CMS Releases New Fee Schedule with Increased Oxygen Rates Effective April 1, 2021

Published in Government Relations on March 17, 2021

Effective for claims with dates of service on or after April 1, 2021, the fee schedule amounts for HCPCS codes E0424, E0431, E0433, E0434, E0439, E0441, E0442, E0443, E0444, E0447, E1390, E1391, E1392, E1405, E1406, and K0738 are adjusted to remove a percentage reduction that was put in place to meet the budget neutrality requirement previously mandated by section 1834(a)(9)(D)(ii) of the Social Security Act. These new rates are not retroactive; they will only be effective for dates of service on or after April 1, 2021. These adjustments result in an increase in Medicare fee schedule amounts ranging from:
  • $6.72 to $8.19 in former competitive bidding areas
  • $5.17 to $5.43 in other non-rural areas
  • $4.41 to $6.82 in noncontiguous and rural area
Providers can access the new CMS fee schedule(s) for rural, non-rural, and Competitive Bid Areas (CBAs) here: https://www.cms.gov/medicaremedicare-fee-service-paymentdmeposfeescheddmepos-fee-schedule/dme21-b
The Oxygen Budget Neutrality issue dates back to 2017, when CMS incorrectly applied a budget neutral “offset” to fee schedules for oxygen concentrators. This led to an improper reduction in reimbursement for several oxygen-related HCPCS codes, and forced reimbursement rates in some areas below the average regional competitive bidding Single Payment Amounts (SPA). The Consolidated Appropriations Act of 2021 (Public Law 116-260), which was signed into law on December 27, 2020, corrected this action for DME suppliers. Section 121 of this Act eliminates the budget neutrality requirement set forth in section 1834(a)(9)(D)(ii) of the Social Security Act for separate classes and national limited monthly payment rates established for any item of oxygen and oxygen equipment. 
Please contact Craig Douglas ([email protected]) or Ronda Buhrmester ([email protected]) with any questions you have regarding this release.

TAGS

  1. billing & reimbursement
  2. cms
  3. vgm government

From Our Experts

Senate Dear Colleague Letter on Power Seat Elevation and Standing Systems Begins to Circulate thumbnail Senate Dear Colleague Letter on Power Seat Elevation and Standing Systems Begins to Circulate Please reach out to your representatives to ask them to sign the Dear Colleague letters, which request that CMS advance Medicare coverage for power seat elevation systems and urge them to promptly move forward with the process for power standing systems. U.S. Rehab and VGM Government Relations Attend Congressional Briefing in Washington D.C. thumbnail U.S. Rehab and VGM Government Relations Attend Congressional Briefing in Washington D.C. Wednesday, Sept. 14, was a momentous day of advocating for CRT and other key legislative issues. Greg Packer and Tom Powers spent time in Washington D.C. attending the NCART/NRRTS Virtual Congressional Fly-In and a congressional briefing on power seating and standing systems for power wheelchairs. State Association Spotlight: PAMES and Big Sky AMES thumbnail State Association Spotlight: PAMES and Big Sky AMES We recently chatted with the Executive Director of PAMES and BIG Sky AMES, Barb Stockert, about her and the success of the two state associations that she works with. That's a Wrap... Here is a Recap of 2022's August of Action! thumbnail That's a Wrap... Here is a Recap of 2022's August of Action! The VGM Government Relations team worked hard this August of Action to make sure that they met with as many elected officials as possible while they were back in their home states and districts. Read about their meetings here! Representative Ashley Hinson Visits VGM in Waterloo, IA thumbnail Representative Ashley Hinson Visits VGM in Waterloo, IA On September 7, 2022 VGM hosted Congresswoman Ashley Hinson at our main campus. This was her second time visiting VGM in the past few years, the first being right before the pandemic and so she was able to see the differences in the corporate environment. DME Industry Disaster Cost Survey Open thumbnail DME Industry Disaster Cost Survey Open We need to hear from you! Your participation in the survey is important as we need a robust response from the DME community as we gather intel to make improvements to reimbursement during disasters. Reminder: CMS has Two Open Comment Periods and Needs to Hear From You! thumbnail Reminder: CMS has Two Open Comment Periods and Needs to Hear From You! Be sure to make your voice heard with the two comment periods that CMS currently has open. One is regarding Medicare Advantage Plans (deadline Aug. 31) and the other is regarding why Medicare should cover power seating systems in complex power wheel chairs (deadline Sep. 14). Be sure to speak up today! VGM Government Relations Attends an Event with Rep. Cathy McMorris Rodgers thumbnail VGM Government Relations Attends an Event with Rep. Cathy McMorris Rodgers On Friday, August 19, Representatives from VGM Government Relations, AAHomecare, and Norco met with Representative Cathy McMorris Rodgers to advocate and educate for the DMEPOS industry.