CMS Releases CPI-U Adjustments For DMEPOS In 2025 And Fee Schedule Q1

Published in Government Relations on December 16, 2024

CMS released the annual inflation factor to be applied to DMEPOS items effective Jan. 1, 2025, with an implementation date of Jan. 6, 2025. The breakdown of the adjustment is dependent upon whether the serviced items are included in the competitive bidding program (CBP) or are in formerly competitive bid areas (CBAs) such as rural and non-rural.  

  • CBP items in former CBAs: +2.9%  
  • CBP items in non-CBAs: +3%  
  • Non-CBP items: +2.4%  

In the current environment, the DMEPOS industry welcomes any increased adjustments to the fee schedule allowables. Even though there is still some ground to cover by getting the allowables adjusted to reflect the higher costs for operational expenses and higher product costs, the increase is welcomed.  

Other Noteworthy Updates: 

  • Lymphedema Items 
    • Some items within this category will see a 3% increase. 
  • Therapeutic Shoes 
    • Updates being made to A5503 – A5507, as well as A5512, A5513, A5514. 
  • Diabetic Testing Supplies 
    • Updates to mail order diabetic testing supplies billed with the KL modifier. 
  • Oxygen Maintenance And Service (MS modifier)  
    • 2.4% increase yielding an allowable of $87.82. 
  • Labor/Repair/Service Codes (K0739, L4205, L7520)  
    • 3% increase. 

CMS has released the DMEPOS fee schedule for Q1 2025. The PDAC will get their updates completed soon. The meantime the allowables can be found using this link

Support DME Legislation as the 118th Congress Concludes  

As the 118th Congress draws to a close, we urgently need your help. Congressional negotiations are currently underway to determine the scope of end-of-year health and budget legislation. We are optimistic that the DME Legislation (H.R. 5555 and S. 1294) will be included in the final legislative package, but your support is crucial to ensure this happens!  

What You Can Do

Please reach out to your legislator’s health staffer in both the Senate and the House, either by phone or email, and urge them to “support the inclusion of H.R. 5555 and/or S. 1294 in any end-of-year package.” You can easily send a message by clicking on this link: Action Center | VGM & Associates. You are able to edit the message and add personal reasons why this legislation is important to your customers, your business, and all users of DME.  

Thank you for being the voice of the DME industry! Your efforts are vital in getting this legislation across the finish line.  

From Our Experts

Evaluating the Value of a Payer Contract thumbnail Evaluating the Value of a Payer Contract In our last article, Key Payers Denied Your Application Citing Their Network Is Closed – Now What?, we discussed strategies for addressing payer contracting denials due to a closed network. As indicated, this process can be an extremely time-consuming exercise with no guarantees and mixed results. Below are a few things to consider as you evaluate whether a contract is worth the extra effort. Webinar: Webinar: "Navigating The New CMS Landscape: RADs, HMVs, and Supplier Survival" on June 25 at 1 p.m. CT. The Centers for Medicare & Medicaid Services (CMS) has released its final National Coverage Determination (NCD) for RADs and HMVs used in treating chronic respiratory failure due to COPD. While the rule potentially expands access to bilevel ST therapy (RADs), it also introduces complex compliance requirements, tighter usage criteria, and increased documentation burdens—without additional reimbursement. The Return of Competitive Bidding thumbnail The Return of Competitive Bidding The Centers for Medicare & Medicaid Services (CMS) appear to be laying the groundwork for another round of the Competitive Bidding Program (CBP). While full implementation will take a couple of years, an official announcement is expected this summer—potentially as early as July. Out With The Old RAC, In With The New thumbnail Out With The Old RAC, In With The New On April 28, 2025, CMS awarded Cotiviti GOV Services LLC, the new RAC Recovery Audit Contractor (RAC) Region 3, 4, and 5 contracts. RAC Region 3 includes the following Medicare Administrative Contractor (MAC) jurisdictions: JJ, JM, and JN. RAC Region 4 includes jurisdictions: JE, JF, and JL. And RAC Region 5 includes jurisdictions: JA, JB, JC, JD, as well as the HH/H MACs: J6, J15, JK, and JM. Iowa Leads the Charge! All Four Representatives Back H.R. 2005—Will Your State Step Up? thumbnail Iowa Leads the Charge! All Four Representatives Back H.R. 2005—Will Your State Step Up? At VGM Group, Inc. we have the pleasure of serving our members and partners throughout the country.  One of the many ways we do this is through legislative advocacy, working with our partners to create a more equitable and effective healthcare system. All our VGM units are dedicated to advancing our partners' businesses, streamlining operations, and working every day to enhance reimbursement for the quality in-home healthcare our industry provides all people. Mike Hamilton Of ADMEA Honored With The Mal Mixon Advocate Award thumbnail Mike Hamilton Of ADMEA Honored With The Mal Mixon Advocate Award Last week, during the 2025 AAHomecare Washington Legislative Conference, Mike Hamilton, Executive Director of ADMEA, was honored with the prestigious Mal Mixon Advocate Award. VGM Senior Leaders Engage in Advocacy at AAHomecare Legislative Conference thumbnail VGM Senior Leaders Engage in Advocacy at AAHomecare Legislative Conference This week, VGM leaders attended the AAHomecare Legislative Conference in Washington, D.C., a premier event dedicated to advancing healthcare policy and advocacy. AAHomecare provided attendees with valuable insights, equipping them with key discussion points and strategies for effective meetings with legislators. Champion of Change: Paula Vineyard of Elana Health & Loop Medical Leads Healthcare Advocacy in West Virginia thumbnail Champion of Change: Paula Vineyard of Elana Health & Loop Medical Leads Healthcare Advocacy in West Virginia On Thursday, May 8, Paula Vineyard, owner of Elana Health & Loop Medical, took a pivotal step in healthcare advocacy by hosting a meeting with Tyler Ohrn, Field Representative for Congresswoman Carol Miller of West Virginia's First District. The hour-long discussion centered on the pressing need for congressional support of H.R. 2005.