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Durable Medical Equipment (DME) Center

Spotlights
  • Coverage of Speech Generating Devices

    On February 27, 2014, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) posted a Coverage Reminder outlining the coding requirements for consideration as a "dedicated" speech generating device under the National Coverage Determination (NCD) for Speech Generating Devices (IOM 100-02 §50.1).  The coverage reminder also referenced a requirement for a written coding verification for speech generating devices that would be effective for dates of service on or after December 1, 2014.  CMS has issued instructions to contractors to rescind the coverage reminder and coding verification for speech generating devices.  We expect beneficiaries to continue to have access to this critical technology.  

    Since the current NCD took effect on January 1, 2001, the technology for devices that generate speech and the ways in which the devices are used by patients to meet their medical needs has changed significantly.  As a result, CMS intends to internally generate a reconsideration of the benefit category NCD addressing Medicare coverage of augmentative and alternative communication devices (IOM 100-02 §50.1).  Additional information about this matter will be made available in the near future.

  • Medicare is finalizing the methodology for adjusting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP).  The rule finalizes special payment rules for DME under the Medicare DMEPOS CBP.  This rule finalizes clarification of the statutory Medicare hearing aid coverage exclusion under section 1862(a)(7) and specifies devices not subject to the hearing aid exclusion.  This rule will not finalize an update to the definition of minimal self-adjustment at 42 CFR §414.402.  Finally, this rule clarifies the Change of Ownership (CHOW) and appeal provisions under the Medicare DMEPOS CBP in the End-Stage Renal Disease Prospective Payment System Final Rulemaking (CMS-1614-F). View Regulation.
  • Medicare is proposing the methodology for adjusting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP).  The rule proposes alternative payment rules for DME and enteral nutrition under the Medicare DMEPOS CBP.  This rule proposes to clarify the statutory Medicare hearing aid coverage exclusion under section 1862(a)(7) and specify devices not subject to the hearing aid exclusion.  This rule proposes to update the definition of minimal self-adjustment at 42 CFR §414.402 regarding what specialized training is needed by suppliers to provide custom fitting services if they are not certified orthotists.  Finally, this rule proposes to clarify the Change of Ownership (CHOW) and to establish an exception for certain CHOWs under the Medicare DMEPOS CBP in the End-Stage Renal Disease Prospective Payment System Proposed Rulemaking (CMS-1614-P).  View Regulation.
  • Medicare is clarifying the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME) and the definition of routinely purchased DME.  This rule also finalizes the implementation of budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician’s office.  Finally, this rule makes a few technical amendments and corrections to existing regulations related to payment for DMEPOS items and services in the End-Stage Renal Disease Prospective Payment System Proposed Rulemaking (CMS-1526-F) .  View Regulation.
  • The Centers for Medicare & Medicaid Services has furnished the list of 2014 HCPCS codes designated as Off-The-Shelf (OTS) orthotics.  View the list of OTS Orthotics.
  • Additional Time to Establish Protocols for Newly Required Face-to-Face Encounters for DME  

    Due to concerns that some providers and suppliers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements mandated by the Affordable Care Act (ACA) for certain items of Durable Medical Equipment (DME), CMS will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on October 1, 2013.

    Section 6407 of the ACA established a face-to-face encounter requirement for certain items of DME. The law requires that a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME.

    Although many DME suppliers and physicians are aware of and are able to comply with this policy, CMS is concerned that some may need additional time to establish operational protocols necessary to comply with this new law.  As such, CMS expects that during the next several months, suppliers and physicians who order certain DME items will continue to collaborate and establish internal processes to ensure compliance with the face-to-face requirement. CMS expects durable medical equipment suppliers to have fully established such internal processes and have appropriate documentation of required encounters by October 1, 2013.  

    CMS will continue to address industry questions concerning the new requirements and will update information on our Medical Review and Education website. CMS and its contractors will also use other communication channels to ensure that the provider community is properly informed of this announcement.

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