Medicare Competitive Bidding Program
Effective January 1, 2024, the Centers for Medicare and Medicaid Services (CMS) has established a temporary gap period with the Medicare Competitive Bidding Program (CBP). What this means is that the Medicare CBP rules governing who can supply and bill Medicare for off-the-shelf (OTS) knee and back braces in the Medicare Competitive Bidding Areas (CBAs) have been temporarily suspended. CMS plans to issue a Proposed Rule (i.e., regulation) sometime in Calendar Year 2024 that will update the Medicare CBP for the next round of bidding. Once that Rule has been issued by CMS as a Final Rule, CMS will then identify when the next round of the Medicare CBP will begin.
Until the next Medicare CBP round begins, providers will be able to order/prescribe OTS knee and back braces for Medicare beneficiaries from DJO, Surgi-Care, Inc., or Ortho Pros Express, Inc. in ANY area of the United States.
DJO, Surgi-Care, Inc., and Ortho Pros Express, Inc. have your practice and your Medicare beneficiaries covered in all areas of the United States during the Medicare CBP temporary gap period.
What is Competitive Bidding?
On 1/1/2021, the Centers for Medicare & Medicaid Services (CMS) contracted with certain DME suppliers who met specific requirements to be the sole suppliers for certain off-the-shelf (OTS) knee and OTS back braces. This was called the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, or Medicare CBP. The most recent round of the Medicare CBP ran from 1/1/2021 to 12/31/2023.
The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MMA required Medicare to replace the current fee schedule payment methodology for selected DMEPOS items with a competitive bidding process. The intent of the MMA was to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts, which would reduce beneficiary out-of-pocket expenses and save the Medicare program money, while ensuring beneficiary access to quality items and services.
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