Round 2 and the National Mail-Order Summary

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required the competition for Round 2 to occur in 2011 in 70 metropolitan statistical areas (MSAs) and authorized competition for national mail-order (NMO) items and services after 2010. The Affordable Care Act of 2010 expanded the number of Round 2 MSAs from 70 to 91 areas. MIPPA allowed for the subdivision of MSAs with populations over eight million into multiple competitive bidding areas (CBAs). Most Round 2 MSAs had only one CBA; however, the three largest MSAs (Chicago, Los Angeles, and New York) were subdivided into multiple CBAs, so a total of 100 CBAs were in Round 2. Round 2 included eight product categories.

The Centers for Medicare & Medicaid Services (CMS) also conducted an NMO competition for diabetic testing supplies at the same time as the Round 2 competition. The NMO CBA encompassed all parts of the United States, including the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.

Round 2 and NMO contracts and prices became effective on July 1, 2013. Beneficiaries with Original Medicare who obtained competitively bid items across the eight product categories in those CBAs were required to obtain those items from a contract supplier unless an exception applied. Round 2 and NMO contracts and prices expired on June 30, 2016.


Round 2 included 100 CBAs and the NMO CBA encompassed all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.



There were eight product categories included in Round 2. The NMO competition included diabetic testing supplies.




The single payment amounts for all Round 2 and NMO product categories.



Fact Sheets


12/29/2023 Antitrust Guidance
12/29/2023 Change of Ownership
12/29/2023 Common Ownership and Control
12/29/2023 Contract Supplier Obligations
12/29/2023 Covered Document Review Date
12/29/2023 Eligibility Requirements
12/29/2023 Enteral Nutrition
12/29/2023 Exemptions from the Requirement to Be a Contract Supplier for Competitively Bid Items and Services
12/29/2023 Grandfathering for Oxygen and Oxygen Equipment
12/29/2023 Grandfathering for Rented DME
12/29/2023 Licensure for Bidding Suppliers
12/29/2023 Licensure for Contract Suppliers
12/29/2023 National Mail-Order Competition for Diabetic Supplies
12/29/2023 Prescription for Specific Brand or Mode of Delivery to Avoid an Adverse Medical Outcome
12/29/2023 Required Financial Documents
12/29/2023 Requirement to Submit a Bona Fide Bid
12/29/2023 Review of Supplier Capacity and Expansion Plans
12/29/2023 Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs)
12/29/2023 Subcontracting of DMEPOS Services
12/29/2023 Supplier Marketing Guidelines
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Updated: 12/29/2023