Comment on CMS-2026-2377-0002

I'm a DME and would like to make a comment about CMS's absolutely ridiculous reimbursment policy fo a Nebulizer (E0570). IT has to be billed as a rental and not a purchse. How stupid is that? In 20+ years in the DME industry this is the single most ignorant rule I've seen. Here's a summary... Recommendation: Reclassify HCPCS E0570 Nebulizer Compressor from Monthly Rental to Purchase (NU) Summary The current Medicare reimbursement methodology for HCPCS E0570 (nebulizer with compressor) creates unnecessary administrative burden, increases supplier costs, delays supplier reimbursement, creates patient confusion, and generates avoidable claims volume for Medicare. Transitioning E0570 from a capped rental item to a one-time purchase would better align reimbursement with the actual delivery model, improve supplier participation, reduce administrative waste, and maintain appropriate Medicare spending controls. 1. Administrative Cost Exceeds the Value of the Monthly Claim Under the current rental structure, suppliers must: •Create and submit up to 13 separate monthly claims for one low-cost device •Track rental months and modifiers (KH, KI, KJ) •Monitor continued eligibility •Manage denials and rework •Post multiple small payments •Maintain open accounts receivable for over a year For a reimbursement amount of approximately $5–$8 per month, the administrative expense associated with billing, posting, follow-up, and compliance often approaches or exceeds the actual reimbursement value. A single nebulizer encounter can require: •13 claims submissions •13 remittance postings •13 opportunities for denial •13 months of AR management This creates inefficiency without improving patient care. 2. Financial Sustainability Concerns for DMEPOS Suppliers The current model requires suppliers to absorb nearly all costs upfront. Supplier expenses occur immediately: •Purchase of nebulizer inventory •Warehouse operations •Shipping expenses •Staff labor •Accreditation expenses •Intake and documentation review •Patient education •Customer support However, reimbursement is spread over approximately one year. This creates a negative cash-flow model where suppliers finance Medicare beneficiaries' equipment. For low-cost DME, delayed reimbursement discourages supplier participation, especially as labor, shipping, technology, and compliance costs continue increasing. 3. Nebulizers Are Functionally Purchased Equipment — Not Rental Equipment The original purpose of rental reimbursement was designed around expensive DME requiring: •Retrieval •Refurbishment •Reassignment •Maintenance •Ongoing supplier management A modern E0570 nebulizer does not operate this way. In practice: •The patient receives a new device •The device remains in the patient's home •The device is not economically retrieved and redeployed •Ownership transfer after rental completion is simply an administrative event The current policy treats a low-cost personal respiratory device like high-cost reusable medical equipment. 4. Medicare Administrative Efficiency Moving E0570 to purchase reimbursement would also benefit Medicare and its contractors. Current state: •1 patient = up to 13 claims •Purchase model: •1 patient = 1 claim Potential benefits: •Reduced claims processing volume •Fewer unnecessary denials/reopenings •Less MAC workload •Reduced supplier inquiries •Lower administrative costs The payment methodology itself creates avoidable system utilization. 5. Compliance and Program Integrity Benefits A purchase model would simplify compliance oversight. The current rental methodology introduces unnecessary failure points: •Incorrect rental modifiers •Rental month tracking errors •Breaks in billing sequence •Confusion around ownership transfer A one-time purchase model creates a cleaner audit trail: Prescription → Medical Necessity → Delivery → Claim