CMS adds clarification to calculator

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Friday, September 6, 2019

WASHINGTON – CMS has added a clarifying note on the lead-item pricing calculator for 14 non-lead item codes.

The codes, several of which are included in two categories in Round 2021 of the competitive bidding program, are:

Standard manual wheelchairs: E0955, E0985, E1020, E1028, E2228, K0015, and K0070
Standard power mobility devices: E0955, E0985, E1020, E1028, E2368, E2369, E2370, E2375, and K0015
Support surfaces (Groups 1 and 2): E0197

Walkers: E0140 and E0149.

The codes were converted from the inexpensive and routinely purchased payment class to the capped-rental class after 2015. However, to comply with federal regulations, CMS used the 2015 fee schedule to determine the relative ratios for the non-lead items in each product category.

As a result, the relative ratios for the 14 affected codes were calculated using the average of the purchase amounts (i.e. NU modifier) in all areas from the 2015 fee schedule, since these codes were still in the IRP payment class in 2015.

Providers with questions should call the Competitive Bidding Implementation Contractor (CBIC) customer service center at 877-577-5331 between 9 a.m. and 9 p.m. EST, Monday through Friday.

The bid window closes Sept. 18.