Medicare fee schedule for DME & CPAP

[Stevoreno_55]

Can anyone provide me with a link that will take me directly to the pages listing Medicare fee schedules for DME and CPAP? I've tried navigating the Medicare website but there are just too many links to go through.



Stevoreno_55
MS Gulf Coast
04/06/14

[Wulfman...]

Can anyone provide me with a link that will take me directly to the pages listing Medicare fee schedules for DME and CPAP? I've tried navigating the Medicare website but there are just too many links to go through.



Stevoreno_55
MS Gulf Coast
04/06/14

Go up to the Search line and put in "Medicare schedule" and you'll have about 40 pages of links to go through to find it.
Some of the forum members even have the link in their profile.


Den

.

[Stevoreno_55]

Can anyone provide me with a link that will take me directly to the pages listing Medicare fee schedules for DME and CPAP? I've tried navigating the Medicare website but there are just too many links to go through.



Stevoreno_55
MS Gulf Coast
04/06/14

Go up to the Search line and put in "Medicare schedule" and you'll have about 40 pages of links to go through to find it.
Some of the forum members even have the link in their profile.


Den

.

Been there; done that; found that out which is why I came here to ask.

[deerslayer]

stevoreno , i don't have a link. However this is a pix from my DME guideline for cpap coverage. keep in mind i have Medicare & a supplemental plan & not sure if that is a factor.Hope this helps you.
tim

[Guest]

i am not sure exactly what you are looking for
the medicare site has changed substantially
if it is what deerslayer posted i am not sure you will find it on the medicare site any longer

if it is a replacement schedule perhaps your dme has one
else try searching the cms dot gov site
it will also explain how you can qualify for a bipap

[6PtStar]

Medicare seems to like to keep everyone off guard by making it hard to know the regulations. I have talked to two different agents and got two completely different answers and never found the answer in their regulations. I used to get a list like Deerslayer but it came from my DME and was told it was not necessarily true. Lately I am being told that there is no schedule. Replacement is based on when equipment is no longer serviceable. Mostly I buy out of pocket but one time I went in they made me sign a form that it was no longer serviceable before they would replace it. Did not ask to see it to certify it was no longer serviceable but was told the could request.

Again, this is coming from a Brick and Mortar DME and we all know they don't always tell the truth. I have not been able to find it in the regulations since all the changes either.

Jerry

[Stevoreno_55]

stevoreno , i don't have a link. However this is a pix from my DME guideline for cpap coverage. keep in mind i have Medicare & a supplemental plan & not sure if that is a factor.Hope this helps you.
tim

Thanks for the information. What I wanted to find out if I could on Medicare's website was the fee schedule amount for a new CPAP machine if that information is in fact on Medicare's website.



Stevoreno_55
MS Gulf Coast
04/06/14

[Wulfman...]

Steve,

Try doing a Google search on "Medicare DMEPOS" and see if you can find what you need in those links.


Den

.

[Pugsy]

http://www.cms.gov/Medicare/Medicare-Fe ... =ascending

You need to know the HCPCS codes for any supplies
CPAP/APAP machine is E0601 blower unit only..humidifier and all the other stuff is separate.
You also need to know the area that you live in to get exact figures because it varies somewhat depending on where you live.
This appears to be the monthly rent to own amount just for the blower unit

http://www.cms.gov/Medicare/Medicare-Fe ... edule.html

[deerslayer]

when you were diagnosed , doc should have hooked you up with a DME ? the DME will have your answer .
to me Medicare is Waaaaayy too liberal with timelines on supplies ! seems wasteful to me
tim

[Guest]

if you are looking for when the machine can be replaced
from all places i have heard it is no longer 5yrs
but when the thing is broke
most insurances are now this way also

a word of caution before you break yours
make sure you have a backup to use
as you know dme s can be very sluggish to respond
and then might have to order the replacement

if you are lookin for a price
you will owe 20% of whatever cms determines is allowable
i am not sure how to determine that

maybe speaking directly to medicare will help you

[Janknitz]

Before competitive bidding, Medicare published a fee schedule that showed you the Medicare rate for each item which varied by state. Now, it varies by competitive bidder in each city or area. What a mess!!!

Here's how to find your provider's reimbursement rates:
1. Go to this page: http://www.cms.gov/Medicare/Medicare-Fe ... OSFeeSched Down at the bottom in "Related Links" you'll see 5 jurisdictions. I don't know how to tell you which one you're in, just try each until you find your state. My state, California, is in Noridian DMAC Jurisdiction D along with most other western states.

2. Click on your jurisdiction and then look for "DMEPOS FEE SCHEDULE".

3. On the DMEPOS fee schedule, if you are in a an area with competitive bidding, you click on the Excel spread sheet that breaks down the reimbursements by city. If you are not in a competitive bid area, at least on the Noridian Jurisdiction D site (I'm not sure about other jurisdictions) you can to go DME FEE SCHEDULE INQUIRY (for this jurisdiction it's at https://www.noridianmedicare.com/dmefee/search.seam), where you can plug in the HCPC's code and the state and get the 2014 price. For example, in California non-competitive bid areas, the monthly rental fee is $99.20 per month in a non-competitive bid area but in San Francisco which has competitive bidding it is $50 per month, and in San Jose it's $47.75 . I saw monthly rental fees range from $41 to $55 in this jurisdiction.

You can see why DME's in competitive bid areas are so reluctant to provide data capable equipment, especially S9 autos now. In the process of competitive bidding, some are accepting less than half of the regular Medicare reimbursement rate. They bid very low to be awarded these competitive bid contracts. What they lost in reimbursement is made up to some degree in volume--they have very little competition now in each competitive bid area, and I'm sure that translates to greater volume discounts by the manufacturers. Part of me feels sorry for the poor DME's who have to accept in some cases less than half of what they made before on the same equipment and supplies, and part of me thinks they deserve it for bidding so low just to get the contracts. Yes, it keeps them in business, but their belts are pretty tight, and they've passed that on to us by providing cheap, lousy aftermarket accessories and making it very difficult to get efficacy data equipment which IMHO is essential to optimal treatment.

[chunkyfrog]

In a few days, my 4 year old Autoset rolls over to 9000 hours.
I fully intend to have my NEXT machine to also be state of the art--one way or t'other!

[Stevoreno_55]

Before competitive bidding, Medicare published a fee schedule that showed you the Medicare rate for each item which varied by state. Now, it varies by competitive bidder in each city or area. What a mess!!!

Here's how to find your provider's reimbursement rates:
1. Go to this page: http://www.cms.gov/Medicare/Medicare-Fe ... OSFeeSched Down at the bottom in "Related Links" you'll see 5 jurisdictions. I don't know how to tell you which one you're in, just try each until you find your state. My state, California, is in Noridian DMAC Jurisdiction D along with most other western states.

2. Click on your jurisdiction and then look for "DMEPOS FEE SCHEDULE".

3. On the DMEPOS fee schedule, if you are in a an area with competitive bidding, you click on the Excel spread sheet that breaks down the reimbursements by city. If you are not in a competitive bid area, at least on the Noridian Jurisdiction D site (I'm not sure about other jurisdictions) you can to go DME FEE SCHEDULE INQUIRY (for this jurisdiction it's at https://www.noridianmedicare.com/dmefee/search.seam), where you can plug in the HCPC's code and the state and get the 2014 price. For example, in California non-competitive bid areas, the monthly rental fee is $99.20 per month in a non-competitive bid area but in San Francisco which has competitive bidding it is $50 per month, and in San Jose it's $47.75 . I saw monthly rental fees range from $41 to $55 in this jurisdiction.

You can see why DME's in competitive bid areas are so reluctant to provide data capable equipment, especially S9 autos now. In the process of competitive bidding, some are accepting less than half of the regular Medicare reimbursement rate. They bid very low to be awarded these competitive bid contracts. What they lost in reimbursement is made up to some degree in volume--they have very little competition now in each competitive bid area, and I'm sure that translates to greater volume discounts by the manufacturers. Part of me feels sorry for the poor DME's who have to accept in some cases less than half of what they made before on the same equipment and supplies, and part of me thinks they deserve it for bidding so low just to get the contracts. Yes, it keeps them in business, but their belts are pretty tight, and they've passed that on to us by providing cheap, lousy aftermarket accessories and making it very difficult to get efficacy data equipment which IMHO is essential to optimal treatment.

Thanks for that very detailed answer; I'll check your links out. So since I live on the MS Gulf Coast which is made up of several cities the schedule fee amount for my city; Biloxi, Mississippi could be more or less than another nearby city; for example Gulfport, MS? That's strange and thanks again for the information.



Stevoreno_55
MS Gulf Coast
04/07/14

[Stevoreno_55]

if you are looking for when the machine can be replaced
from all places i have heard it is no longer 5yrs
but when the thing is broke
most insurances are now this way also

a word of caution before you break yours
make sure you have a backup to use
as you know dme s can be very sluggish to respond
and then might have to order the replacement

if you are lookin for a price
you will owe 20% of whatever cms determines is allowable
i am not sure how to determine that

maybe speaking directly to medicare will help you

I have been told by my insurance company that I am eligible to receive a new CPAP machine once every 5 years; eligible to receive and actually getting one where insurance will agree to pay for it are 2 different things. My insurance company subs out all of their DME requests to a company in Florida who has already informed me that before they would approve any new machine for me they would need documentation stating my old machine had died and could not be repaired. It makes you want to go to the doctor; ask him to write a new Rx for the machine that I want and using my other form of insurance; MasterCard Healthcare; take my MasterCard Healthcare card and buy myself a new machine.



Stevoreno_55
MS Gulf Coast
04/07/14