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 bids amount. Then all other items in that payment category have 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. Remember, payment amount is the allowable amount for the patient’s permanent address.

View a listing of the SPAs for each competitive bidding area on dmecompetitivebid.com.

Download the entire DMEPOS fee schedule, effective January 1, 2021 here.