Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment

Master List of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items Potentially Subject to Conditions of Payment

CMS has streamlined regulatory requirements to help simplify DMEPOS payment requirements and reduce provider and supplier burden. The Master List serves as a library of Fee-for-Service DMEPOS codes that were flagged as potential vulnerabilities based on the criteria outlined in CMS-1713-F.

As of August 12, 2024, the Master List includes 512 items. View the Master List (PDF).

What Does the Master List Mean for Providers and Suppliers?

Providers and suppliers don’t need to take action unless an item on the Master List also appears on one or both Required Lists:

The Required Lists Comparison Chart (PDF) is a side-by-side crosswalk of both Required Lists.

Master List Life Cycle

Step 1. CMS Selects Items for the Master List: Per statute (CMS-1713-F); The item appears to be a source of potential fraud or unnecessary utilization based on an OIG report, GAO report, or CERT Improper Payment Data report (and the item also meets the applicable cost threshold). The item has been subject to aberrant billing patterns. (Aberrant billing is suggested when an item with at least 1,000 claims and $1 million in payments during a recent 12-month period shows an unexpected increase in billed claims without explanatory contributing factors (such as new technology or updated coverage policies.) Step 2: CMS Periodically Selects Items from the Master List to Include on One or Both Required Lists: CMS considers factors such as geographic location, item utilization or cost, system capabilities, emerging trends, vulnerabilities identified in official agency reports, or other analysis. Step 3: CMS Issues a Formal Notice. When items from the Master List are added to one or both Required Lists: CMS will announce the item(s) selected and a formal notice period of at least 60 days will begin. Step 4: Requirements Take Effect: Requirements only take effect when the formal notice period ends. Required Lists are generally updated annually but may also be updated on an ad hoc basis per statute.
Page Last Modified:
09/10/2024 06:21 PM
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