Competitive Bidding: Physicians Billing for Back and Knee Braces

Competitive Bidding, Round 2021 took effect on January 1, 2021. This post is the first in a series aimed to provide you additional information about Competitive Bidding, guide you to appropriate resources, and answer the most commonly asked questions about CB.

This round of Competitive Bidding includes off the shelf knee and back braces. Only the winning bidders in a specific geographical area are able to provide these braces to Medicare beneficiaries. The exception to this rule is physicians and PTs/OTs may provide the braces to their patients as part of the treatment.

​​​​​​What Does This Mean for You?

• Make sure you know if you are in a Competitive Bid Area. To determine if a ZIP Code is in a CBA, enter it in the “FIND A CBA” tool on the toolbar at the top of the page here.
• Suppliers who have received a Competitive Bid for a specific CA, and physicians providing bracing, must still meet all the medical necessity requirements outlined in the LCDs.
• Physicians who bill for off-the-shelf bracing items covered under the CB program must use modifier KV on all claims, in addition to any other modifiers required per the LCDs.
• The claim is sent to the appropriate DME MAC.
• The date of service on the claim must be the same date you bill for professional services to the Part A/Part B intermediary.
• You will be paid according to the Competitive Bid rates established for the particular code in your specific geographic region.

Additional information may be found here.

Next week we will cover Traveling Beneficiaries and how this impacts CBA and billing.