Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Reimbursement - Medicare Advantage

Policy No: 118
Originally Created: 08/01/2014
Section: Administrative
Last Reviewed: 05/01/2018
Last Revised: 05/01/2018
Approved: 05/17/2018
Effective: 10/01/2018

This policy applies only to physicians and other qualified healthcare professionals.


Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are classified by the Centers for Medicare & Medicaid (CMS) into 10 categories below:

  • IN - Inexpensive and Other Routinely Purchased Items
  • FS - Frequently Serviced Items
  • CR - Capped Rental Items
  • OX - Oxygen and Oxygen Equipment
  • OS - Ostomy, Tracheostomy & Urological Items
  • PO - Prosthetics & Orthotics
  • SD - Surgical Dressings
  • SU - Supplies
  • TE - Transcutaneous Electrical Nerve Stimulators
  • TS - Therapeutic Shoes
  • IL - Intra Ocular lens
  • SC - Splinting and Casting

Policy statement

Medicare Advantage reimbursement of DMEPOS codes will be at the lesser of billed charges or 100% of current DMEPOS fee schedule amount published by CMS.

Parenteral and Enteral Nutrition (PEN) codes will be reimbursed at the lesser of billed charges or 80% of the current DMEPOS fee schedule published by CMS.

Our health plan reserves the right to set a fee schedule amount for a DMEPOS code which is different from the amount published in the CMS DMEPOS fee schedule. For codes which do not have CMS fees, we may assign a payment rate that is a fee schedule amount or a percentage of billed charges.




Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.