Traditional MedicareBilling CodesLow impact
R13889BP: Update to Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 110.8 Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Benefit Category Determinations
Medicare/CMS - Transmittals·General Practice, Urology, Endocrinology·CMS Transmittal
Effective date
Aug 28, 2026
We identified it
Jul 31, 2026
Summary
CMS updated Medicare Benefit Policy Manual Chapter 15, Section 110.8 to reflect benefit category determinations for new HCPCS Level II codes from the 2025 biannual 1 and 2 coding cycles. This is a technical update establishing whether specific DMEPOS items (durable medical equipment, prosthetics, orthotics, and supplies) are covered under Medicare and their benefit classifications. No change in policy occurred; this update merely documents coding cycle changes.
Action Required
By August 28, 2026: Billing team should review the updated DMEPOS Benefit Category Determinations table in Pub. 100-02 Chapter 15, Section 110.8 to understand benefit classifications for the newly listed HCPCS codes (A4271, A4287, A4288, A4295, A4296, A4297, A4318, A4341, A4342, A4438, A4457). Update billing software lookup tables and claim editing rules to reflect new benefit categories (e.g., A4288 now has no Medicare DMEPOS benefit category; A4318 is classified as Prosthetic Device; A4295-A4297 are Prosthetic Devices). Verify that claims submitted for items with 'No Medicare DMEPOS benefit category' designation will be denied appropriately. Providers should be educated via MLN Connects newsletter (CMS will distribute). No immediate action required if codes are not currently in use at your practice.