The Centers for Medicare & Medicaid Services (CMS) released its consumer price index for all urban consumers (CPI-U) adjustment updates for calendar year 2025 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedules. The adjustments are as follows:
- Competitive bidding program (CBP) items in former competitive bidding areas (CBAs) are projected to increase by 2.9 percent.
- CBP items in non-CBAs (CPI-U) will increase by 3 percent.
- Non-CBP items (CPI-U minus a productivity adjustment) will increase by 2.4 percent.
The update also included details about therapeutic shoe modification codes and labor payment amounts for repairs and service codes.
CMS adjusted the fee schedule amounts for shoe modification codes A-5503 through A-5507 to reflect the most current allowed service data to establish payment amounts for the codes to prevent a net increase in expenditures when substituting these items for therapeutic shoe insert codes A-5512, A-5513, and A-5514.
To establish fee schedule amounts for the shoe modification codes, CMS weighed the base fees for codes A-5512 and A-5513 based on the approximate total allowed services for each code for items provided during the second quarter of 2004.
For 2025, CMS updated the weighted average insert fees used to establish the fee schedule amounts for the shoe modification codes with the most current allowed service data for each insert code. CMS said it will also weigh the base fees for A-5512, A-5513, and A-5514 based on the approximate total allowed services for each code for items provided during CY 2023.
The 2025 labor payment amounts are effective for claims submitted using Healthcare Common Procedure Coding System (HCPCS) codes K-0739, L-4205, and L-7520.
“We’re preparing to include the labor payment amounts for HCPCS Level II codes K-0739, L-4205, and L-7520 in the DMEPOS fee schedule file, which necessitates a new payment category indicator be established. The labor payment amounts associated with repairing, maintaining, and servicing an item have been issued in an attachment document to the [calendar year] update for the DMEPOS fee schedule,” CMS said in the update.
“We’ll add the HCPCS codes and Medicare labor payment amounts to the DMEPOS fee schedule file as part of the April quarterly update for 2025 DMEPOS Fee Schedule for processing claims with dates of service on or after April 1, 2025.”
The file on April’s DMEPOS fee schedule for codes K-0739, L-4205, and L-7520 will include a new payment category indicator: LT = labor rates.
To read the update, visit CY 2025 Update: DMEPOS Fee Schedule on the CMS website.
To read the attachment to the update, visit Pub 100-04 Medicare Claims Processing, Related Change Request (CR) Number: CR 13888.
