What is the difference between the 2015 fee schedule and the 2019 fee schedule, which are both used in Round 2021?
Starting in 2016, competitive bidding pricing information has been used to adjust fees in areas where the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program has not been implemented. That means the 2015 fee schedule is the last fee schedule that was not adjusted using competitive bidding pricing information and, for some items, was not exposed to price inversions among similarly coded items (i.e., where single payment amounts (SPAs) for DMEPOS items with less features are higher than SPAs for DMEPOS items with more features). This is why the 2015 fee schedule was used to determine the relative ratios for non-lead items in the product category. Please review the Lead Item Pricing fact sheet for more information and an example of how the 2015 fee schedule was used to determine the relative ratios.
The 2019 unadjusted fee schedule was used for establishing bid limits for Round 2021. It is simply the annual unadjusted fee schedule adjusted for inflation (i.e., what the 2015 fee schedule would be today if the Centers for Medicare & Medicaid Services did not apply competitive bidding information to the fee schedule).
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