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Zip Code Changes For Q1 2020

One year ago is when VGM first heard of changes affecting zip codes that moved them from rural to non-rural, which resulted in a reduction in the allowable. It was a member in Texas that reached out when they noticed a difference in their payments between the first quarter and second quarter of 2019. The VGM team researched and found out there were hundreds of zip code changes going from rural to non-rural.

Here we are one year later with only a couple of changes in the first quarter of 2020. The two zip codes affected are 04429 in Maine and 54472 Wisconsin. They changed from rural to non-rural, which means that oxygen went from $136 to $72 for suppliers that have beneficiaries in those areas. CPAP (E0601) went from $76 (WI) and $72 (ME) to $41 (WI) and $39 (ME). This does mean the purchase allowable dropped on capped rental equipment. See graphic below.

While this is a small volume of Medicare beneficiaries overall within the two zip codes, the VGM team continues to monitor any changes that will affect your business and your territories. As your billing team is posting payments, be sure to monitor the allowable. Please keep VGM in the loop if you notice any changes in zip codes and payments. Information on zip codes and fee schedules for rural versus non-rural can be found at www.dmepdac.com.