DMEPOS Competitive Bidding

DMEPOS Competitive Bidding

Temporary Gap Period

All DMEPOS Competitive Bidding Program (CBP) Round 2021 Contracts for Off-the-Shelf (OTS) back braces and for OTS knee braces expired on December 31, 2023. As of January 1, 2024, there’s a temporary gap period for the DMEPOS CBP.

We’ll start bidding for the next round of the DMEPOS CBP after we: 

  • Complete the formal public notice and comment rulemaking process 
  • Implement necessary DMEPOS CBP changes to: 
    • Establish sustainable prices 
    • Save money for Medicare beneficiaries and taxpayers 
    • Help limit fraud, waste, and abuse in the Medicare Program 
    • Ensure beneficiary access to quality items and services 

Here are the payment rules for Medicare-enrolled DMEPOS suppliers during the temporary gap period: 

  • We adjust fees in former competitive bidding areas (CBAs) based on 100% of the single payment amount for the CBA increased by the projected percentage change in the Consumer Price Index for All Urban Consumers (CPI-U) from January 2023 – January 2024 
  • We adjust fees in non-CBAs based on fully adjusted rates per the applicable methodology under 42 CFR 414.210(g)

We’ll continue health status monitoring.

DMEPOS CBP

This content is primarily for DMEPOS suppliers and referral agents. Bidding and contract suppliers should utilize the Competitive Bidding Implementation Contractor (CBIC) website as their primary source of program information. 

Note: CMS, along with the CBIC, doesn’t review or verify DMEPOS CBP information on websites other than the CBIC website, Medicare.gov, and CMS.gov.

Operations

Bidders compete to become contract suppliers by submitting bids to provide DMEPOS items throughout a CBA.

  • Not all DMEPOS items are subject to competitive bidding
  • Suppliers submit bids for selected products through a web-based application
  • We evaluate bids based on the supplier’s enrollment eligibility, financial stability, bid price, etc.
  • We award contracts to enough qualified suppliers who offer the most competitive price to meet beneficiary demand
  • Contract suppliers must agree to accept assignment on all claims for bid items, and we’ll pay a single payment amount

DMEPOS suppliers and referral agents play a critical role in providing information and services to Medicare beneficiaries. CBP referral agents include:

  • Medicare-enrolled providers, physicians, treating practitioners, discharge planners, social workers, and pharmacists
  • Other health care professionals who refer beneficiaries for services in a competitive bidding area

Learn how to become enrolled as a DMEPOS supplier and participate in the DMEPOS CBP.

History & Goals

Congress mandated the DMEPOS CBP through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). We replaced the previous fee schedule payment method for selected DMEPOS items with a competitive bid process to:

  • Improve the effectiveness of the Medicare method for setting DMEPOS payment amounts
  • Reduce beneficiary out-of-pocket expenses
  • Reduce Medicare program costs
  • Ensure beneficiary access to quality items and services

Resources

  • Become a Medicare Supplier
  • Sign up to get weekly CMS Medicare FFS Provider e-News for the latest Fee-For-Service program information, including National Provider Call announcements, event announcements, claims and pricer information, and MLN educational product updates

 

Page Last Modified:
09/10/2024 06:21 PM
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