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Support Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM 4 Allentown-Bethlehem-Easton, PA-NJ 4 Asheville, NC 5 Atlanta-Sandy Springs-Marietta, GA 5 Augusta-Richmond County, GA-SC 5 Austin-Round Rock-San Marcos, TX 6 Bakersfield-Delano, CA 6 Baltimore-Towson, MD 6 Baton Rouge, LA 6 Beaumont-Port Arthur, TX 7 Birmingham-Hoover, AL 7 Boise City-Nampa, ID 7 Boston-Cambridge-Quincy, MA-NH 8 Bridgeport-Stamford-Norwalk, CT 8 Bronx-Manhattan, NY CBA 8 Buffalo-Niagara Falls, NY 9 Cape Coral-Fort Myers, FL 9 Central-Chicago Metro CBA 9 Charleston-North Charleston-Summerville, SC 9 Chattanooga, TN-GA 10 Colorado Springs, CO 10 Columbia, SC 10 Columbus, OH 11 Dayton, OH 11 Deltona-Daytona Beach-Ormond Beach, FL 11 Denver-Aurora-Broomfield, CO 11 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2 Single Payment Amounts

Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

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Page 1: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

Support Surfaces (Group 2 Mattresses and Overlays)

Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM 4 Allentown-Bethlehem-Easton, PA-NJ 4 Asheville, NC 5 Atlanta-Sandy Springs-Marietta, GA 5 Augusta-Richmond County, GA-SC 5 Austin-Round Rock-San Marcos, TX 6 Bakersfield-Delano, CA 6 Baltimore-Towson, MD 6 Baton Rouge, LA 6 Beaumont-Port Arthur, TX 7 Birmingham-Hoover, AL 7 Boise City-Nampa, ID 7 Boston-Cambridge-Quincy, MA-NH 8 Bridgeport-Stamford-Norwalk, CT 8 Bronx-Manhattan, NY CBA 8 Buffalo-Niagara Falls, NY 9 Cape Coral-Fort Myers, FL 9 Central-Chicago Metro CBA 9 Charleston-North Charleston-Summerville, SC 9 Chattanooga, TN-GA 10 Colorado Springs, CO 10 Columbia, SC 10 Columbus, OH 11 Dayton, OH 11 Deltona-Daytona Beach-Ormond Beach, FL 11 Denver-Aurora-Broomfield, CO 11

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2

Single Payment Amounts

Page 2: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

Detroit-Warren-Livonia, MI 12 El Paso, TX 12 Flint, MI 12 Fresno, CA 13 Grand Rapids-Wyoming, MI 13 Greensboro-High Point, NC 13 Greenville-Mauldin-Easley, SC 14 Hartford-West Hartford-East Hartford, CT 14 Honolulu, HI 14 Houston-Sugar Land-Baytown, TX 14 Huntington-Ashland, WV-KY-OH 15 Indiana-Chicago Metro 15 Indianapolis-Carmel, IN 15 Jackson, MS 16 Jacksonville, FL 16 Knoxville, TN 16 Lakeland-Winter Haven, FL 16 Las Vegas-Paradise, NV 17 Little Rock-North Little Rock-Conway, AR 17 Los Angeles County CBA 17 Louisville/Jefferson County, KY-IN 18 McAllen-Edinburg-Mission, TX 18 Memphis, TN-MS-AR 18 Milwaukee-Waukesha-West Allis, WI 19 Minneapolis-St. Paul-Bloomington, MN-WI 19 Nashville-Davidson--Murfreesboro--Franklin, TN 19 Nassau-Brooklyn-Queens-Richmond County Metro CBA 19 New Haven-Milford, CT 20 New Orleans-Metairie-Kenner, LA 20 North East NY CBA Metro 20 North Port-Bradenton-Sarasota, FL 21 Northern NJ Metro CBA 21 Northern-Chicago Metro CBA 21 Ocala, FL 21 Oklahoma City, OK 22 Omaha-Council Bluffs, NE-IA 22 Orange County CBA 22 Oxnard-Thousand Oaks-Ventura, CA 23

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 2 of 33

Page 3: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

Palm Bay-Melbourne-Titusville, FL 23 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 23 Phoenix-Mesa-Glendale, AZ 24 Portland-Vancouver-Hillsboro, OR-WA 24 Poughkeepsie-Newburgh-Middletown, NY 24 Providence-New Bedford-Fall River, RI-MA 24 Raleigh-Cary, NC 25 Richmond, VA 25 Rochester, NY 25 Sacramento--Arden-Arcade--Roseville, CA 26 Salt Lake City, UT 26 San Antonio-New Braunfels, TX 26 San Diego-Carlsbad-San Marcos, CA 26 San Francisco-Oakland-Fremont, CA 27 San Jose-Sunnyvale-Santa Clara, CA 27 Scranton--Wilkes-Barre, PA 27 Seattle-Tacoma-Bellevue, WA 28 South-West-Chicago-Metro CBA 28 Southern NY Metro CBA 28 Springfield, MA 29 St. Louis, MO-IL 29 Stockton, CA 29 Suffolk County CBA 29 Syracuse, NY 30 Tampa-St. Petersburg-Clearwater, FL 30 Toledo, OH 30 Tucson, AZ 31 Tulsa, OK 31 Virginia Beach-Norfolk-Newport News, VA-NC 31 Visalia-Porterville, CA 31 Washington-Arlington-Alexandria, DC-VA-MD-WV 32 Wichita, KS 32 Worcester, MA 32 Youngstown-Warren-Boardman, OH-PA 33

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 3 of 33

Page 4: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Akron, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $677.50

Akron, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $210.31

Akron, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Akron, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00

Akron, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Albany-Schenectady-Troy, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $724.65

Albany-Schenectady-Troy, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.81

Albany-Schenectady-Troy, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.10

Albany-Schenectady-Troy, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00

Albany-Schenectady-Troy, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $297.71

Albuquerque, NM E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $713.91

Albuquerque, NM E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $217.82

Albuquerque, NM E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Albuquerque, NM E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

Albuquerque, NM E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.59

Allentown-Bethlehem-Easton, PA-NJ E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $652.43

Allentown-Bethlehem-Easton, PA-NJ E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.31

Support Surfaces (Group 2 Mattresses and Overlays)

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 4 of 33

Page 5: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Allentown-Bethlehem-Easton, PA-NJ E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.75

Allentown-Bethlehem-Easton, PA-NJ E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $222.40

Allentown-Bethlehem-Easton, PA-NJ E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Asheville, NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $646.00

Asheville, NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.00

Asheville, NC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45

Asheville, NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.17

Asheville, NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $392.21

Atlanta-Sandy Springs-Marietta, GA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $667.21

Atlanta-Sandy Springs-Marietta, GA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $259.00

Atlanta-Sandy Springs-Marietta, GA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $280.92

Atlanta-Sandy Springs-Marietta, GA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20

Atlanta-Sandy Springs-Marietta, GA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Augusta-Richmond County, GA-SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $667.21

Augusta-Richmond County, GA-SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Augusta-Richmond County, GA-SC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Augusta-Richmond County, GA-SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 5 of 33

Page 6: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Augusta-Richmond County, GA-SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Austin-Round Rock-San Marcos, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $581.91

Austin-Round Rock-San Marcos, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $252.96

Austin-Round Rock-San Marcos, TX E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $238.10

Austin-Round Rock-San Marcos, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $208.10

Austin-Round Rock-San Marcos, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.00

Bakersfield-Delano, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $759.80

Bakersfield-Delano, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.12

Bakersfield-Delano, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45

Bakersfield-Delano, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $232.11

Bakersfield-Delano, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Baltimore-Towson, MD E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $618.50

Baltimore-Towson, MD E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $293.07

Baltimore-Towson, MD E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $255.40

Baltimore-Towson, MD E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.56

Baltimore-Towson, MD E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $318.10

Baton Rouge, LA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $675.40

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 6 of 33

Page 7: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Baton Rouge, LA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50

Baton Rouge, LA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $266.77

Baton Rouge, LA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $237.35

Baton Rouge, LA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $370.83

Beaumont-Port Arthur, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $671.77

Beaumont-Port Arthur, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Beaumont-Port Arthur, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Beaumont-Port Arthur, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $220.00

Beaumont-Port Arthur, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Birmingham-Hoover, AL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $675.40

Birmingham-Hoover, AL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50

Birmingham-Hoover, AL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $319.80

Birmingham-Hoover, AL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Birmingham-Hoover, AL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $443.10

Boise City-Nampa, ID E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $687.50

Boise City-Nampa, ID E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.81

Boise City-Nampa, ID E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 7 of 33

Page 8: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Boise City-Nampa, ID E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Boise City-Nampa, ID E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Boston-Cambridge-Quincy, MA-NH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81

Boston-Cambridge-Quincy, MA-NH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.90

Boston-Cambridge-Quincy, MA-NH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Boston-Cambridge-Quincy, MA-NH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.95

Boston-Cambridge-Quincy, MA-NH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18

Bridgeport-Stamford-Norwalk, CT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81

Bridgeport-Stamford-Norwalk, CT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.90

Bridgeport-Stamford-Norwalk, CT E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Bridgeport-Stamford-Norwalk, CT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.95

Bridgeport-Stamford-Norwalk, CT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18

Bronx-Manhattan NY CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $520.92

Bronx-Manhattan NY CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $194.81

Bronx-Manhattan NY CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $194.23

Bronx-Manhattan NY CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $182.07

Bronx-Manhattan NY CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $276.16

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 8 of 33

Page 9: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Buffalo-Niagara Falls, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $600.00

Buffalo-Niagara Falls, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.17

Buffalo-Niagara Falls, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.60

Buffalo-Niagara Falls, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Buffalo-Niagara Falls, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.00

Cape Coral-Fort Myers, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $550.09

Cape Coral-Fort Myers, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $191.91

Cape Coral-Fort Myers, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.10

Cape Coral-Fort Myers, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $169.96

Cape Coral-Fort Myers, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $196.72

Central-Chicago Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $559.41

Central-Chicago Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $301.19

Central-Chicago Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.56

Central-Chicago Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Central-Chicago Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18

Charleston-North Charleston-Summerville, SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $591.91

Charleston-North Charleston-Summerville, SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $244.50

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 9 of 33

Page 10: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Charleston-North Charleston-Summerville, SC E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Charleston-North Charleston-Summerville, SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $235.37

Charleston-North Charleston-Summerville, SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.55

Chattanooga, TN-GA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Chattanooga, TN-GA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50

Chattanooga, TN-GA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Chattanooga, TN-GA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Chattanooga, TN-GA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $332.86

Colorado Springs, CO E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $698.50

Colorado Springs, CO E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $287.78

Colorado Springs, CO E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Colorado Springs, CO E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Colorado Springs, CO E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Columbia, SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $620.00

Columbia, SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $259.00

Columbia, SC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Columbia, SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 10 of 33

Page 11: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Columbia, SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Columbus, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $596.91

Columbus, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $197.31

Columbus, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.67

Columbus, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00

Columbus, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $297.71

Dayton, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $671.91

Dayton, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.13

Dayton, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $258.45

Dayton, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.47

Dayton, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.39

Deltona-Daytona Beach-Ormond Beach, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18

Deltona-Daytona Beach-Ormond Beach, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.53

Deltona-Daytona Beach-Ormond Beach, FL E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $264.35

Deltona-Daytona Beach-Ormond Beach, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $174.98

Deltona-Daytona Beach-Ormond Beach, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43

Denver-Aurora-Broomfield, CO E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $672.00

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 11 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Denver-Aurora-Broomfield, CO E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $303.80

Denver-Aurora-Broomfield, CO E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Denver-Aurora-Broomfield, CO E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20

Denver-Aurora-Broomfield, CO E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.74

Detroit-Warren-Livonia, MI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $627.31

Detroit-Warren-Livonia, MI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.91

Detroit-Warren-Livonia, MI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Detroit-Warren-Livonia, MI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $231.00

Detroit-Warren-Livonia, MI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

El Paso, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $678.93

El Paso, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

El Paso, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

El Paso, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.95

El Paso, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18

Flint, MI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Flint, MI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Flint, MI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 12 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Flint, MI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Flint, MI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $328.20

Fresno, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $759.80

Fresno, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $181.91

Fresno, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $280.00

Fresno, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $244.68

Fresno, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $345.49

Grand Rapids-Wyoming, MI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $738.88

Grand Rapids-Wyoming, MI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $227.50

Grand Rapids-Wyoming, MI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Grand Rapids-Wyoming, MI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

Grand Rapids-Wyoming, MI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $316.81

Greensboro-High Point, NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $699.50

Greensboro-High Point, NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Greensboro-High Point, NC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Greensboro-High Point, NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Greensboro-High Point, NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 13 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Greenville-Mauldin-Easley, SC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $696.10

Greenville-Mauldin-Easley, SC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.50

Greenville-Mauldin-Easley, SC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45

Greenville-Mauldin-Easley, SC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83

Greenville-Mauldin-Easley, SC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Hartford-West Hartford-East Hartford, CT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.00

Hartford-West Hartford-East Hartford, CT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $268.90

Hartford-West Hartford-East Hartford, CT E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Hartford-West Hartford-East Hartford, CT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20

Hartford-West Hartford-East Hartford, CT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $300.00

Honolulu, HI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $713.94

Honolulu, HI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $320.00

Honolulu, HI E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Honolulu, HI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Honolulu, HI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $430.62

Houston-Sugar Land-Baytown, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $620.00

Houston-Sugar Land-Baytown, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $251.38

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 14 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Houston-Sugar Land-Baytown, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Houston-Sugar Land-Baytown, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $202.50

Houston-Sugar Land-Baytown, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $282.50

Huntington-Ashland, WV-KY-OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81

Huntington-Ashland, WV-KY-OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $227.50

Huntington-Ashland, WV-KY-OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Huntington-Ashland, WV-KY-OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

Huntington-Ashland, WV-KY-OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $298.30

Indiana-Chicago Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $627.31

Indiana-Chicago Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Indiana-Chicago Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Indiana-Chicago Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Indiana-Chicago Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Indianapolis-Carmel, IN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Indianapolis-Carmel, IN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.63

Indianapolis-Carmel, IN E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Indianapolis-Carmel, IN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $248.93

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 15 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Indianapolis-Carmel, IN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Jackson, MS E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $688.10

Jackson, MS E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $264.90

Jackson, MS E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $290.00

Jackson, MS E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Jackson, MS E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $435.30

Jacksonville, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18

Jacksonville, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Jacksonville, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Jacksonville, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $180.00

Jacksonville, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $223.95

Knoxville, TN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $640.00

Knoxville, TN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50

Knoxville, TN E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Knoxville, TN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $234.36

Knoxville, TN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18

Lakeland-Winter Haven, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $555.09

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 16 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Lakeland-Winter Haven, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $224.53

Lakeland-Winter Haven, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $264.48

Lakeland-Winter Haven, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $174.53

Lakeland-Winter Haven, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $198.57

Las Vegas-Paradise, NV E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $624.43

Las Vegas-Paradise, NV E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $293.22

Las Vegas-Paradise, NV E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Las Vegas-Paradise, NV E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.64

Las Vegas-Paradise, NV E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $345.49

Little Rock-North Little Rock-Conway, AR E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $674.25

Little Rock-North Little Rock-Conway, AR E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $256.25

Little Rock-North Little Rock-Conway, AR E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Little Rock-North Little Rock-Conway, AR E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83

Little Rock-North Little Rock-Conway, AR E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $331.26

Los Angeles County CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $595.56

Los Angeles County CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $174.60

Los Angeles County CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $272.20

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 17 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Los Angeles County CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $234.61

Los Angeles County CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $317.71

Louisville/Jefferson County, KY-IN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $571.91

Louisville/Jefferson County, KY-IN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $210.31

Louisville/Jefferson County, KY-IN E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.60

Louisville/Jefferson County, KY-IN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00

Louisville/Jefferson County, KY-IN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $298.30

McAllen-Edinburg-Mission, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $685.86

McAllen-Edinburg-Mission, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $303.80

McAllen-Edinburg-Mission, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

McAllen-Edinburg-Mission, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

McAllen-Edinburg-Mission, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Memphis, TN-MS-AR E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Memphis, TN-MS-AR E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $312.60

Memphis, TN-MS-AR E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $290.00

Memphis, TN-MS-AR E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.46

Memphis, TN-MS-AR E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $378.53

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 18 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Milwaukee-Waukesha-West Allis, WI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $711.75

Milwaukee-Waukesha-West Allis, WI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $261.53

Milwaukee-Waukesha-West Allis, WI E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Milwaukee-Waukesha-West Allis, WI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $272.30

Milwaukee-Waukesha-West Allis, WI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Minneapolis-St. Paul-Bloomington, MN-WI E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Minneapolis-St. Paul-Bloomington, MN-WI E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.63

Minneapolis-St. Paul-Bloomington, MN-WI E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Minneapolis-St. Paul-Bloomington, MN-WI E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Minneapolis-St. Paul-Bloomington, MN-WI E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Nashville-Davidson--Murfreesboro--Franklin, TN E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $720.00

Nashville-Davidson--Murfreesboro--Franklin, TN E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $247.49

Nashville-Davidson--Murfreesboro--Franklin, TN E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Nashville-Davidson--Murfreesboro--Franklin, TN E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Nashville-Davidson--Murfreesboro--Franklin, TN E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Nassau-Brooklyn-Queens-Richmond County Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $572.13

Nassau-Brooklyn-Queens-Richmond County Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $226.90

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 19 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Nassau-Brooklyn-Queens-Richmond County Metro CBA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $235.65

Nassau-Brooklyn-Queens-Richmond County Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $198.75

Nassau-Brooklyn-Queens-Richmond County Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $276.16

New Haven-Milford, CT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81

New Haven-Milford, CT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $280.98

New Haven-Milford, CT E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

New Haven-Milford, CT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.57

New Haven-Milford, CT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $291.18

New Orleans-Metairie-Kenner, LA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $650.00

New Orleans-Metairie-Kenner, LA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.50

New Orleans-Metairie-Kenner, LA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

New Orleans-Metairie-Kenner, LA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

New Orleans-Metairie-Kenner, LA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

North East NY CBA Metro E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $501.85

North East NY CBA Metro E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $194.62

North East NY CBA Metro E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

North East NY CBA Metro E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.15

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 20 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

North East NY CBA Metro E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.00

North Port-Bradenton-Sarasota, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18

North Port-Bradenton-Sarasota, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.83

North Port-Bradenton-Sarasota, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.77

North Port-Bradenton-Sarasota, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.96

North Port-Bradenton-Sarasota, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43

Northern NJ Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $515.13

Northern NJ Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.13

Northern NJ Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $231.60

Northern NJ Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $200.00

Northern NJ Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $273.73

Northern-Chicago Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $563.81

Northern-Chicago Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $281.26

Northern-Chicago Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Northern-Chicago Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.20

Northern-Chicago Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Ocala, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $560.18

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 21 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Ocala, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.83

Ocala, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.77

Ocala, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.96

Ocala, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43

Oklahoma City, OK E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $670.42

Oklahoma City, OK E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $255.05

Oklahoma City, OK E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Oklahoma City, OK E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Oklahoma City, OK E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $302.71

Omaha-Council Bluffs, NE-IA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $620.00

Omaha-Council Bluffs, NE-IA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $195.63

Omaha-Council Bluffs, NE-IA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Omaha-Council Bluffs, NE-IA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $220.00

Omaha-Council Bluffs, NE-IA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Orange County CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $585.49

Orange County CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $124.70

Orange County CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $274.40

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 22 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Orange County CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Orange County CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $349.66

Oxnard-Thousand Oaks-Ventura, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $595.56

Oxnard-Thousand Oaks-Ventura, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $147.70

Oxnard-Thousand Oaks-Ventura, CA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $258.45

Oxnard-Thousand Oaks-Ventura, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.96

Oxnard-Thousand Oaks-Ventura, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Palm Bay-Melbourne-Titusville, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $481.78

Palm Bay-Melbourne-Titusville, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $208.16

Palm Bay-Melbourne-Titusville, FL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.77

Palm Bay-Melbourne-Titusville, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $169.96

Palm Bay-Melbourne-Titusville, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $193.34

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $700.00

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $265.00

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $234.27

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 23 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Phoenix-Mesa-Glendale, AZ E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $711.75

Phoenix-Mesa-Glendale, AZ E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $227.50

Phoenix-Mesa-Glendale, AZ E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $245.50

Phoenix-Mesa-Glendale, AZ E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Phoenix-Mesa-Glendale, AZ E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.59

Portland-Vancouver-Hillsboro, OR-WA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $712.50

Portland-Vancouver-Hillsboro, OR-WA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $311.09

Portland-Vancouver-Hillsboro, OR-WA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.10

Portland-Vancouver-Hillsboro, OR-WA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.31

Portland-Vancouver-Hillsboro, OR-WA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $380.26

Poughkeepsie-Newburgh-Middletown, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $575.92

Poughkeepsie-Newburgh-Middletown, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $167.51

Poughkeepsie-Newburgh-Middletown, NY E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Poughkeepsie-Newburgh-Middletown, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $211.25

Poughkeepsie-Newburgh-Middletown, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $297.71

Providence-New Bedford-Fall River, RI-MA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $687.15

Providence-New Bedford-Fall River, RI-MA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $233.01

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 24 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Providence-New Bedford-Fall River, RI-MA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45

Providence-New Bedford-Fall River, RI-MA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $233.10

Providence-New Bedford-Fall River, RI-MA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.50

Raleigh-Cary, NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $606.00

Raleigh-Cary, NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $246.25

Raleigh-Cary, NC E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Raleigh-Cary, NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

Raleigh-Cary, NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.58

Richmond, VA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Richmond, VA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00

Richmond, VA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $290.00

Richmond, VA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Richmond, VA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Rochester, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $674.25

Rochester, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $262.98

Rochester, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Rochester, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.45

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 25 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Rochester, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $332.31

Sacramento--Arden-Arcade--Roseville, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $642.50

Sacramento--Arden-Arcade--Roseville, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $208.56

Sacramento--Arden-Arcade--Roseville, CA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Sacramento--Arden-Arcade--Roseville, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00

Sacramento--Arden-Arcade--Roseville, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Salt Lake City, UT E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $631.16

Salt Lake City, UT E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $255.00

Salt Lake City, UT E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.45

Salt Lake City, UT E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $243.08

Salt Lake City, UT E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $367.50

San Antonio-New Braunfels, TX E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $610.00

San Antonio-New Braunfels, TX E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $252.96

San Antonio-New Braunfels, TX E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $238.10

San Antonio-New Braunfels, TX E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $211.25

San Antonio-New Braunfels, TX E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $285.10

San Diego-Carlsbad-San Marcos, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $595.07

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 26 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

San Diego-Carlsbad-San Marcos, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $181.91

San Diego-Carlsbad-San Marcos, CA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $282.20

San Diego-Carlsbad-San Marcos, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $237.35

San Diego-Carlsbad-San Marcos, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $335.66

San Francisco-Oakland-Fremont, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $784.14

San Francisco-Oakland-Fremont, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $245.00

San Francisco-Oakland-Fremont, CA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

San Francisco-Oakland-Fremont, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83

San Francisco-Oakland-Fremont, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

San Jose-Sunnyvale-Santa Clara, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $707.18

San Jose-Sunnyvale-Santa Clara, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $253.74

San Jose-Sunnyvale-Santa Clara, CA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

San Jose-Sunnyvale-Santa Clara, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

San Jose-Sunnyvale-Santa Clara, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $298.30

Scranton--Wilkes-Barre, PA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $724.65

Scranton--Wilkes-Barre, PA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $210.31

Scranton--Wilkes-Barre, PA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.75

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 27 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Scranton--Wilkes-Barre, PA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.40

Scranton--Wilkes-Barre, PA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $323.37

Seattle-Tacoma-Bellevue, WA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $683.81

Seattle-Tacoma-Bellevue, WA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $311.78

Seattle-Tacoma-Bellevue, WA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $268.10

Seattle-Tacoma-Bellevue, WA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $265.00

Seattle-Tacoma-Bellevue, WA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $384.95

South-West-Chicago-Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $518.70

South-West-Chicago-Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00

South-West-Chicago-Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

South-West-Chicago-Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

South-West-Chicago-Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

Southern NY Metro CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $515.13

Southern NY Metro CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.15

Southern NY Metro CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $196.93

Southern NY Metro CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $202.50

Southern NY Metro CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $273.73

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 28 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Springfield, MA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $650.00

Springfield, MA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00

Springfield, MA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

Springfield, MA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $224.90

Springfield, MA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.42

St. Louis, MO-IL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $650.00

St. Louis, MO-IL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $293.07

St. Louis, MO-IL E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.20

St. Louis, MO-IL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

St. Louis, MO-IL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Stockton, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $794.59

Stockton, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Stockton, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Stockton, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Stockton, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Suffolk County CBA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $520.92

Suffolk County CBA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $177.31

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 29 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Suffolk County CBA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $192.23

Suffolk County CBA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $190.82

Suffolk County CBA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $280.89

Syracuse, NY E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $724.65

Syracuse, NY E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $212.81

Syracuse, NY E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $248.45

Syracuse, NY E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $239.83

Syracuse, NY E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $315.66

Tampa-St. Petersburg-Clearwater, FL E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $550.00

Tampa-St. Petersburg-Clearwater, FL E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.23

Tampa-St. Petersburg-Clearwater, FL E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.00

Tampa-St. Petersburg-Clearwater, FL E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $179.96

Tampa-St. Petersburg-Clearwater, FL E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $203.43

Toledo, OH E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $644.41

Toledo, OH E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $197.76

Toledo, OH E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Toledo, OH E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 30 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Toledo, OH E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $302.71

Tucson, AZ E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $732.79

Tucson, AZ E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $223.25

Tucson, AZ E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $240.05

Tucson, AZ E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $222.48

Tucson, AZ E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $290.59

Tulsa, OK E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $712.28

Tulsa, OK E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $237.50

Tulsa, OK E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Tulsa, OK E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $227.48

Tulsa, OK E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $316.25

Virginia Beach-Norfolk-Newport News, VA-NC E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $712.50

Virginia Beach-Norfolk-Newport News, VA-NC E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $264.75

Virginia Beach-Norfolk-Newport News, VA-NC E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $295.00

Virginia Beach-Norfolk-Newport News, VA-NC E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Virginia Beach-Norfolk-Newport News, VA-NC E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $335.66

Visalia-Porterville, CA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $794.59

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 31 of 33

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CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Visalia-Porterville, CA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $169.20

Visalia-Porterville, CA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $270.00

Visalia-Porterville, CA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $249.66

Visalia-Porterville, CA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Washington-Arlington-Alexandria, DC-VA-MD-WV E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $621.00

Washington-Arlington-Alexandria, DC-VA-MD-WV E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $277.78

Washington-Arlington-Alexandria, DC-VA-MD-WV E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

Washington-Arlington-Alexandria, DC-VA-MD-WV E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $236.11

Washington-Arlington-Alexandria, DC-VA-MD-WV E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.81

Wichita, KS E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $725.00

Wichita, KS E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $230.00

Wichita, KS E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Wichita, KS E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $230.00

Wichita, KS E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

Worcester, MA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $687.15

Worcester, MA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $209.81

Worcester, MA E0371NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.55

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 32 of 33

Page 33: Support Surfaces (Group 2 Mattresses and Overlays)File/R2_SPA_Support.pdfSupport Surfaces (Group 2 Mattresses and Overlays) Akron, OH 4 Albany-Schenectady-Troy, NY 4 Albuquerque, NM

CBA NameHCPCSCode HCPCS Code Description Modifier 1 Modifier 2 Modifier 3 SPA

Support Surfaces (Group 2 Mattresses and Overlays)

Worcester, MA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $225.00

Worcester, MA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $305.55

Youngstown-Warren-Boardman, OH-PA E0193 POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY) RR $695.89

Youngstown-Warren-Boardman, OH-PA E0277 POWERED PRESSURE-REDUCING AIR MATTRESS RR $225.00

Youngstown-Warren-Boardman, OH-PA E0371

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $246.89

Youngstown-Warren-Boardman, OH-PA E0372 POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH RR $248.93

Youngstown-Warren-Boardman, OH-PA E0373 NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS RR $341.32

DMEPOS Competitive Bidding Program Round 2 SPA - Effective July 01, 2013 Page 33 of 33