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Get Ready for DMEPOS Competitive Bidding - Lead Item Pricing

In Round 2021, the Centers for Medicare & Medicaid Services (CMS) is implementing the 'lead item pricing' methodology for all items included in the product categories. This means that rather than submitting individual bids for each item within a product category, bidders will only submit one bid for the lead item in the product category. The supplier’s bid for the lead item represents the supplier’s bid for furnishing the lead item and all other items (the non-lead items) in the product category. The lead item in the product category is the item with the highest total allowed charges nationwide (all states, District of Columbia, Puerto Rico, and the United States Virgin Islands).

Bids for the lead item in the product category will be used to calculate the single payment amounts (SPAs) for the non-lead items within that product category. The SPA for the lead item is the maximum bid amount submitted for that lead item by suppliers whose bid amount for the lead item is in the winning range in that competitive bidding area and product category. The SPAs for the non-lead items within the product category are determined by multiplying the lead item SPA by a relative ratio. The ratios are based on the historic differences in the fee schedule amounts for the lead item and non-lead items.

Bidders should take into account the costs of furnishing all of the items described by the Healthcare Common Procedure Coding System (HCPCS) codes in each product category when submitting their bid for the lead item.

For additional information, please see the Lead Item Pricing fact sheet and the Lead Item Pricing Calculator.

As a reminder, the Competitive Bidding Implementation Contractor (CBIC) is the official information source for bidders and bidder education. CMS cautions bidders about potential inaccurate information concerning the Competitive Bidding Program posted on websites other than the CBIC website. Bidders that rely on this information in the preparation or submission of their bids could be at risk of submitting a non-compliant bid.

If you have any questions or need assistance, please call the CBIC customer service center at 877-577-5331 between 9 a.m. and 5:30 p.m. prevailing Eastern Time, Monday through Friday.



last updated on 04/23/2019

 

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