CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—MEDICARE PROGRAM (parts 405 to 426) > PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES > SUBPART F—Competitive Bidding for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) (§414.400 to §414.426) > 414.416—Determination of competitive bidding payment amounts.

414.416—Determination of competitive bidding payment amounts.

(a) General rule. CMS establishes a single payment amount for each item furnished under a competitive bidding program.
(b) Methodology for setting payment amount. (1) The single payment amount for an item furnished under a competitive bidding program is equal to the median of the bids submitted for that item by suppliers whose composite bids for the product category that includes the item are equal to or below the pivotal bid for that product category. If there is an even number of bids, the single payment amount for the item is equal to the average of the two middle bids.
(2) The single payment amount for an item must be less than or equal to the amount that would otherwise be paid for the same item under subpart C or subpart D.
[72 FR 18085, Apr. 10, 2007]