Support Surfaces (Group 2 Mattresses and Overlays) · Support Surfaces (Group 2 Mattresses and...
Transcript of Support Surfaces (Group 2 Mattresses and Overlays) · Support Surfaces (Group 2 Mattresses and...
Support Surfaces (Group 2 Mattresses and Overlays)
Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM 4 Allentown-Bethlehem-Easton, PA-NJ 4 Asheville, NC 5 Atlanta-Sandy Springs-Marietta, GA 5 Augusta-Richmond County, GA-SC 5 Austin-Round Rock-San Marcos, TX 6 Bakersfield-Delano, CA 6 Baltimore-Towson, MD 6 Baton Rouge, LA 6 Beaumont-Port Arthur, TX 7 Birmingham-Hoover, AL 7 Boise City-Nampa, ID 7 Boston-Cambridge-Quincy, MA-NH 8 Bridgeport-Stamford-Norwalk, CT 8 Bronx-Manhattan, NY CBA 8 Buffalo-Niagara Falls, NY 9 Cape Coral-Fort Myers, FL 9 Central-Chicago Metro CBA 9 Charleston-North Charleston-Summerville, SC 9 Chattanooga, TN-GA 10 Colorado Springs, CO 10 Columbia, SC 10 Columbus, OH 11 Dayton, OH 11 Deltona-Daytona Beach-Ormond Beach, FL 11 Denver-Aurora-Broomfield, CO 11
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2
Single Payment Amounts
Detroit-Warren-Livonia, MI 12 El Paso, TX 12 Flint, MI 12 Fresno, CA 13 Grand Rapids-Wyoming, MI 13 Greensboro-High Point, NC 13 Greenville-Mauldin-Easley, SC 14 Hartford-West Hartford-East Hartford, CT 14 Honolulu, HI 14 Houston-Sugar Land-Baytown, TX 14 Huntington-Ashland, WV-KY-OH 15 Indiana-Chicago Metro 15 Indianapolis-Carmel, IN 15 Jackson, MS 16 Jacksonville, FL 16 Knoxville, TN 16 Lakeland-Winter Haven, FL 16 Las Vegas-Paradise, NV 17 Little Rock-North Little Rock-Conway, AR 17 Los Angeles County CBA 17 Louisville/Jefferson County, KY-IN 18 McAllen-Edinburg-Mission, TX 18 Memphis, TN-MS-AR 18 Milwaukee-Waukesha-West Allis, WI 19 Minneapolis-St. Paul-Bloomington, MN-WI 19 Nashville-Davidson--Murfreesboro--Franklin, TN 19 Nassau-Brooklyn-Queens-Richmond County Metro CBA 19 New Haven-Milford, CT 20 New Orleans-Metairie-Kenner, LA 20 North East NY CBA Metro 20 North Port-Bradenton-Sarasota, FL 21 Northern NJ Metro CBA 21 Northern-Chicago Metro CBA 21 Ocala, FL 21 Oklahoma City, OK 22 Omaha-Council Bluffs, NE-IA 22 Orange County CBA 22 Oxnard-Thousand Oaks-Ventura, CA 23
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 2 of 33
Palm Bay-Melbourne-Titusville, FL 23 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 23 Phoenix-Mesa-Glendale, AZ 24 Portland-Vancouver-Hillsboro, OR-WA 24 Poughkeepsie-Newburgh-Middletown, NY 24 Providence-New Bedford-Fall River, RI-MA 24 Raleigh-Cary, NC 25 Richmond, VA 25 Rochester, NY 25 Sacramento--Arden-Arcade--Roseville, CA 26 Salt Lake City, UT 26 San Antonio-New Braunfels, TX 26 San Diego-Carlsbad-San Marcos, CA 26 San Francisco-Oakland-Fremont, CA 27 San Jose-Sunnyvale-Santa Clara, CA 27 Scranton--Wilkes-Barre, PA 27 Seattle-Tacoma-Bellevue, WA 28 South-West-Chicago-Metro CBA 28 Southern NY Metro CBA 28 Springfield, MA 29 St. Louis, MO-IL 29 Stockton, CA 29 Suffolk County CBA 29 Syracuse, NY 30 Tampa-St. Petersburg-Clearwater, FL 30 Toledo, OH 30 Tucson, AZ 31 Tulsa, OK 31 Virginia Beach-Norfolk-Newport News, VA-NC 31 Visalia-Porterville, CA 31 Washington-Arlington-Alexandria, DC-VA-MD-WV 32 Wichita, KS 32 Worcester, MA 32 Youngstown-Warren-Boardman, OH-PA 33
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 3 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Akron, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $677.50
Akron, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $210.31
Akron, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Akron, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00
Akron, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Albany-Schenectady-Troy, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $724.65
Albany-Schenectady-Troy, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.81
Albany-Schenectady-Troy, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.10
Albany-Schenectady-Troy, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00
Albany-Schenectady-Troy, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $297.71
Albuquerque, NM E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $713.91
Albuquerque, NM E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $217.82
Albuquerque, NM E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Albuquerque, NM E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
Albuquerque, NM E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.59
Allentown-Bethlehem-Easton, PA-NJ E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $652.43
Allentown-Bethlehem-Easton, PA-NJ E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.31
Support Surfaces (Group 2 Mattresses and Overlays)
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 4 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Allentown-Bethlehem-Easton, PA-NJ E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.75
Allentown-Bethlehem-Easton, PA-NJ E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $222.40
Allentown-Bethlehem-Easton, PA-NJ E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Asheville, NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $646.00
Asheville, NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.00
Asheville, NC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45
Asheville, NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.17
Asheville, NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $392.21
Atlanta-Sandy Springs-Marietta, GA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $667.21
Atlanta-Sandy Springs-Marietta, GA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $259.00
Atlanta-Sandy Springs-Marietta, GA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $280.92
Atlanta-Sandy Springs-Marietta, GA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20
Atlanta-Sandy Springs-Marietta, GA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Augusta-Richmond County, GA-SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $667.21
Augusta-Richmond County, GA-SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Augusta-Richmond County, GA-SC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Augusta-Richmond County, GA-SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 5 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Augusta-Richmond County, GA-SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Austin-Round Rock-San Marcos, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $581.91
Austin-Round Rock-San Marcos, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $252.96
Austin-Round Rock-San Marcos, TX E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $238.10
Austin-Round Rock-San Marcos, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $208.10
Austin-Round Rock-San Marcos, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.00
Bakersfield-Delano, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $759.80
Bakersfield-Delano, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.12
Bakersfield-Delano, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45
Bakersfield-Delano, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $232.11
Bakersfield-Delano, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Baltimore-Towson, MD E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $618.50
Baltimore-Towson, MD E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $293.07
Baltimore-Towson, MD E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $255.40
Baltimore-Towson, MD E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.56
Baltimore-Towson, MD E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $318.10
Baton Rouge, LA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $675.40
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 6 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Baton Rouge, LA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50
Baton Rouge, LA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $266.77
Baton Rouge, LA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $237.35
Baton Rouge, LA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $370.83
Beaumont-Port Arthur, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $671.77
Beaumont-Port Arthur, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Beaumont-Port Arthur, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Beaumont-Port Arthur, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $220.00
Beaumont-Port Arthur, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Birmingham-Hoover, AL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $675.40
Birmingham-Hoover, AL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50
Birmingham-Hoover, AL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $319.80
Birmingham-Hoover, AL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Birmingham-Hoover, AL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $443.10
Boise City-Nampa, ID E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $687.50
Boise City-Nampa, ID E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.81
Boise City-Nampa, ID E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 7 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Boise City-Nampa, ID E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Boise City-Nampa, ID E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Boston-Cambridge-Quincy, MA-NH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81
Boston-Cambridge-Quincy, MA-NH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.90
Boston-Cambridge-Quincy, MA-NH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Boston-Cambridge-Quincy, MA-NH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.95
Boston-Cambridge-Quincy, MA-NH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18
Bridgeport-Stamford-Norwalk, CT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81
Bridgeport-Stamford-Norwalk, CT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.90
Bridgeport-Stamford-Norwalk, CT E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Bridgeport-Stamford-Norwalk, CT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.95
Bridgeport-Stamford-Norwalk, CT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18
Bronx-Manhattan NY CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $520.92
Bronx-Manhattan NY CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $194.81
Bronx-Manhattan NY CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $194.23
Bronx-Manhattan NY CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $182.07
Bronx-Manhattan NY CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $276.16
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 8 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Buffalo-Niagara Falls, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $600.00
Buffalo-Niagara Falls, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.17
Buffalo-Niagara Falls, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.60
Buffalo-Niagara Falls, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Buffalo-Niagara Falls, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.00
Cape Coral-Fort Myers, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $550.09
Cape Coral-Fort Myers, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $191.91
Cape Coral-Fort Myers, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.10
Cape Coral-Fort Myers, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $169.96
Cape Coral-Fort Myers, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $196.72
Central-Chicago Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $559.41
Central-Chicago Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $301.19
Central-Chicago Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.56
Central-Chicago Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Central-Chicago Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18
Charleston-North Charleston-Summerville, SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $591.91
Charleston-North Charleston-Summerville, SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $244.50
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 9 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Charleston-North Charleston-Summerville, SC E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Charleston-North Charleston-Summerville, SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $235.37
Charleston-North Charleston-Summerville, SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.55
Chattanooga, TN-GA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Chattanooga, TN-GA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50
Chattanooga, TN-GA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Chattanooga, TN-GA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Chattanooga, TN-GA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $332.86
Colorado Springs, CO E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $698.50
Colorado Springs, CO E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $287.78
Colorado Springs, CO E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Colorado Springs, CO E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Colorado Springs, CO E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Columbia, SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $620.00
Columbia, SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $259.00
Columbia, SC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Columbia, SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 10 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Columbia, SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Columbus, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $596.91
Columbus, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $197.31
Columbus, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.67
Columbus, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00
Columbus, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $297.71
Dayton, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $671.91
Dayton, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.13
Dayton, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $258.45
Dayton, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.47
Dayton, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.39
Deltona-Daytona Beach-Ormond Beach, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18
Deltona-Daytona Beach-Ormond Beach, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.53
Deltona-Daytona Beach-Ormond Beach, FL E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $264.35
Deltona-Daytona Beach-Ormond Beach, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $174.98
Deltona-Daytona Beach-Ormond Beach, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43
Denver-Aurora-Broomfield, CO E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $672.00
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 11 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Denver-Aurora-Broomfield, CO E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $303.80
Denver-Aurora-Broomfield, CO E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Denver-Aurora-Broomfield, CO E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20
Denver-Aurora-Broomfield, CO E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.74
Detroit-Warren-Livonia, MI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $627.31
Detroit-Warren-Livonia, MI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.91
Detroit-Warren-Livonia, MI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Detroit-Warren-Livonia, MI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $231.00
Detroit-Warren-Livonia, MI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
El Paso, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $678.93
El Paso, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
El Paso, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
El Paso, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.95
El Paso, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18
Flint, MI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Flint, MI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Flint, MI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 12 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Flint, MI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Flint, MI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $328.20
Fresno, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $759.80
Fresno, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $181.91
Fresno, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $280.00
Fresno, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $244.68
Fresno, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $345.49
Grand Rapids-Wyoming, MI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $738.88
Grand Rapids-Wyoming, MI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $227.50
Grand Rapids-Wyoming, MI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Grand Rapids-Wyoming, MI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
Grand Rapids-Wyoming, MI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $316.81
Greensboro-High Point, NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $699.50
Greensboro-High Point, NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Greensboro-High Point, NC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Greensboro-High Point, NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Greensboro-High Point, NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 13 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Greenville-Mauldin-Easley, SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $696.10
Greenville-Mauldin-Easley, SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.50
Greenville-Mauldin-Easley, SC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45
Greenville-Mauldin-Easley, SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83
Greenville-Mauldin-Easley, SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Hartford-West Hartford-East Hartford, CT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.00
Hartford-West Hartford-East Hartford, CT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.90
Hartford-West Hartford-East Hartford, CT E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Hartford-West Hartford-East Hartford, CT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20
Hartford-West Hartford-East Hartford, CT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $300.00
Honolulu, HI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $713.94
Honolulu, HI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $320.00
Honolulu, HI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Honolulu, HI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Honolulu, HI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $430.62
Houston-Sugar Land-Baytown, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $620.00
Houston-Sugar Land-Baytown, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $251.38
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 14 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Houston-Sugar Land-Baytown, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Houston-Sugar Land-Baytown, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $202.50
Houston-Sugar Land-Baytown, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $282.50
Huntington-Ashland, WV-KY-OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81
Huntington-Ashland, WV-KY-OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $227.50
Huntington-Ashland, WV-KY-OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Huntington-Ashland, WV-KY-OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
Huntington-Ashland, WV-KY-OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $298.30
Indiana-Chicago Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $627.31
Indiana-Chicago Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Indiana-Chicago Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Indiana-Chicago Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Indiana-Chicago Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Indianapolis-Carmel, IN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Indianapolis-Carmel, IN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.63
Indianapolis-Carmel, IN E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Indianapolis-Carmel, IN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $248.93
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 15 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Indianapolis-Carmel, IN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Jackson, MS E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $688.10
Jackson, MS E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $264.90
Jackson, MS E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $290.00
Jackson, MS E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Jackson, MS E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $435.30
Jacksonville, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18
Jacksonville, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Jacksonville, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Jacksonville, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $180.00
Jacksonville, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $223.95
Knoxville, TN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $640.00
Knoxville, TN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50
Knoxville, TN E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Knoxville, TN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $234.36
Knoxville, TN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18
Lakeland-Winter Haven, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $555.09
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 16 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Lakeland-Winter Haven, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $224.53
Lakeland-Winter Haven, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $264.48
Lakeland-Winter Haven, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $174.53
Lakeland-Winter Haven, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $198.57
Las Vegas-Paradise, NV E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $624.43
Las Vegas-Paradise, NV E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $293.22
Las Vegas-Paradise, NV E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Las Vegas-Paradise, NV E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.64
Las Vegas-Paradise, NV E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $345.49
Little Rock-North Little Rock-Conway, AR E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $674.25
Little Rock-North Little Rock-Conway, AR E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $256.25
Little Rock-North Little Rock-Conway, AR E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Little Rock-North Little Rock-Conway, AR E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83
Little Rock-North Little Rock-Conway, AR E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $331.26
Los Angeles County CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $595.56
Los Angeles County CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $174.60
Los Angeles County CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $272.20
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 17 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Los Angeles County CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $234.61
Los Angeles County CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $317.71
Louisville/Jefferson County, KY-IN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $571.91
Louisville/Jefferson County, KY-IN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $210.31
Louisville/Jefferson County, KY-IN E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.60
Louisville/Jefferson County, KY-IN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00
Louisville/Jefferson County, KY-IN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $298.30
McAllen-Edinburg-Mission, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $685.86
McAllen-Edinburg-Mission, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $303.80
McAllen-Edinburg-Mission, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
McAllen-Edinburg-Mission, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
McAllen-Edinburg-Mission, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Memphis, TN-MS-AR E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Memphis, TN-MS-AR E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $312.60
Memphis, TN-MS-AR E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $290.00
Memphis, TN-MS-AR E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.46
Memphis, TN-MS-AR E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $378.53
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 18 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Milwaukee-Waukesha-West Allis, WI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $711.75
Milwaukee-Waukesha-West Allis, WI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $261.53
Milwaukee-Waukesha-West Allis, WI E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Milwaukee-Waukesha-West Allis, WI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $272.30
Milwaukee-Waukesha-West Allis, WI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Minneapolis-St. Paul-Bloomington, MN-WI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Minneapolis-St. Paul-Bloomington, MN-WI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.63
Minneapolis-St. Paul-Bloomington, MN-WI E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Minneapolis-St. Paul-Bloomington, MN-WI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Minneapolis-St. Paul-Bloomington, MN-WI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Nashville-Davidson--Murfreesboro--Franklin, TN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $720.00
Nashville-Davidson--Murfreesboro--Franklin, TN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $247.49
Nashville-Davidson--Murfreesboro--Franklin, TN E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Nashville-Davidson--Murfreesboro--Franklin, TN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Nashville-Davidson--Murfreesboro--Franklin, TN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Nassau-Brooklyn-Queens-Richmond County Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $572.13
Nassau-Brooklyn-Queens-Richmond County Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $226.90
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 19 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Nassau-Brooklyn-Queens-Richmond County Metro CBA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $235.65
Nassau-Brooklyn-Queens-Richmond County Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $198.75
Nassau-Brooklyn-Queens-Richmond County Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $276.16
New Haven-Milford, CT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81
New Haven-Milford, CT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $280.98
New Haven-Milford, CT E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
New Haven-Milford, CT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.57
New Haven-Milford, CT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18
New Orleans-Metairie-Kenner, LA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $650.00
New Orleans-Metairie-Kenner, LA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50
New Orleans-Metairie-Kenner, LA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
New Orleans-Metairie-Kenner, LA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
New Orleans-Metairie-Kenner, LA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
North East NY CBA Metro E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $501.85
North East NY CBA Metro E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $194.62
North East NY CBA Metro E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
North East NY CBA Metro E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.15
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 20 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
North East NY CBA Metro E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.00
North Port-Bradenton-Sarasota, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18
North Port-Bradenton-Sarasota, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.83
North Port-Bradenton-Sarasota, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.77
North Port-Bradenton-Sarasota, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.96
North Port-Bradenton-Sarasota, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43
Northern NJ Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $515.13
Northern NJ Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.13
Northern NJ Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $231.60
Northern NJ Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $200.00
Northern NJ Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $273.73
Northern-Chicago Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81
Northern-Chicago Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $281.26
Northern-Chicago Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Northern-Chicago Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20
Northern-Chicago Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Ocala, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 21 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Ocala, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.83
Ocala, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.77
Ocala, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.96
Ocala, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43
Oklahoma City, OK E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $670.42
Oklahoma City, OK E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $255.05
Oklahoma City, OK E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Oklahoma City, OK E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Oklahoma City, OK E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $302.71
Omaha-Council Bluffs, NE-IA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $620.00
Omaha-Council Bluffs, NE-IA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.63
Omaha-Council Bluffs, NE-IA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Omaha-Council Bluffs, NE-IA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $220.00
Omaha-Council Bluffs, NE-IA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Orange County CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $585.49
Orange County CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $124.70
Orange County CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $274.40
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 22 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Orange County CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Orange County CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $349.66
Oxnard-Thousand Oaks-Ventura, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $595.56
Oxnard-Thousand Oaks-Ventura, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $147.70
Oxnard-Thousand Oaks-Ventura, CA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $258.45
Oxnard-Thousand Oaks-Ventura, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.96
Oxnard-Thousand Oaks-Ventura, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Palm Bay-Melbourne-Titusville, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $481.78
Palm Bay-Melbourne-Titusville, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $208.16
Palm Bay-Melbourne-Titusville, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.77
Palm Bay-Melbourne-Titusville, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $169.96
Palm Bay-Melbourne-Titusville, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $193.34
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $700.00
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $265.00
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $234.27
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 23 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Phoenix-Mesa-Glendale, AZ E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $711.75
Phoenix-Mesa-Glendale, AZ E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $227.50
Phoenix-Mesa-Glendale, AZ E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $245.50
Phoenix-Mesa-Glendale, AZ E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Phoenix-Mesa-Glendale, AZ E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.59
Portland-Vancouver-Hillsboro, OR-WA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $712.50
Portland-Vancouver-Hillsboro, OR-WA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $311.09
Portland-Vancouver-Hillsboro, OR-WA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.10
Portland-Vancouver-Hillsboro, OR-WA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.31
Portland-Vancouver-Hillsboro, OR-WA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $380.26
Poughkeepsie-Newburgh-Middletown, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $575.92
Poughkeepsie-Newburgh-Middletown, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $167.51
Poughkeepsie-Newburgh-Middletown, NY E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Poughkeepsie-Newburgh-Middletown, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $211.25
Poughkeepsie-Newburgh-Middletown, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $297.71
Providence-New Bedford-Fall River, RI-MA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $687.15
Providence-New Bedford-Fall River, RI-MA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $233.01
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 24 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Providence-New Bedford-Fall River, RI-MA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45
Providence-New Bedford-Fall River, RI-MA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $233.10
Providence-New Bedford-Fall River, RI-MA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.50
Raleigh-Cary, NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $606.00
Raleigh-Cary, NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $246.25
Raleigh-Cary, NC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Raleigh-Cary, NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
Raleigh-Cary, NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.58
Richmond, VA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Richmond, VA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00
Richmond, VA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $290.00
Richmond, VA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Richmond, VA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Rochester, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $674.25
Rochester, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.98
Rochester, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Rochester, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.45
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 25 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Rochester, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $332.31
Sacramento--Arden-Arcade--Roseville, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $642.50
Sacramento--Arden-Arcade--Roseville, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $208.56
Sacramento--Arden-Arcade--Roseville, CA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Sacramento--Arden-Arcade--Roseville, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00
Sacramento--Arden-Arcade--Roseville, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Salt Lake City, UT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $631.16
Salt Lake City, UT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $255.00
Salt Lake City, UT E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45
Salt Lake City, UT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.08
Salt Lake City, UT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $367.50
San Antonio-New Braunfels, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $610.00
San Antonio-New Braunfels, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $252.96
San Antonio-New Braunfels, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $238.10
San Antonio-New Braunfels, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $211.25
San Antonio-New Braunfels, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $285.10
San Diego-Carlsbad-San Marcos, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $595.07
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 26 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
San Diego-Carlsbad-San Marcos, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $181.91
San Diego-Carlsbad-San Marcos, CA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.20
San Diego-Carlsbad-San Marcos, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $237.35
San Diego-Carlsbad-San Marcos, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $335.66
San Francisco-Oakland-Fremont, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $784.14
San Francisco-Oakland-Fremont, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $245.00
San Francisco-Oakland-Fremont, CA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
San Francisco-Oakland-Fremont, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83
San Francisco-Oakland-Fremont, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
San Jose-Sunnyvale-Santa Clara, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $707.18
San Jose-Sunnyvale-Santa Clara, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $253.74
San Jose-Sunnyvale-Santa Clara, CA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
San Jose-Sunnyvale-Santa Clara, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
San Jose-Sunnyvale-Santa Clara, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $298.30
Scranton--Wilkes-Barre, PA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $724.65
Scranton--Wilkes-Barre, PA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $210.31
Scranton--Wilkes-Barre, PA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.75
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 27 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Scranton--Wilkes-Barre, PA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.40
Scranton--Wilkes-Barre, PA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37
Seattle-Tacoma-Bellevue, WA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $683.81
Seattle-Tacoma-Bellevue, WA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $311.78
Seattle-Tacoma-Bellevue, WA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.10
Seattle-Tacoma-Bellevue, WA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $265.00
Seattle-Tacoma-Bellevue, WA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $384.95
South-West-Chicago-Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $518.70
South-West-Chicago-Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00
South-West-Chicago-Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
South-West-Chicago-Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
South-West-Chicago-Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
Southern NY Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $515.13
Southern NY Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.15
Southern NY Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $196.93
Southern NY Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $202.50
Southern NY Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $273.73
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 28 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Springfield, MA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $650.00
Springfield, MA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00
Springfield, MA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
Springfield, MA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.90
Springfield, MA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42
St. Louis, MO-IL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $650.00
St. Louis, MO-IL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $293.07
St. Louis, MO-IL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20
St. Louis, MO-IL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
St. Louis, MO-IL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Stockton, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $794.59
Stockton, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Stockton, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Stockton, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Stockton, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Suffolk County CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $520.92
Suffolk County CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $177.31
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 29 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Suffolk County CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $192.23
Suffolk County CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $190.82
Suffolk County CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $280.89
Syracuse, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $724.65
Syracuse, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.81
Syracuse, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $248.45
Syracuse, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83
Syracuse, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $315.66
Tampa-St. Petersburg-Clearwater, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $550.00
Tampa-St. Petersburg-Clearwater, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.23
Tampa-St. Petersburg-Clearwater, FL E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.00
Tampa-St. Petersburg-Clearwater, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.96
Tampa-St. Petersburg-Clearwater, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43
Toledo, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $644.41
Toledo, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $197.76
Toledo, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Toledo, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 30 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Toledo, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $302.71
Tucson, AZ E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $732.79
Tucson, AZ E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.25
Tucson, AZ E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.05
Tucson, AZ E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $222.48
Tucson, AZ E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.59
Tulsa, OK E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $712.28
Tulsa, OK E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $237.50
Tulsa, OK E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Tulsa, OK E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48
Tulsa, OK E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $316.25
Virginia Beach-Norfolk-Newport News, VA-NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $712.50
Virginia Beach-Norfolk-Newport News, VA-NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $264.75
Virginia Beach-Norfolk-Newport News, VA-NC E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $295.00
Virginia Beach-Norfolk-Newport News, VA-NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Virginia Beach-Norfolk-Newport News, VA-NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $335.66
Visalia-Porterville, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $794.59
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 31 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Visalia-Porterville, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $169.20
Visalia-Porterville, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $270.00
Visalia-Porterville, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66
Visalia-Porterville, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Washington-Arlington-Alexandria, DC-VA-MD-WV E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $621.00
Washington-Arlington-Alexandria, DC-VA-MD-WV E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $277.78
Washington-Arlington-Alexandria, DC-VA-MD-WV E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
Washington-Arlington-Alexandria, DC-VA-MD-WV E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.11
Washington-Arlington-Alexandria, DC-VA-MD-WV E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.81
Wichita, KS E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00
Wichita, KS E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00
Wichita, KS E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Wichita, KS E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00
Wichita, KS E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
Worcester, MA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $687.15
Worcester, MA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.81
Worcester, MA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 32 of 33
CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA
Support Surfaces (Group 2 Mattresses and Overlays)
Worcester, MA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00
Worcester, MA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.55
Youngstown-Warren-Boardman, OH-PA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $695.89
Youngstown-Warren-Boardman, OH-PA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00
Youngstown-Warren-Boardman, OH-PA E0371
NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89
Youngstown-Warren-Boardman, OH-PA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $248.93
Youngstown-Warren-Boardman, OH-PA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32
DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 33 of 33