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CMS Announces Round 2021 Single Payment Amounts For Knee And Back Braces

The following is an excerpt from the offical “CMS Round 2021 DMEPOS Competitive Bidding Program Single Payment Amounts and Contract Offers” announcment. 

The Centers for Medicare & Medicaid Services (CMS) competed 16 product categories in 130 competitive bid areas (CBAs) in Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP), although the product category for non-invasive ventilators was removed in April 2020 due to the coronavirus disease 2019 (COVID-19) public health emergency (PHE). Of the remaining 15 product categories that were bid for Round 2021, 13 of the product categories have been in previous rounds of the CBP, while off-the-shelf (OTS) back and knees braces were competed for the first time in Round 2021. There were 130 CBAs resulting in over 2,000 competitions. CMS received and has reviewed over 49,000 bids.

CMS has heard from a range of stakeholders requesting that the agency delay or cancel the Round 2021 DMEPOS CBP due to the ongoing COVID-19 Public Health Emergency. CMS considered that feedback in moving forward with the Round 2021 DMEPOS CBP. CMS is not awarding competitive bidding contracts for any of the 13 product categories for Round 2021 that were previously competed because the payment amounts did not achieve expected savings.

Contract offers have been made in 127 CBAs for the OTS Back Braces and OTS Knee Braces product categories, as Medicare expects to save $600 million for the program and beneficiaries over the three year Round 2021 contract performance period. Contracts for OTS back braces and OTS knee braces are not being awarded in certain CBAs where savings would not be achieved. Payment for the items where contracts will not be awarded will be based on adjusted fee schedule amounts in accordance with regulations in CFR 414.210(g). 

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The VGM Government team will provide additional guidance in the days to come.