update associated policies and processes. CMS also proposed processes that it would use to evaluate HCPCS Level II code applications to add a code, revise an existing code, or discontinue an existing code. CMS said the new policies and procedures would increase transparency and gather stakeholder input.
The proposed rule would streamline the process for getting new technology approved for Medicare coverage, payment, and coding.
“With the policies outlined in this proposed rule, innovators have a much more predictable path to understanding the kinds of products that Medicare will pay for,” said CMS Administrator Seema Verma. “For manufacturers, bringing a new product to market will mean they can get a Medicare payment amount and billing code right off the bat, resulting in quicker access for Medicare beneficiaries to the latest technological advances and the most, cutting-edge devices available. It’s clearly a win-win for patients and innovators alike.”
Last year, CMS reduced the timeframe for making Medicare benefit classifications, pricing determinations, and creating billing codes from up to 18 months to six months in many cases, and is now proposing to establish a streamlined process for coding, coverage, and payment in regulation. Under the accelerated process, benefit classification and pricing decisions could happen on the same day the billing codes used for payment of new items take effect, which would facilitate seamless coverage and payment for new DMEPOS and services.
For a fact sheet or to download the proposed rule (CMS-1738-P), visit the CMS website.
