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Medical Coding News Archives

2011 Durable Medical Equipment Reimbursement Changes

February 11, 2011:

The transmittal (R2142CP) includes a table for codes specific to the labor required to repair certain DME items. The reimbursement amounts were adjusted by 1.1 percent to reflect an increase in the consumer price index (CPI) for the 12 months ending June 30, 2010. It is important to note that the codes are per 15 minutes of time and are identified in appendix A of the transmittal or in MLN article NN7248. These labor codes are:

K0739Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes
L4205Repair of orthotic device, labor component, per 15 minutes
L7520Repair prosthetic device, labor component, per 15 minutes

Transmittal R2142CP also finalized a change to the reimbursement for power-driven wheelchairs. This changes the reimbursement to 15 percent of the purchase price for months one through three. However, months four through 13 will be reimbursed at 6 percent—down from the 7.5 percent previously reimbursed. This change was enacted as a result of the Affordable Care Act (ACA) of 2010. It is important to note that this change is effective for initial dates of service on or after January 1, 2011.

The DME fee schedule was updated to reflect a 0.1 percent decrease for 2011. Again, as a result of the ACA, the reimbursement rate accounts for the consumer price index for urban consumers (CPI-U), which was calculated to be 1.1 percent for the 12 months ending June 30, 2010. This is offset by the annual private nonfarm economy average multifactor productivity (MFP). The MFP was calculated to be 1.2 percent, resulting in the 0.1 percent decrease.

The payment rate for stationary oxygen is adjusted, when needed, on a yearly basis to maintain budget neutrality. The rate for 2011 will be $173.31 per month. Oxygen equipment may need maintenance After the initial 36 months or end of the associated warranty, oxygen equipment can receive maintenance once every six months. For 2011 the reimbursement for such maintenance will be $65.93 for oxygen concentrators and transfilling equipment.

Finally, new codes were added to the following DME sections:

  • Inexpensive or routinely purchased DME
  • Capped rental payment
  • Prosthetics, orthotics


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