As HME providers are most aware, last October CMS released the zip codes for the non-bid areas that will be impacted by the national expansion of competitive bidding, which went into effect Jan. 1, 2016. CMS also designated rural zip codes, which covered 16,285 zip codes (37.8 percent of the total); these areas received rates based on a national average plus a 10 percent increase.
Change request (CR) 9554 provides the April quarterly update for the Medicare DMEPOS fee schedule. While there are no fee schedule updates from the previous quarter (January through March 2016), an April 2016 DMEPOS rural ZIP code file containing quarter two, 2016 rural ZIP code changes is now available. Information on these updates is available in MLN Matters® article MM9554 .
VGM members may access the first quarter and this new second quarter rural ZIP code file at vgmncbservices.com.
Many thank are due to a lot of our VGM members that were very active in bringing these zip code inaccuracies to light including Regina Gillispie of Best Home Medical in West Virginia. Regina brought these issues forward to staff members of HHS with VGM’s Tom Powers in a meeting this past month to show that these zip codes desperately needed to be improved to reflect truly rural areas. Admiral Earl Gay from the Small Business Administration also played a key role in these updates from the repeated provider examples during Regulatory Fairness Hearings coordinated by the VGM Group and the SBA.