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2019 Reimbursement Rate Guide

We are receiving a lot of questions from suppliers about the 2019 reimbursement rates. Below is a summary of changes that occurred or didn't occur in 2019 and an explanation of the reimbursement rates.

Overall, these are the changes that occurred in 2019:

  • Former competitive bidding areas: single payment amount (SPA) + 2.5% (except oxygen)
  • Oxygen in former competitive bidding areas: single payment amount (SPA) adjusted for budget neutrality - click here for details
  • Diabetic supplies - non-mail order:remain at current rate
  • Items not included in CB program: 2018 rates +2.3% (for example-orthotics & prosthetics)
  • Rural/non-contiguous areas: 50% unadjusted fee schedule and 50% new adjusted fee schedule
  • Non-rural/non-former competitive bidding areas: remain at current regional rate

Below are instructions on how to find the 2019 reimbursements:

There are three levels of reimbursement. You can see the different color-coded CBAs in your state. A map of Iowa is used as an example below.

  • Competitive bid areas (CBAs) (Round 2 bid areas are red, Round 1 bid areas will be in blue)
  • Areas deemed “Non-Rural- by CMS (in yellow)

Areas deemed “Rural- by CMS (in green)

Click here to view your state's DME Geographic Classification map located on our VGM DC link website.

Competitive Bid Area Rates

The rates for competitive bid areas can be found here:

Round 1 https://dmecompetitivebid.com/palmetto/cbicrd12017.nsf/DocsCat/Home

Round 2 Recompete https://dmecompetitivebid.com/palmetto/cbicrd2recompete.nsf/DocsCat/Home

To view the Competitive Bidding Area zip codes, choose Competitive Bid Areas on the left side of the screen.

To view the Competitive Bidding Area reimbursements choose, Single Payment Amounts.

Then scroll to the bottom of the page. Choose the appropriate region. This will take you to a compressed folder of Excel spreadsheets and .pdf based on product category. Once you open the chosen spreadsheet, you will need to scroll down to find the competitive area with every bid code and reimbursement rate. These are the 2018 reimbursement rates. You will need to add 2.5% increase to these rates.  (CMS granted a 2.5% CPI increase in 2019 for bid items).

Rural and Non-Rural Rates

To find rural and non-rural area reimbursements:

Go to: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME19-A.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

Under Downloads-Click on DME19-A (updated 01/03/19). This will take you to a compressed folder that houses excel spreadsheets and pdf. Choose the excel spreadsheet labeled DMEPOS.JAN or DMEPEN.JAN for enteral supplies.

Once opened, you will see the hcpcs codes on the left, and the states (R) for rural and (NR) for non-rural rates.

We hope this helps! Please call the VGM Government Relations team if you have any additional questions. 866-512-8465