CMS Provides Clarification on the Lead Item Pricing Calculator

The Centers for Medicare & Medicaid Services (CMS) has added a clarifying note on the Lead Item Pricing Calculator on the following 14 non-lead item Healthcare Common Procedure Coding System (HCPCS) codes:

Standard Manual Wheelchairs: E0955*, E0985*, E1020*, E1028*, E2228, K0015*, and K0070
Standard Power Mobility Devices: E0955*, E0985*, E1020*, E1028*, E2368, E2369, E2370, E2375, and K0015*
Support Surfaces (Groups 1 and 2): E0197
Walkers: E0140 and E0149
*Included in both the standard manual wheelchairs and standard power mobility devices product categories. 

These HCPCS codes were converted from the inexpensive and routinely purchased (IRP) payment class to the capped rental payment class after 2015. In accordance with federal regulations, CMS used the 2015 fee schedule to determine the relative ratios for the non-lead items in each product category. As a result, the relative ratios for the 14 affected HCPCS codes were calculated using the average of the purchase amounts (i.e., NU modifier) in all areas from the 2015 fee schedule since these HCPCS codes were still in the IRP payment class in 2015.

If you have any questions or need assistance, please call the Competitive Bidding Implementation Contractor (CBIC) customer service center at 877-577-5331 between 9 a.m. and 7 p.m. prevailing Eastern Time, Monday through Friday. Hours are currently extended to 9 p.m. prevailing Eastern Time until the close of the bid window on September 18, 2019.

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Updated: 09/06/2019