CMS DMEPOS fee schedule amounts can vary based on a beneficiary zip code. Suppliers who supply products across multiple geographic areas are often times faced with the challenge of identifying pricing based on a patient's address to determine the appropriate fee schedule allowable.
You can automate the allowable calculation by selecting the option to Use Medicare Fee Schedule Allowable when creating a price option.
When this option is enabled for a price option, the system will look for the following to determine the CMS fee schedule amount based on Former CBA, Rural or Non Rural rates.
The beneficiary address
The HCPC
Modifiers
For capped rental items where a price option rental interval of 4 - 13 is used or a KJ modifier is present:
For each of the remaining months, the monthly rental is limited to 7.5 percent of the average allowed purchase price.
For power wheelchair rentals, monthly rental payment amounts under the DMEPOS fee schedule are calculated using a different percentage of the purchase price than the percentage used for regular capped rental items, payment for months 4 through 13 is 6 percent (instead of 7.5 percent).