DME billing payer complexity isn’t going away. Payers will continue to update their policies, tighten documentation requirements, and expand audit activity. The question is whether your billing operation is built to handle it proactively or reactively.
Recent Medicare enforcement activity indicates an increasing emphasis on supplier compliance with state licensure requirements. This focus is further underscored by a recent reminder posted on the CMS Competitive Bidding Program website, which noted that supplier licensure will be validated throughout the bidding process.
CMS has recently provided additional guidance to the DME MACs regarding documentation expectations for demonstrating continued medical need for Continuous Glucose Monitors Supplies (CGMs) under the applicable Local Coverage Determination (LCD).
On January 13, 2026, CMS published in the Federal Register an update to the Master List, required items for face to face, written order prior to delivery and prior authorization.
On December 4, 2025, the DME MACs issued new guidance regarding the use of SC, GA, GZ, and GY modifiers for Ventilators, Lymphedema Compression Treatment Items, and Pneumatic Compression Devices.
CGS has expanded its CGS Connect program to include the following Lymphedema Compression Treatment HCPCS codes
Medicare has initiated audits of Lymphedema Compression Treatment Items, resulting in further clarification regarding acceptable documentation standards.
Over the years there have been many changes to the HCPCS coding for orthoses. With the most recent overall CMS established two L code sets; Prefabricated and Custom Fabricated.
The Pricing Data Analysis and Coding Contractor (PDAC), Palmetto GBA, submitted a request to revise HCPCS Level II code E1028 and establish three new HCPCS Level II codes to further identify wheelchair mounting hardware accessories.
In October 2024, the OIG announced a new oxygen audit titled "Medicare Payments to Suppliers for Oxygen and Oxygen Equipment." According to the OIG,...
Please be advised that the National Provider Enrollment (NPE) contractors, Novitas Solutions and Palmetto GBA, mailed out revalidation notices at...
It is the time of the year when the National Provider Enrollment (NPE) Contractors will start mailing letters or post cards to all suppliers,...