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CMS releases list of Rural Zip Codes

Coming this January, the competitive bidding program will expand to all areas of the country. Current non-competitive bid areas will not be subject to a bidding process. But they will be forced to accept the reimbursement rates of the bid winners in the current competitive bidding areas in their region.

Theoretically bid winners are able to balance the significant payment cuts through increased volume of beneficiaries. But rural providers will not gain any volume and will be forced to accept the reduced bid rates of those in the nearest bid regions. To offset the lack of volume, CMS has implemented a 10% increase in reimbursement rates for suppliers in rural areas, in order to make up for the absent volume.

Today, CMS released the long awaited list of rural zip codes of which “rural areas” will receive a 10 percent add-on. Click here to view the list of zip codes.

We at VGM are still digesting this information but wanted to share as soon as it was received. We will keep you updated with any further details on this matter.

Message from CMS

The Centers for Medicare and Medicaid Services (CMS) has released preliminary DMEPOS rural ZIP Code file containing Quarter 4 2015 rural ZIP codes. Beginning January 1, 2016, fee schedule amounts for certain items will be adjusted based on information from the DMEPOS competitive bidding program, and for some items, the adjusted fee schedule amounts for items furnished in rural areas within the state will be different than the adjusted fee schedule amounts in other areas of the state. The ZIP codes for areas defined as rural areas per regulations at 42 CFR 414.202 are based on current ZIP code boundaries. Changes to the ZIP code public use file will be made, as needed, based on future changes to ZIP codes by the United States Postal Service. The public use files for the DMEPOS and PEN fee schedules do not contain fee schedule amounts, but are being posted to show what changes are being planned for the file formats to accommodate the fee schedule amounts for rural areas, as well as statewide fee schedule amounts for enteral nutrition.

The files are available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html.