Referring to DMEPOS Suppliers: The Competitive Bidding Program

Round 2 competitive bidding program (Program) went into effect on July 1, 2013 in 91 Metropolitan Statistical Areas (MSAs). At the same time, Medicare also began the national mail-order program for diabetic supplies. Below we highlight some of the new features of the Program.

Beginning in 2011 Medicare established the competitive bidding program which changed the amount Medicare pays for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The Program also specified that only “contract suppliers,” i.e., qualified, accredited suppliers with winning bids will be reimbursed by Medicare for items (unless an exception applies).

The DMEPOS competitive bidding program impacts beneficiaries with Original Medicare whose permanent residence is in a zip code that is part of a competitive bidding area (CBA) or who obtain competitively bid items while visiting a CBA.  In order for Medicare to help pay for DMEPOS items, such beneficiaries will need to obtain the prescribed medical supplies and equipment from a Medicare contract supplier unless an exception applies.

As the first step to finding the right supplier for their patients, referring practitioners need to assess whether a beneficiary has Original Medicare. Patients with Medicare Advantage Plans have to obtain DMEPOS from suppliers approved by the plan.

Referring practitioners next need to determine if the beneficiaries are located or visiting one of the CBAs.  If that’s the case, referring practitioners then determine if the item is included in any of the competitive bid product categories by analyzing the HCPCS codes for each bidding round of the program.  If the medical supplies or equipment falls into one of the competitive bid product categories, providers should inform beneficiaries that Medicare will assist in the payment of the item if it is obtained from Medicare’s contract supplier.

Practitioners may assist patients in obtaining the supplies from contract suppliers in their area by going to Medicare’s supplier directory.

Round 1 of the Program began on January 1, 2011 and is in effect in certain zip codes in the following states: California, Florida, Indiana, Kansas, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas. Round 2 Program includes certain zip codes in the New York-New Jersey-Long Island area.

If you have questions regarding CMS DMEPOS Bidding Program or other questions concerning DMEPOS, please contact us here.