You didn’t get into healthcare to play phone tag with insurance companies. But now? It feels like you’re running a billing business, not a practice.

If you think DME billing has always been tricky, you’re right. Add to that a slew of code updates, tighter documentation rules, faster prior authorization demands, and expanding telehealth regulations. Claims that used to sail through are now getting kicked back for tiny mistakes.

Even seasoned providers and billers are feeling the strain. So, let’s break down what’s new this year and what you can do to bill smarter.

Fee updates that affect your bottom line

CMS had rolled out new DME reimbursement rates and while some providers see slight increases, these gains are meaningless if you’re not billing accurately.

• Competitive bidding areas: About a 2.9% boost.
• Non-competitive items: Around 2.4% increase (like ostomy, urological supplies).
• Rural areas: Still operating under the “50/50 blend” model, with some category-specific increases.

Pro Tip: Always pull the most recent fee schedule before submitting claims. Old rates + New claims = instant denial.

Code shake-ups you can’t ignore

Some of the most notable new additions? 12 fresh codes for dynamic adjustable elbow extension devices. Meanwhile, certain old chronic care management codes like G0511 are gone for good.

Action Step: Update your billing software and ensure every coder and provider knows the new codes and the ones to avoid.

Prior authorizations – Faster, but stricter

DME is speeding things up in the prior authorization (PA) world:

• Standard PA: Must be processed within 7 days.
• Expedited PA: Just 2 business days.
• Some items (like certain bone growth stimulators) are temporarily off the PA list.
• By Jan 1, 2026, manual PA is out. Electronic Prior Authorization will be mandatory.

Bottom Line: Now is the time to adopt or upgrade to an e-PA system so you’re ready before the crunch.

Impact of recent telehealth updates in DME

The days of saying “we can only prescribe that in person” are fading fast. More DME can now be prescribed and monitored virtually, and more provider types are eligible to prescribe via telehealth.

But documentation expectations are higher than for in-person prescribing.

Tip: Detailed medical necessity documentation is non-negotiable.

Value-based care & remote monitoring

Integrating remote patient monitoring (RPM) into DME billing services can open fresh revenue streams but only if billing is precise and well-documented. CMS is cracking down on overlapping codes between Chronic Care Management (CCM) and RPM.

The audit storm is real

CMS is stepping up oversight, and DME suppliers are squarely in the spotlight. Every payer has their own rules. Medicare, Medicaid, private insurers—they all want different things.

Gaps that trigger denials are:

• Missing or incomplete documentation
• Wrong HCPCS codes or modifiers
• No proof of delivery
• Frequent high-dollar claims without clear justification

Defensive Strategy: Do quarterly internal audits. Keep Detailed Written Orders (DWOs), delivery receipts, signatures, and physician documentation ready to go.

Quick turnaround for DME billing

• Updated codes and fee schedules 
• Move toward electronic prior authorization now
• Audit documentation for every claim
• Tighten telehealth workflows and compliance
• Stay glued to CMS and payer update bulletins

One simple rule: If you wouldn’t feel confident showing a claim file to an auditor tomorrow, fix it today.

Final thoughts

DME billing is about staying three steps ahead. Those who train their teams, embrace tech, and double down on compliance will survive the changes with more profitable outcomes. You signed up to care for people, not to chase down claims all day. Some days, it feels like billing is the whole job. Think about outsourcing. Let billing pros like us from Hamly Business Solutions handle the back-end so you can focus on your patients.

FAQs

1. How urgent is it to switch to electronic prior authorization (e-PA)?

Manual prior authorizations will be phased out by January 1, 2026. Waiting too long could cause costly delays or denials. Start integrating or upgrading to e-PA systems now to keep your claims moving smoothly.

2. What’s changed with telehealth prescribing for DME?

More DME items can be prescribed virtually, and more provider types can participate. But telehealth prescriptions come with stricter documentation requirements.

3. How can I protect my practice from CMS audits?

Regular internal audits are key. Keep all documentation airtight with Detailed Written Orders   (DWOs), delivery confirmations, signatures, and clear physician notes. If your claims aren’t audit-ready, fix them promptly to avoid penalties or payment delays.

4. Should I consider outsourcing my DME billing?

If billing feels like it’s taking over your practice, DME outsourcing to billing experts can save you time. They stay on top of changing rules and technology so you can focus on patient care. At HBS, we have seasoned professionals to handle your DME billing services. Schedule your free online consultation today. Contact: +1 (818)-853-8889 | info@hamlybusinesssolutions.com