Product Categories and HCPCS Codes

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program ? Round 2021

Product Categories and HCPCS Codes

Commode Chairs

2

Continuous Positive Airway Pressure (CPAP) Devices and Related Accessories (RADs)

3

Enteral Nutrition

4

Hospital Beds

5

Nebulizers

6

Negative Pressure Wound Therapy (NPWT) Pumps

7

Non-Invasive Ventilators

8

Off-The-Shelf Back Braces

9

Off-The-Shelf Knee Braces

10

Oxygen and Oxygen Equipment

11

Patient Lifts and Seat Lifts

12

Standard Manual Wheelchairs

13

Standard Power Mobility Devices

16

Support Surfaces (Groups 1 and 2)

19

Transcutaneous Electrical Nerve Stimulation (TENS) Devices

20

Walkers

21

DMEPOS Competitive Bidding Program

Product Category HCPCS Codes

Round 2021

Commode Chairs

Lead Item HCPCS Code

Lead Item HCPCS Code Description

E0163

Commode Chair, Mobile Or Stationary, With Fixed Arms

Non-Lead Item HCPCS Code

Non-Lead Item HCPCS Code Description

E0160 E0161 E0165 E0167 E0168 E0170 E0171 E0275 E0276 E0325 E0326

Sitz Type Bath Or Equipment, Portable, Used With Or Without Commode Sitz Type Bath Or Equipment, Portable, Used With Or Without Commode, With Faucet Attachments Commode Chair, Mobile Or Stationary, With Detachable Arms Pail Or Pan For Use With Commode Chair, Replacement Only Commode Chair, Extra Wide And/Or Heavy Duty, Stationary Or Mobile, With Or Without Arms, Any Type, Each Commode Chair With Integrated Seat Lift Mechanism, Electric, Any Type Commode Chair With Integrated Seat Lift Mechanism, Non-Electric, Any Type Bed Pan, Standard, Metal Or Plastic Bed Pan, Fracture, Metal Or Plastic Urinal; Male, Jug-Type, Any Material Urinal; Female, Jug-Type, Any Material

Relative Ratio

Ratio HCPCS Modifiers

NU

Relative Ratio

Ratio HCPCS Modifiers

0.297690 NU 0.227971 NU 0.163797 RR 0.107266 NU 1.412432 NU 1.504158 RR 0.270643 RR 0.136245 NU 0.118690 NU 0.087442 NU 0.093994 NU

March 2019

2

DMEPOS Competitive Bidding Program

Product Category HCPCS Codes

Round 2021

Continuous Positive Airway Pressure (CPAP) Devices and Respiratory Assist Devices (RADs)

Lead Item HCPCS Code

Lead Item HCPCS Code Description

Relative Ratio

Ratio HCPCS Modifiers

E0601

Continuous Positive Airway Pressure (CPAP) Device

RR

Non-Lead Item HCPCS Code

Non-Lead Item HCPCS Code Description

Relative Ratio

Ratio HCPCS Modifiers

A4604 A7027 A7028 A7029 A7030 A7031 A7032 A7033 A7034 A7035 A7036 A7037 A7038 A7039 A7044 A7045 A7046

E0470

E0471

E0472

E0561 E0562

Tubing With Integrated Heating Element For Use With Positive Airway Pressure Device

0.626673 NU

Combination Oral/Nasal Mask, Used With Continuous Positive Airway Pressure Device, Each

1.990718 NU

Oral Cushion For Combination Oral/Nasal Mask, Replacement Only, Each

0.539424 NU

Nasal Pillows For Combination Oral/Nasal Mask, Replacement Only, Pair

0.220225 NU

Full Face Mask Used With Positive Airway Pressure Device, Each

1.769907 NU

Face Mask Interface, Replacement For Full Face Mask, Each

0.654617 NU

Cushion For Use On Nasal Mask Interface, Replacement Only, Each

0.380264 NU

Pillow For Use On Nasal Cannula Type Interface, Replacement Only, Pair

0.266536 NU

Nasal Interface (Mask Or Cannula Type) Used With Positive Airway Pressure Device, With Or Without Head Strap

1.103664 NU

Headgear Used With Positive Airway Pressure Device

0.356619 NU

Chinstrap Used With Positive Airway Pressure Device

0.157401 NU

Tubing Used With Positive Airway Pressure Device

0.378407 NU

Filter, Disposable, Used With Positive Airway Pressure Device

0.046702 NU

Filter, Non Disposable, Used With Positive Airway Pressure Device

0.134734 NU

Oral Interface Used With Positive Airway Pressure Device, Each

1.134441 NU

Exhalation Port With Or Without Swivel Used With Accessories For Positive Airway Devices, Replacement Only

0.182609 NU

Water Chamber For Humidifier, Used With Positive Airway Pressure Device, Replacement, Each

0.183000 NU

Respiratory Assist Device, Bi-Level Pressure Capability, Without Backup Rate Feature, Used With Noninvasive Interface, E.G.,

Nasal Or Facial Mask (Intermittent Assist Device With Continuous Positive Airway Pressure Device)

2.264289 RR

Respiratory Assist Device, Bi-Level Pressure Capability, With Back-Up Rate Feature, Used With Noninvasive Interface, E.G., Nasal

Or Facial Mask (Intermittent Assist Device With Continuous Positive Airway Pressure Device)

5.659990 RR

Respiratory Assist Device, Bi-Level Pressure Capability, With Backup Rate Feature, Used With Invasive Interface, E.G., Tracheostomy Tube (Intermittent Assist Device With Continuous Positive Airway Pressure Device)

5.659990 RR

Humidifier, Non-Heated, Used With Positive Airway Pressure Device

1.005569 NU

Humidifier, Heated, Used With Positive Airway Pressure Device

2.826185 NU

March 2019

3

DMEPOS Competitive Bidding Program

Product Category HCPCS Codes

Round 2021

Enteral Nutrition

Lead Item HCPCS Code

Lead Item HCPCS Code Description

Relative Ratio

Ratio HCPCS Modifiers

B4035

Enteral Feeding Supply Kit; Pump Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape

Non-Lead Item HCPCS Code

Non-Lead Item HCPCS Code Description

Relative Ratio

Ratio HCPCS Modifiers

B4034

B4036 B4081 B4082 B4083 B4087 B4088 B4149

B4150

B4152

Enteral Feeding Supply Kit; Syringe Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Enteral Feeding Supply Kit; Gravity Fed, Per Day, Includes But Not Limited To Feeding/Flushing Syringe, Administration Set Tubing, Dressings, Tape Nasogastric Tubing With Stylet

Nasogastric Tubing Without Stylet

Stomach Tube - Levine Type

Gastrostomy/Jejunostomy Tube, Standard, Any Material, Any Type, Each

Gastrostomy/Jejunostomy Tube, Low-Profile, Any Material, Any Type, Each Enteral Formula, Manufactured Blenderized Natural Foods With Intact Nutrients, Includes Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Formula, Nutritionally Complete With Intact Nutrients, Includes Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Formula, Nutritionally Complete, Calorically Dense (Equal To Or Greater Than 1.5 kcal/ml) With Intact Nutrients, Includes Proteins, Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit

0.523849

0.686192 1.854393 1.378243 0.211715 3.060251 3.060251

0.134728

0.058577

0.047699

B4153 B4154 B4155

Enteral Formula, Nutritionally Complete, Hydrolyzed Proteins (Amino Acids And Peptide Chain), Includes Fats, Carbohydrates, Vitamins And Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit

Enteral Formula, Nutritionally Complete, For Special Metabolic Needs, Excludes Inherited Disease Of Metabolism, Includes Altered Composition Of Proteins, Fats, Carbohydrates, Vitamins And/Or Minerals, May Include Fiber, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit Enteral Formula, Nutritionally Incomplete/Modular Nutrients, Includes Specific Nutrients, Carbohydrates (E.G., Glucose Polymers), Proteins/Amino Acids (E.G., Glutamine, Arginine), Fat (E.G., Medium Chain Triglycerides) Or Combination, Administered Through An Enteral Feeding Tube, 100 Calories = 1 Unit

0.164017 0.104603 0.081172

B9002 E0776BA

Enteral Nutrition Infusion Pump, Any Type IV Pole

105.155649 NU 8.744770 NUBA

March 2019

4

DMEPOS Competitive Bidding Program

Product Category HCPCS Codes

Round 2021

Hospital Beds

Lead Item HCPCS Code

Lead Item HCPCS Code Description

E0260

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Non-Lead Item HCPCS Code

Non-Lead Item HCPCS Code Description

E0250 E0251 E0255 E0256 E0261 E0271 E0272 E0280 E0290 E0291 E0292 E0293 E0294 E0295

E0301

E0302

E0303

E0304

E0305 E0310 E0910 E0911 E0912 E0940

Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress Mattress, Innerspring Mattress, Foam Rubber Bed Cradle, Any Type Hospital Bed, Fixed Height, Without Side Rails, With Mattress Hospital Bed, Fixed Height, Without Side Rails, Without Mattress Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, With Mattress Bed Side Rails, Half Length Bed Side Rails, Full Length Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached To Bed, With Grab Bar Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar Trapeze Bar, Free Standing, Complete With Grab Bar

Relative Ratio

Ratio HCPCS Modifiers

RR

Relative Ratio

Ratio HCPCS Modifiers

0.661929 RR 0.507962 RR 0.804435 RR 0.569504 RR 0.924245 RR 1.511162 NU 1.392023 NU 0.263804 NU 0.500744 RR 0.363521 RR 0.572779 RR 0.485489 RR 0.892469 RR 0.846703 RR

1.882423 RR

5.099568 RR

2.118396 RR

5.491740 RR 0.119586 RR 1.329737 NU 0.136702 RR 0.356154 RR 0.818053 RR 0.236568 RR

March 2019

5

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