DMEPOS Reimbursement Changes for 2016 To Require Reprogramming

This week the DWC posted adjustments to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.  The DWC’s December 16 Newsline announcing this change is posted under “What’s News” at www.dir.ca.gov/dwc/.

Please note that these changes include payment rates that may vary depending on whether the injured workers’ residence (rather than the provider address) is classified by Medicare as having a rural or non-rural ZIP code.  The Medicare ZIP code file DME16-A, can be downloaded here.

The use of an injured workers’ residence ZIP code is a new factor for fee schedule repricing, so this is an important processing change. Given that DMEPOS bills are often submitted electronically, the deadlines for responding to medical bills, and the 1/1/16 effective date for these adjustments, claims organizations will need to act quickly to reprogram their systems and implement these changes.