The whole world of durable medical equipment (DME) is standing on the verge of change. For years, the competitive bidding program has shaped reimbursement, billing workflows, and supplier participation. Now, as CMS announces new rounds of bidding and broader product-inclusion, the implications for equipment like CPAPs, and upcoming high-tech categories are vast. For DME suppliers, a billing partner, or a practice administrator, understanding this shift is vital for staying a step ahead.
What is the DME Competitive Bidding Program?
The DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) Competitive Bidding Program is administered by CMS.
Suppliers submit their best bids under this program to provide some of the DME products in designated Competitive Bidding Areas (CBAs). The supplier who has won the bid or we can say the chosen ones are then considered under the category of contract-suppliers and reimbursement is set at “Single Payment Amounts” (SPAs) rather than traditional fee schedules.
Historically, categories such as CPAP devices and Respiratory Assist Devices (RADs) were included in earlier bidding rounds. The result, strong downward pressure on reimbursement in bid areas, and subsequent adjustments in non-bid areas. This is the heart of competitive bidding DME.
Why CPAP Matters and What “CPAP Competitive Bidding Impact” Looks Like?
When CPAPs were brought into the bidding program, the ripple effects were significant. For DME suppliers and billing teams, the impact ranged from lower reimbursement rates to tighter supplier eligibility and compressed rental/purchase margins. For instance, an OIG report found that in Round 2, CPAP/RAD supplies saw payment stoppages for 46% of beneficiaries in bidding areas (versus 33% in non-bid areas).
Why does all of this still matter?The competitive bidding may have included CPAP, but the upcoming rounds of bidding will further expand to newer methodologies and categories. The message is clear, if CPAP was impacted, what’s on the horizon may hit even more categories and that means the billing ecosystem must adapt.
What’s New And What’s Coming for 2026?
CMS Hints a Return of Competitive Bidding
The relaunch of DMEPOS competitive bidding program has been confirmed by CMS after a significant pause. In its FY 2026 budget, HHS earmarked $22 million to restart the program. Meanwhile, a proposed rule issued June 30, 2025, lays out structural changes like new methodology for setting SPAs, new product categories (including CGMs, insulin pumps), and a new “Remote Item Delivery” competitive bidding program.
Expanded Scope “Beyond CPAP”
The current proposed rule suggests that this time CMS is going beyond traditional categories and targeting new, technology-intensive DME. For example:
- Urological, tracheostomy, ostomy, and supplies are also under consideration for the bidding program.
- Continuous Glucose Monitors (CGMs) and insulin pumps are proposed for inclusion, reclassified under the “frequent and substantial servicing payment category”.
What does this mean?
Well, in simple words it means that the next round of DMEPOS Competitive Bidding is not just about CPAP anymore. It has spread and is more about high-tech, high-volume, and remote-delivery equipment and supplies. This expansion raises the stakes for suppliers and billing teams alike.
Implications for Reimbursement & Billing Workflows
1. Rental vs Purchase Model Shift
Previous models had an option of CPAP devices to be rented and then owned after a certain period of time. As bidding expands, payment models may shift toward rental-heavy or service-heavy models, especially for technology-driven equipment like CGMs and insulin pumps. Billing teams must revisit contract terms, rental durations,insurance coding workflows, and ownership rules.
2. Payment Pressure & Margin Compression
Since a lot of new devices and supplies are entering bidding areas (or being subject to SPAs in non-bid areas), reimbursement levels are anticipated to come under downward pressure. Prior data shows fee schedules adjusted downward once bidding SPAs are established. For CPAP suppliers, that meant tighter margins, and for new categories, the same may apply.
3. Supplier Eligibility, Accreditation & Contract Supplier Status
Contract-supplier status in CBAs becomes compulsory when items are included in competitive bidding. In any circumstance of the supplier not being properly enrolled, the claims may be denied. The latest proposed rule brings in reaccreditation plus stricter supplier enrollment rules. Hence, the billing teams must confirm supplier status, specifically as vast categories are pulled into the bidding framework.
4. Coding, Documentation & Compliance Risks
Alongside the changes in reimbursement models change, so do coding and documentation requirements. For equipment like CPAPs, RADs, CGMs, or insulin pumps, strict documentation of medical necessity, compliance testing, physician orders, and rental/purchase transition matters. If a device moves into a new bidding category (for example via “competitive bidding DME”), claims may face increased denial risks and audits.
5. Revenue Forecasting & Cash Flow Challenges
Change equals risk.
The transition period, when CMS releases a final rule, public comment concludes, categories are announced creates uncertainty. Billing departments must assume every possible scenario, reimbursement declines of 20-40%? rental periods shortened? supplier network contraction? Historically, bidding rounds have led to a 40% payment reduction in some categories.
What Are the Steps that Suppliers & Billing Partners Should Take Now?
- Audit Your Device & Supplies Catalog
Begin with identifying which items you currently bill that have the maximum chances to be subjected to “competitive bidding DME” in the next round. The items can be CPAP/RADs, CGMs, insulin pumps, urological/ostomy supplies. Tag them for heightened monitoring. - Review Supplier Contracts and Eligibility
Ensure that your suppliers are properly enrolled, accredited, and ready to participate as contract-suppliers if bidding applies. Non-contract status could result in claim denial. - Update Billing Workflows
Adjust rental vs purchase logic, document ownership transitions, ensure HCPCS codes match the new device classifications, check physician orders and compliance timelines especially for CPAP. - Model Revenue & Margin Scenarios
The best tip is to develop forecasts with “what-if” scenarios. Such as, 20-40% reimbursement drop, shorter rental durations, or reduced accessory supply volumes. Understand how that impacts your cash flow, margin, and pricing strategy. - Communicate with Clinical & Procurement Teams
Having good communication is the key! Alert physician practices and procurement staff about upcoming changes for instance, if a device moves into competitive bidding, the supplier network may change, or device options may shift. Active communication prevents patient access issues and billing surprises.
Conclusion
The phrase “CPAP and beyond” isn’t just rhetorical, the shift in competitive bidding is expanding the playing field. When equipment that once seemed stable becomes subject to competitive bidding DME pressures, the ripple effects move fast. Billing teams, suppliers, and partner practices must adapt accordingly not react.
At Med Karma, we focus on helping our clients do exactly that. Monitor upcoming CMS changes, identify device categories at risk like CPAP, CGMs, insulin pumps, audit supplier eligibility, and align billing workflows with what’s coming. Because as the scope of bidding widens, reimbursement certainty becomes less about what you hope for and more about what you prepare for in advance.