New DMEPOS Competitive Bidding Program Begins July 2008

If you are a Medicare provider who orders, refers, or supplies specific durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to your patients, you may need to change the suppliers your patients will use. Beginning on July 1, Medicare will start implementation of a new program for purchasing DMEPOS for Medicare patients.

Medicare beneficiaries who live in one of 10 metropolitan statistical areas (MSAs) must obtain equipment or supplies from a Medicare-contracted supplier. The 10 MSAs are:

• Charlotte-Gastonia-Concord, North Carolina; South Carolina

• Cincinnati-Middletown, Ohio; Kentucky; Indiana

• Cleveland-Elyria-Mentor, Ohio

• Dallas-Fort Worth-Arlington, Texas

• Kansas City, Missouri; Kansas

• Miami-Fort Lauderdale-Miami Beach, Florida

• Orlando-Kissimmee, Florida

• Pittsburgh, Pennsylvania

• Riverside-San Bernardino-Ontario, California

• San Juan-Caguas-Guaynabo, Puerto Rico

The program will expand to an additional 70 areas in 2009, and into more areas after that.

If you have patients in one of these 10 areas and order, refer, or supply specific medical equipment or supplies that fall within 10 product categories, that equipment and supplies can only be acquired from a Medicare-contracted supplier.

The 10 product categories are as follows:

• Oxygen supplies and equipment*

• Standard power wheelchairs, scooters, and related accessories

• Complex rehabilitative power wheelchairs and related accessories*

• Mail-order diabetic supplies

• Enteral nutrients, equipment, and supplies*

• Continuous Positive Airway Pressure (CPAP) devices, Respiratory Assist Devices (RADs), and related supplies\

• Hospital beds and related accessories*

• Negative pressure wound therapy pumps and related supplies and accessories

• Walkers and related accessories

• Support surfaces, including group two mattresses and overlays (in Miami-Fort Lauderdale-Miami Beach, Florida, only)

*This product category is not included in San Juan-Caguas-Guaynabo, PR

Physicians can assist their patients in finding out which suppliers are contracted by Medicare website. The suppliers should be announced in May. If patients do not use Medicare-contracted suppliers for these DMEPOS, they will not be covered.

You can also provide patients with a CMS fact sheet entitled: “What You Should Know if You Need Medicare-Covered Equipment or Supplies.” The fact sheet can be found by clicking here (PDF Download).