CMS Creates ESRD Add-On Payments, Requires Prior Authorization for Master List of DMEPOS Items, and Implements Other Changes in Calendar Year 2020 Final Rule

AHLA Practice Group Bulletins

Authored Article


On November 8, 2019, the Centers for Medicare and Medicaid Services (CMS) published changes to the End-Stage Renal Disease (ESRD) Prospective Payment System and the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule for calendar year (CY) 2020. Such changes in CMS’ CY 2020 ESRD and DMEPOS Final Rule include creating transitional add-on payment adjustments for certain new ESRD equipment and supplies; reducing payments under the ESRD Quality Incentive Program; establishing a gap-filling methodology to determine DMEPOS prices; subjecting a Master List of DMEPOS items to prior authorization, face-to-face encounter requirements, and written order requirements; and streamlining DMEPOS order requirements.

The original articles, “CMS Issues CY 2020 ESRD Final Rule” and “CMS Issues CY 2020 DMEPOS Final Rule,” first appeared as AHLA Practice Group Bulletins on January 9, 2020.