Competitive Bidding: Fee Schedule

CMS establishes an allowed amount for each covered HCPCS code and adjusts according to the state or geographical area served. When establishing a fee schedule, there is a ceiling amount, which is the maximum amount allowed in any area, and a floor, which is the minimum amount allowed.

The DMEPOS fee schedule is updated every quarter, with the major changes becoming effective on January 1 of the current year. The 2021 fee schedule includes Single Payment Amounts (SPAs) for off-the-shelf back braces and knee braces. Under the SPA method, the lead item amount is based upon the winning bid amount. Then all other items in that payment category have a rate based upon the lead item amount.

The lead item HCPCS code for off-the-shelf back braces is L0650.

The lead item HCPCS code for off-the-shelf knee braces is L1833.

​​​​​​What Does This Mean for You?

Be familiar with the CMS Fee Schedule and allowable amounts for products you provide.

For a listing of the SPAs for each competitive bidding area, follow this link:

Single Payment Amounts - Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (dmecompetitivebid.com)

To download the entire DMEPOS fee schedule, effective January 1, 2021, go here.