Noridian Administrative Services, the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) for Jurisdiction D, released a fee schedule amount for oral appliances (HCPCS code E0486).
According to an announcement from the carrier, “Effective April 1, 2011, E0486 has a fee schedule amount of $1,175.39 for services provided in 2009 and 2010. The fee schedule amount for services in 2011 is $1,290.63.”
The amount was determined based on CMS gap filling criteria where contractors gather price information and claims processing data. “After the contractor has processed a minimum number of claims using an interim payment method, they must gap-fill base fees using the average allowed amount for the claims they have paid,” information from the contractor stated. “A minimum number of claims required for establishing a fee are claims from at least four suppliers who have at least three charges each.”