DMEPOS benefit category determination timelines follow the HCPCS Level II coding cycle timelines for non-drug and non-biologicals. The HCPCS Level II non-drug and non-biological coding cycles occur no less frequently than bi-annually as follows:

Coding Cycle 1

Application Deadline: 11:59 PM first business day of January

Publish Preliminary Decisions by: May-June

Public Meeting: June (dates to be announced in Federal Register)

Publication of Final Decisions: July-August

Coding Cycle 2

Application Deadline: 11:59 PM first business day of July

Publish Preliminary Decisions by: November

Public Meeting: November-December (dates to be announced in Federal Register)

Publication of Final Decisions: January (following year)

Applications that CMS receives and determines to be complete by the deadline will be considered for inclusion in that cycle. Applications received after the deadline will be considered for the subsequent coding cycle. Applications received by the deadline that are determined to be incomplete will also be declined and the applicant should submit a completed application in a subsequent coding cycle.

We review information in the application and may request more information or ask questions during our review. Those requests and questions will be sent to you through MEARIS in the form of a “Request for Information.”

Review these web pages for some information about what we may consider when reviewing your application. Cost or pricing is not a factor in determining whether equipment or services fit in a DMEPOS benefit category:

• DME & Supplies & Accessories Used with DME
• Prosthetics & Orthotics, Prosthetic Devices, & Therapeutic Shoes
• Surgical Dressings
• Lymphedema Compression Treatment Items
• Payment Determinations for New DMEPOS Items & Services

After reviewing all applications, we prepare a preliminary benefit category and payment determination. These preliminary determinations are posted in the form of agendas for the upcoming Public Meeting on HCPCS Level II Public Meetings. 

The purpose of the Public Meeting is to give the public an opportunity to provide comments on the preliminary determinations, which we’ll consider when making final decisions.

When the agendas are posted on cms.gov, you’ll be notified in MEARIS. You’ll also get instructions on how to register to attend the public meeting and to speak at the meeting. Attendance is optional but if you have any comments or input for CMS based on the preliminary determinations, you must either provide the comments verbally at the meeting, or in writing by the deadline given in the instructions.

We’ll review all verbal and written comments we receive during the Public Meeting to make our final benefit category and payment determinations. We may request more information or ask more questions during our review. Those requests and questions will be sent to you through MEARIS in the form of a “Request for Information.”

Final determinations are posted on the HCPCS Level II Public Meetings page within the timeframes mentioned in “When to Request a Benefit Category Determination.”

We’ll make every effort to complete the review within the applicable coding cycle for all timely and complete applications. However, on the rare occasion a particularly complex or multi-faceted decision requires additional evaluation beyond the timeframe of the coding cycle, we maintain the flexibility to continue consideration of that application into the next coding cycle.

Examples of circumstances under which application consideration may be extended to the next coding cycle may include, but aren’t limited to, benefit category considerations that require in-depth clinical or other research and complicated claims adjudication scenarios.

Question:

After CMS publishes the final benefit category determination, who do we contact if we have questions about that determination?

Answer:

You may send questions about your benefit category determination in one of these ways:

• Submit an RFI for your application through MEARIS
• Send an email to: DMEPOS@cms.hhs.gov
• Send an email to the new technology liaison team: MedicareInnovation@cms.hhs.gov

Question:

Do I use the process described on this webpage to request a benefit category determination for a product or service that isn’t a DMEPOS item or service?

Answer:

No. Under the process set forth in section 531(b) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554) and further described in 42 CFR 42 414.114, 414.240, and 414.1670(Q), we have authority to issue benefit categories for DMEPOS items and services, including lymphedema compression treatment items, using the process described on this web page. These authorities don’t extend to other CMS benefit categories.