**Detailed description of payment rate calculations associated with recently published rules affecting Medicare payment for oxygen and oxygen equipment are available in the Downloads section below.**

Medicare payment for durable medical equipment (DME), prosthetics and orthotics (P&O), parenteral and enteral nutrition (PEN), surgical dressings, and therapeutic shoes and inserts is equal to 80 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, less any unmet deductible. The beneficiary is responsible for 20 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, plus any unmet deductible. The DME and P&O fee schedule payment methodology is mandated by section 4062 of the Omnibus Budget Reconciliation Act (OBRA) of 1987, which added section 1834(a) to the Social Security Act. OBRA of 1990 added a separate subsection, 1834(h), for P&O. The DME and P&O fee schedules were implemented on January 1, 1989 with the exception of the oxygen fee schedules, which were implemented on June 1, 1989. Section 13544 of OBRA of 1993, which added section 1834(i) to the Social Security Act, mandates a fee schedule for surgical dressings; the surgical dressing fee schedule was implemented on January 1, 1994. Section 4315 of the Balanced Budget Act of 1997, which added section 1842(s) to the Social Security Act, authorizes a fee schedule for PEN, which was implemented on January 1, 2002. Section 627 of the Medicare Modernization Act of 2003 mandates fee schedule amounts for therapeutic shoes and inserts effective January 1, 2005, calculated using the P&O fee schedule methodology in section 1834(h) of the Social Security Act.

Contact Information:

Who should you contact to determine which HCPCS code to use for billing?

SADMERC Helpline:  877-735-1326

DURABLE MEDICAL EQUIPMENT (DME) CENTER
For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) DMEPOS suppliers, go to the DME Center (see under "Related Links Inside CMS" below).

Downloads
Oxygen Payment Rate Calculations 2007 [PDF, 55KB] Oxygen Table 3a 2006 [PDF, 36KB] Oxygen Table 3b 2007 [PDF, 39KB] Oxygen Table 3c 2008 estimated [PDF, 40KB] Oxygen Table 3d 2009 estimated [PDF, 53KB] Oxygen Table 3e 2010 estimated [PDF, 54KB] Durable Medical Equipment (DME) Background Information for CMS-1304-P [PDF, 40KB] Medicare Program; Payment for Respiratory Assist Devices With Bi-Level Capability and a Backup Rate (published in the Federal Register on January 27, 2006) [PDF, 86KB] 2005 Payment Rates for Stationary and Portable Oxygen Have Been Calculated [PDF, 10KB] Processing of Claims for External Ambulatory Insulin Infusion Pumps [PDF, 10KB] DME MAC/ DMERC Contacts [PDF, 16KB]
Related Links Inside CMS
Special Edition MLN Matters Article (SE0628):  DME Medicare Administrative Contractors'Implementation - Information for Suppliers CMS Program Transmittals Durable Medical Equipment Center
Related Links Outside CMS
DMERC Information Form (DIF) AdminaStar Federal DME MAC National Heritage Insurance Company (NHIC) DME MAC Noridian DME MAC

Page Last Modified: 04/21/2008 10:43:33 AM
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