What's the Competitive Bidding Program?
Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program changes the amount Medicare pays for certain DMEPOS. Under this program, suppliers submit bids to provide certain items and supplies to people with Medicare living in, or visiting, competitive bidding areas. Medicare uses these bids to set the amount it pays for each item. All suppliers are thoroughly screened to make sure they meet Medicare requirements (like eligibility and financial, quality, and accreditation standards) before they're awarded contracts.
Round 2021 of the Competitive Bidding Program began on January 1, 2021, and only includes off-the-shelf back and knee braces. If you have Original Medicare , the program requires you to get competitively bid off-the-shelf back and knee braces in competitive bidding areas from a contract supplier, unless an exception applies.
What if I need a specific brand of an off-the-shelf back or knee brace?
If you need a specific brand of an off-the-shelf back or knee brace to avoid an adverse medical outcome, your doctor must prescribe the specific brand in writing. Your doctor must also document in your medical record why this specific brand is needed to avoid an adverse medical outcome. In these situations, a contract supplier is required to do one of these:
- Give you the exact brand of off-the-shelf back or knee brace your doctor prescribes for you.
- Help you find another contract supplier that offers that brand of off-the-shelf back or knee brace.
- Work with your doctor to find an appropriate alternative brand of off-the-shelf back or knee brace and get a revised written prescription.
What if I need to repair or replace an off-the-shelf back or knee brace I own?
If you own a competitively bid off-the-shelf back or knee brace, you can use any Medicare-enrolled supplier (even a non-contract supplier) for repairs or replacement parts needed. Before your equipment is serviced, you should make sure the supplier is Medicare-enrolled so Medicare can help pay. If you need to replace your off-the-shelf back or knee brace, you must use a contract supplier for Medicare to help pay for the brace.
Medicare doesn’t pay for repairs that a manufacturer’s or supplier’s warranty covers. If you need warranty repairs, follow the warranty rules.
More about the DMEPOS Competitive Bidding Program