Final DMEPOS Competitive Bidding Rules Released

The final Medicare rules for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding were released on April 2, 2007. The Medicare Modernization Act of 2003 (MMA) mandated the implementation of a competitive bidding program to reduce Medicare payments for DMEPOS by replacing current fee schedules with competitively bid prices.

The Academy had submitted comments to the Centers for Medicare and Medicaid Services (CMS) in June 2006 expressing concern that the competitive bidding rules would make it difficult for physiatrists to provide items such as crutches, canes, and walkers directly to patients. The Academy had urged CMS to establish an exception for the competitive bidding program allowing physicians to dispense these items directly to patients.

The final rule does allow for an exception for physicians and treating practitioners who provide these items to their own patients. The exception is limited to crutches, canes, walkers, folding manual wheelchairs, blood glucose monitors and infusion pumps, as these are the same items of DME that physicians can provide under the Stark law.

The Academy also requested a similar exception for certain low cost off-the-shelf (OTS) orthotics including splints for fractures and sprains, spinal stabilization braces, corsets, rib belts, cervical collars, and other similar items. While CMS did provide for an exception for these items in the final rule, it only applies to physical and occupational therapists, not physicians.

Physicians who plan to continue providing DME to their patients will be required to become accredited in order to bill Medicare Part B for items such as crutches, canes, and walkers. For a list of organizations that will accredit suppliers of DMEPOS please see this Click here.

Physicians will also have to meet new quality standards for suppliers of DMEPOS. For these standards, please click here (PDF Download).