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The Division of Workers’ Compensation (DWC) has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule to conform to the third quarter 2016 changes in the Medicare payment system, as required by Labor Code section 5307.1.

The update includes all changes identified in Center for Medicare and Medicaid Services Change Request (CR) number 9642.

The CMS issues instructions for implementing and/or updating DMEPOS payment amounts on a semiannual basis (January and July), with quarterly updates as necessary (April and October). Updates to the codes adjusted using information from the competitive bidding program (CBP) will be made each time the payment amounts under the CBPs are adjusted or additional CBPs or payment amounts are established for the items and services. When applicable, these updates will be included in the quarterly DMEPOS change request instructions. The DMEPOS fee schedule is provided to DME MACs, the Pricing, Data Analysis and Coding Contractor (PDAC), Part A MACs, HHH MACs and Part B MACs via CMS’ mainframe telecommunication system.

The DMEPOS fee schedules are calculated by CMS. A separate DMEPOS Fee Schedule file is released to the intermediaries, regional home health intermediaries, Railroad Retirement Board (RRB), Indian Health Service and United Mine Workers. The fee schedule for parenteral and enteral nutrition (PEN) is released to the PDAC and DME MACs in a separate file. These files are also available through the CMS Website for interested parties like the State Medicaid agencies and managed care organizations.

The order, effective for services on or after July 1, 2016, adopts the Medicare DMEPOS quarterly update for calendar year 2016.

The order adopting the Official Medical Fee Schedule adjustment is posted online