2003 Medicare Rates for Ostomy Supplies (updated for 2004)

Note: The table below has been updated with 2004 rates, as of March 17, 2004.

At our February 17 meeting in Stillwater, James Knight of Knight Medical Supply presented current information on Medicare benefits for ostomy supplies. Unfortunately, the product feature "add-on" codes introduced in April 2002 have been rescinded, although new codes have been provided for products with some of those features. The Medicare "fees" (allowables) for many products are lower than at the end of 2002 although, in most cases, still better than they were at the beginning of 2002. James noted that both Hollister and ConvaTec are expected to increase prices soon, which may badly squeeze him and other dealers who wish to continue taking Medicare assignment on ostomy supplies.

The table below, distributed by James at our meeting, lists Medicare fees for all ostomy products. This "fee" is the amount that Medicare considers the reasonable price for each product. This is how much the dealer gets if accepting assignment. Whether or not the dealer accepts assignment, Medicare (Part B) pays 80% of the "fee." If the dealer takes assignment, then the patient (and any supplemental insurance) pay the other 20% of the fee. If the dealer doesn't take assignment, the patient (and supplemental insurance) must make up the entire difference between the amount paid by Medicare and amount charged by the dealer.

These fees are for Oklahoma; some of them differ somewhat in other states. The fees for some products aren't currently available and are listed as zero in the table. For more information about the January 2003 Medicare changes, see the page about this topic on the UOA national site. You may contact James at 405-743-1646 or (if you're outside Stillwater) at 800-267-6531.