Written and maintained by CASRAI Editorial Board
Last updated
Short answer: The DMEPOS fee schedule is the set of Medicare fee schedule amounts that CMS publishes as downloadable files, listing a fee schedule amount, floor and ceiling for each billing code, together with the code’s payment category, jurisdiction and short description. CMS labels the files by year and release letter (for example DME26-A through DME26-D for 2026), and under 42 CFR 414.210(a) Medicare pays on the basis of 80 percent of the lesser of the actual charge or the fee schedule amount. This page explains how the files are organised and what to check before relying on a figure. It does not reproduce any rates, and it is general information, not billing or medical advice.
Definition and scope
CMS describes Medicare Part B coverage of “medically necessary equipment, devices, and supplies” in benefit categories defined in section 1861 of the Social Security Act, and refers to them collectively as DMEPOS (durable medical equipment, prosthetics, orthotics and supplies). The “DMEPOS fee schedule” is the pricing side of that program: for each item a supplier can bill, there is a code, and for each code CMS publishes fee schedule data (source: CMS DMEPOS landing page, checked 2026-10-30).
The same CMS landing page links separately to related schedules and topics, including power mobility devices, prosthetics, orthotics and therapeutic shoes, surgical dressings, lymphedema compression treatment items and competitive bidding. So “the” fee schedule is a family of files and related pages, not a single table. The code system underneath it is HCPCS; see the CASRAI guide to DME HCPCS codes for how the codes and their payment categories are laid out, and the HCPCS vs CPT comparison if the two code sets are unfamiliar.
How the files are organised and released
This is the part most explainers skip. On its “DMEPOS Fee Schedule Files” page (checked 2026-10-30), CMS states that the list contains “the fee schedule amounts, floors, and ceilings for all procedure codes” plus the payment category, jurisdiction and short description assigned to each code. Files are named by two-digit year and a release letter. The 2026 files are DME26-A, DME26-B, DME26-C and DME26-D, and the 2025, 2024 and 2023 listings follow the same A to D pattern, corresponding to January, April, July and October releases. CMS also keeps an archive that runs back to 1998 and offers a subscription feed and email updates.
Decoder for file names seen on the CMS page
| File label | What CMS says it is |
|---|---|
| DMEyy-A, -B, -C, -D | The regular releases for the year, one lettered file per release month (January, April, July, October) |
| DME16-C | The 50/50 blend fee schedules for the transition extension under Section 16007(a) of the 21st Century Cures Act (revised for July 2016) |
| DME20-CARES | Changes required under section 3712 of the CARES Act, published with the Interim Final Rule CMS-5531-IFC |
| DME22-R | Corrections for items furnished in non-contiguous areas such as Alaska, Hawaii and Puerto Rico |
| Rural ZIP code files (for example DME16-B) | A separate file listing rural ZIP codes, published alongside the fee schedule |
The practical point: a file name carries the year and the release, so a figure copied from a spreadsheet is only meaningful together with its label. Two “2026” figures for the same code can come from different releases.
How a fee schedule amount becomes a payment (42 CFR 414.210)
The federal rule that governs DME payment is 42 CFR 414.210 (eCFR, checked 2026-10-30). Its main points:
- The 80 percent rule. Paragraph (a) says Medicare pays on the basis of 80 percent of the lesser of the actual charge for the item or the fee schedule amount.
- Classes of items. Paragraph (b)(1) lists seven classes of equipment and devices for which fee schedules are determined: inexpensive or routinely purchased items, items requiring frequent and substantial servicing, certain customized items, oxygen and oxygen equipment, prosthetic and orthotic devices, other DME (capped rental items) and transcutaneous electrical nerve stimulators (TENS).
- Regional versus rural adjustment. Under the rule’s regional-price provisions, amounts in non-rural areas are adjusted to a regional price, and regional prices are bounded so that they are not greater than 110 percent nor less than 90 percent of the national average price. For rural areas, amounts were adjusted to 110 percent of the national average price before 2022-02-28; on and after that date, the rule uses a 50/50 blend of 110 percent of the national average price and the 2015-based amount.
- Areas outside the contiguous United States. For areas outside the contiguous United States and rural areas, the rule increases the 2015 amount for each subsequent year beginning in 2016 by the annual update factors in the specified sections of the Social Security Act.
- Competitive bidding. For DME furnished on or after 2016-01-01, fee schedule amounts shall be adjusted using information from the competitive bidding program.
Related concepts: floors, ceilings, blends
CMS lists floors and ceilings next to each fee schedule amount in the files, so a row carries three figures for the same code. The schedule also has layers: a regular quarterly release, special files that implement a statute or correct an error, and rural or non-contiguous-area rules in the regulation. Reading a number correctly means identifying which layer produced it.
Where it matters for labs, clinics and supply decisions
Staff who handle DME billing or supplier contracts can use this checklist before relying on any schedule figure:
- Identify the file release (year and letter, or a special file such as DME22-R).
- Confirm the billing code, then its payment category and jurisdiction in the same row. The DME HCPCS codes guide explains the category column.
- Check whether the item was furnished in a rural area or outside the contiguous United States, because the regulation treats those differently.
- Remember that the schedule amount is not the payment: Medicare pays on 80 percent of the lesser of the charge or the schedule amount.
For coverage and supplier-side requirements that sit outside the fee schedule itself, see the guides on Medicare DME coverage, DMEPOS supplier standards, the DME MAC and the broader durable medical equipment list.
Common misunderstandings
- “The CMS DMEPOS page lists the rates.” The landing page describes the program and links to the files; the amounts are in the downloadable fee schedule files.
- “There is one annual table.” CMS publishes lettered files within each year and special-purpose files, so the label matters.
- “Medicare pays the schedule amount.” Under 42 CFR 414.210(a) the basis is 80 percent of the lesser of the charge or the schedule amount.
- “Rural and urban amounts are the same.” The regulation applies a different adjustment to rural areas than to non-rural areas.
FAQ
What is the Medicare DMEPOS fee schedule?
It is the CMS-published set of fee schedule amounts, floors and ceilings for DMEPOS billing codes, with each code’s payment category, jurisdiction and short description, distributed as downloadable files (CMS, checked 2026-10-30).
How often is the DMEPOS fee schedule updated?
CMS labels each year’s files A to D. For 2026 these are DME26-A, DME26-B, DME26-C and DME26-D, corresponding to January, April, July and October releases, and special files appear when a statute or correction requires one.
Where are the DMEPOS fee schedule files?
On the CMS page titled “DMEPOS Fee Schedule Files” under Medicare payment fee schedules, which also hosts the archive back to 1998 and the subscription options.
DMEPOS fee schedule explained: how much does Medicare actually pay?
Medicare pays on the basis of 80 percent of the lesser of the actual charge or the fee schedule amount (42 CFR 414.210(a)); the schedule amount itself comes from the file for the relevant release, code and area.
Sources
- CMS, Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics, and Supplies (DMEPOS), checked 2026-10-30.
- CMS, DMEPOS Fee Schedule Files, checked 2026-10-30.
- eCFR, 42 CFR 414.210, General payment rules, checked 2026-10-30.
