Durable Medical Equipment Rate Methodology
Rate Methodology
Pursuant to Welfare & Institutions Code (WIC) 14105.48, the Department is required to set Medi-Cal FFS Durable Medical Equipment (DME) reimbursement rates at no more than 100% of the
corresponding Medicare rate for wheelchairs and wheelchair accessories,
speech-generating devices, complex rehabilitation technology and services, and
oxygen and respiratory items, and no more than than 80% of the corresponding Medicare rural rate for all other DME.
In an effort to comply with the DME rate methodology requirement, the Department conducts an annual review of the rates and adjusts rates that exceed the 80 or 100 percent of Medicare requirement, as applicable.
The Department received approval of State Plan Amendment 22-0039 to exempt all DME items and services from the AB 97 10% payment reductions for dates of service on or after July 1, 2022.
January 1, 2023 Rate Review:
As a result of the rate review, it was found that no DME rates require a rate adjustment.
On June 12, 2023, the Department received approval
of State Plan Amendment 23-0003 to update the reimbursement methodology for Durable
Medical Equipment, which states that effective January 1, 2023, and on January 1 each year
thereafter, rates for wheelchairs, wheelchair accessories, and
speech-generating devices and related accessories, that exceed 100 percent of the
most current Medicare rate, as provided in the Medicare rural fee schedule for
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, will be
reduced to 100 percent of the corresponding Medicare rate,
and rates for all other DME that exceed 80 percent of the corresponding Medicare
rate, as provided in the Medicare rural fee schedule for Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies, will be reduced to 80 percent
of the corresponding Medicare rate.
January 1, 2022 Rate Review:
As a result of the rate review, it was found that no DME rates require a rate adjustment.
DHCS will not submit proposed State Plan Amendment 22-0008 to adjust DME rates, effective January 1, 2022.
April 1, 2021 Rate Review:
The Department received approval of State Plan Amendment (SPA) 21-0016 on March 26, 2021, with an effective date of March 1, 2020 and January 1, 2021, authorizing a retroactive increase of reimbursement rates and a temporary exemption of DME oxygen and respiratory equipment codes from the AB 97 10% payment reductions during the public health emergency (PHE).
January 1, 2021 Rate Review:
As a result of the rate review, it was found that no DME rates require a rate adjustment.
DHCS will not submit State Plan Amendment to adjust DME rates, effective January 1, 2021.
January 1, 2020 Rate Review:
As a result of the rate review, it was found that no DME rates require a rate adjustment.
DHCS State Plan Amendment (SPA) 20-0005 to adjust DME rates, effective January 1, 2020, as described in the Public Notice (PN) posted on April 23, 2020, will not result in any rate adjustment.
January 1, 2019 Rate Review:
As a result of the rate review, the DME reimbursement rates identified in the link below were adjusted, as authorized in SPA 19-0005.
January 1, 2019 Adjusted Rates
