CMS is proposing to revise the coding used to describe miscellaneous durable medical equipment (DME). The agency notes that HCPCS code E1399, “durable medical equipment, miscellaneous,” is currently used to bill for inexpensive DME, other covered DME, and replacement parts, which are subject to different payment rules. Likewise, HCPCS code K0108 describes a “wheelchair component or accessory, not otherwise specified” and is currently being used to bill for inexpensive DME, other covered DME, and replacement parts of wheelchairs. To promote more accurate payment of Medicare DME claims, CMS is proposing replace HCPCS codes E1399 and K0108 with the following HCPCS codes, effective January 1, 2016:

  1. KXXX1 Durable Medical Equipment, Miscellaneous, the Purchase Price Does Not Exceed $150 -- Based on the average reasonable charges for items that could be included in this code, CMS calculates that the 2015 fee schedule amount would be $97.94; this amount will be updated by the 2016 covered item update. 
  2. KXXX2 Durable Medical Equipment, Miscellaneous, the Purchase Price Exceeds $150 -- Based on the average reasonable charges for all items covered by this code, CMS determines that the 2015 capped rental fee schedule amounts would be $80.60 for rental months 1 thru 3 and $60.45 for months 4 thru 13; these amounts will be updated by the 2016 covered item update. 
  3. KXXX3 Wheelchair Component or Accessory, Miscellaneous, the Purchase Price Does not Exceed $150 -- The 2015 fee schedule amount generated based on CMS calculations would be $72.56; this amount will be updated by the 2016 covered item update.
  4. KXXX4 Wheelchair Component or Accessory, Miscellaneous, the Purchase Price Exceeds $150 – CMS calculates that the 2015 fee schedule amounts for items in this code would be $53.41 for months 1 thru 3 and $40.06 for months 4 thru 13; these amounts will be updated by the 2016 covered item update. 
  5. KXXX5 Repair Part For Use With Beneficiary Owned Durable Medical Equipment, Other Than Wheelchair, Not Covered Under Supplier Or Manufacturer Warranty, Not Otherwise Specified -- Payment will be made on a lump sum purchase basis, per the contractor’s individual consideration of the item. 
  6. KXXX6 Repair Part For Use With Beneficiary Owned Wheelchair, Not Covered Under Supplier Or Manufacturer Warranty, Not Otherwise Specified -- Payment will be made on a lump sum purchase basis, per the contractor’s individual consideration of the item.

CMS will accept electronic comments on this proposal until July 9, 2015.