CMS Releases the 2019 Medicare DMEPOS Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released the 2019 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2019.  The 2018 Medicare fee schedule for orthotic and prosthetic services will be increased by 2.3% over 2018 rates. The 2.3% increase is a net reflection of the 2.9% increase in the Consumer Pricing Index for Urban Areas (CPI-U) from June 2017 through June 2018, combined with the annual Multi-Factor Productivity Adjustment (MFP) of -0.6%.

The 2.3% increase in the O&P Medicare fee schedule for 2019 represents a 1.2% larger amount than the 2018 increase of 1.1%.  Unfortunately, the 2% sequestration-based reduction to all Medicare payments remains in effect meaning that Medicare fee for service payments will continue to be reduced by 2% due to sequestration.  While sequestration continues to impact Medicare reimbursement, it is not cumulative.  You will still receive 2.3% more for a service you provide in 2019 then you did in 2018 since the 2% sequestration reduction would be applied to both claims.


HCPCS CATG Ceiling Floor CA Description
A5500 TS 87.85 65.89 73.21 Diab shoe for density insert
A5501 TS 263.51 197.63 219.59 Diabetic custom molded shoe
A5503 TS 43.49 32.62 36.24 Diabetic shoe w/roller/rockr
A5504 TS 43.49 32.62 36.24 Diabetic shoe with wedge
A5505 TS 43.49 32.62 36.24 Diab shoe w/metatarsal bar
A5506 TS 43.49 32.62 36.24 Diabetic shoe w/off set heel
A5507 TS 43.49 32.62 36.24 Modification diabetic shoe
A5512 TS 35.83 26.87 29.86 Multi den insert direct form
A5513 TS 53.47 40.1 44.56 Multi den insert custom mold
A5514 TS 53.47 40.1 44.56 Mult den insert dir carv/cam