CMS Pub. 100-04, ch. 20, § 20.5

The CMS provides updates to the DMEPOS fee schedule and related schedules annually or as

otherwise necessary. A/B MACs (B) or DME MACs must maintain at least five full

calendar years of fee schedules and related pricing data (i.e., the current and four prior

calendar years), regardless of the number of updates or pricing periods within those five

years.

20.6 - Phase-in For Competitive Bid Rates in Areas Not in a

Competitive Bid Area

(Rev. 3801, Issued: 06-28-17, Effective: 07-01-16, Implementation: 07-03-17 - For contractors to retrieve and test the fee schedule and begin the adjustment process; 10-02-17 - For contractors to complete the adjustment process)

Section 1834(a)(1)(F)(ii) of the Act mandates adjustments to the fee schedule amounts

for certain DME items furnished on or after January 1, 2016, in areas that are not

competitive bid areas, based on information from competitive bidding programs for

DME. Regulations at section 414.210(g)(9) phased in these adjusted fees so that from

January 1, 2016 through June 30, 2016, the fee schedule amount in non-bid areas was

based on 50 percent of the adjusted payment amount established using competitive

bidding information and 50 percent of the unadjusted fee schedule amount (i.e., the 2015

fee schedule amount updated by the 2016 covered item update). Beginning July 1, 2016,

the fee schedule amounts for non-bid areas reverted to 100 percent of the adjusted

payment amounts determined using competitive bidding information.

Section 16007 of the 21st Century Cures Act changes the 2016 fee schedule transition

period so that payment based on 50 percent of the adjusted payment amount established

using competitive bidding information and 50 percent of the unadjusted fee schedule

amount extends from June 30, 2016 to December 31, 2016. Section 16007 also changes

from July 1, 2016 to January 1, 2017 the date that payment based on 100 percent of the

adjusted payment amounts in non-bid areas is effective.

Repriced Cures Act claim adjustments for the above mentioned dates of service shall use

the following RARC code: N689 - Alert: This reversal is due to a retroactive rate

change.