Several clients have requested the entire DME fee schedule for 2025, thinking that all DMEPOS payments are the same nationwide. To satisfy those wishing a specific DMEPOS fee schedule as well as provide an answer to those who wish the entire fee schedule, this article, should provide those answers. First let’s provide some basic background material:
Therapeutic Shoes: Those products covered under the Therapeutic Shoe Program (A5500-A5514) for Diabetes, are reimbursed the same nationwide. Technically these services are covered as a Congressional benefit. Thus, the fees are the same in all states and territories.
Other DMEPOS: For all other product categories covered by the DME MAC, the fees vary depending on the state and for some product categories, they vary depending on whether the patient lives in a designated rural or non-rural area.
While technically the DMEPOS fee schedule is released in December for the following year, there are quarterly edits mostly provided for adding new HCPCS codes to the fee schedule. However, at times, fees for existing codes may also be adjusted. Thus, providing a link to a ‘look up tool” is as important as providing the entire fee schedule.
The look up tool for DMEPOS fee schedule may be found here.
The above tool allows you to research the fees for a HCPCS code by DOS and in one or all states. Each DME MAC website may also provide a similar look-up tool.
The entire fee schedule (as a zip file) and more information on the DME program may be found here.
