ARLINGTON, Virginia—The Centers for Medicare and Medicaid Services (CMS) released its consumer price index for all urban consumers (CPI-U) adjustment updates for calendar year (CY) 2025 durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) fee schedules, the American Association for Homecare (AAHomecare) released in a recent newsletter to members. AAHomecare said that although the CPI-U will increase from 2.4% to 3% in CY 2025, the inflation adjustment will differ depending on whether the DMEPOS item has been included in the competitive bidding program (CBP) and whether the patient’s zip code is in a former competitive bidding area (CBA).
The CPI-U adjustments for the CY 2025 are listed below:
- CBP items in former CBAs (projected percentage change): Increase by 2.9%.
- CBP items in non-CBAs (CPI-U): Increase by 3%. (Note: not directly stated in the change request.)
- Non-CBP items (CPI-U minus productivity adjustment): Increase by 2.4%.
What This Means for CBP Items in Former CBAs
For DME items like CPAP devices, oxygen devices and negative pressure wound therapy pumps for which the payment is based on CBP payment rates, the 2.9% increase should be directly applied to the current 2024 fee schedule.
What This Means for Non-CBP Items
For DME items that have never been part of the CBP, such as urological and ostomy supplies, the 2.4% inflation adjustment should be directly applied to the current 2024 fee schedule, regardless of location in the country.
What This Means for CBP Items in Rural Areas
For CBP items in rural areas, the 50-50 blended rate would continue to be applied (50% fully adjusted regional payment and 50% unadjusted fee schedule from 2015), meaning that the 3% increase would only be applied to the fully adjusted portion of the calculation. The portion of the reimbursement calculation that is based on the static 2015 rates would remain the same, but the fully adjusted portion will increase by 3%. Additionally, the 2024 rate is equal to 50% derived from the 2015 rates and 50% derived from the current regional rates, plus the 3% increase.
What This Means for CBP Items in Non-Rural Areas
For CBP items in non-rural, non-bid areas, the payment rate would be a 3% increase to the current CY 2024 non-rural, non-bid rates.
AAHomecare said the official CY 2025 DMEPOS fee schedule is anticipated to be published by CMS soon.
