CMS Medicare Competitive Bidding Program

Medicare Part B Competitive Bidding

Orthotics/Braces – the Background

• In 2003, Congress originally authorized CMS to implement a Competitive Bidding Program (CBP) for DMEPOS. Multiple rounds of bidding have been conducted for many different DMEPOS categories over the past decade.
• On November 3, 2018, CMS requested feedback on a proposal to include certain off-the-shelf (OTS) knee and back orthotics/braces in the next round of competitive bidding (known as Round 2021, since contracts will become effective on January 1, 2021).
• In early 2019, CMS announced that OTS knee and back braces would be included in Round 2021.
• OTS orthotics are defined as products that require minimal self-adjustment, and do not require expertise in trimming, bending, molding, assembling, or customizing to fit to the individual.

Next Steps for DJO and the Industry

• DMEPOS suppliers will compete to become Medicare contract suppliers by submitting one bid for the “lead” item within a product category (e.g., knee orthotics/braces) for each Competitive Bidding Area (CBA). There are 130 CBAs included in Round 2021.
• Winning bidders must be able to provide the lead item in a product category, as well as all other products included in that category. This can be accomplished through various approaches.
• CMS will evaluate bids based on the supplier’s eligibility to provide the identified products within a CBA, its financial stability, and the bid price offered. Contracts will be awarded to suppliers who offer the best price and meet applicable quality and financial standards.
• DJO also has been working closely with industry associations and thought leaders to protect access to high quality products needed by our patients and advocated for the exclusion of certain codes of the identified products/HCPCS codes from the CMS competitive bidding process and changes to the Correct Coding Guidance with respect to custom fitted codes.
• DMACs issued a revised Correct Coding Guidance in March 2019:
  • https://cgsmedicare.com/jb/pubs/news/2019/03/cope11845.html
  • https://cgsmedicare.com/jc/pubs/news/2019/07/cope13077.html