// DME Supplier Account

Valley Medical Supply Co. DME SUPPLIER

HCPCS rate intelligence · Allowed amount variance by payer and product line

Illustrative example

☑

Founder's Promise applies to DME suppliers.

If your paid DME Audit does not identify at least $10,000/mo in documented reimbursement opportunity across your HCPCS and payer panel, we refund your fee. Actual recovery depends on payer response, contract terms, and negotiation outcome.

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Total Documented Opportunity

$8,200

per month across all payers

illustrative example

HCPCS Codes Monitored

active product codes

illustrative example

Payers Analyzed

commercial payer contracts

illustrative example

Confidence Coverage

7 / 12

codes at High Confidence

illustrative example

ⓘ

Competitive Bidding Area (CBA)

CBA pricing applies in select markets and overrides standard fee schedule rates for many HCPCS codes. Review your CBA designation before submitting rate appeals for oxygen, standard power wheelchairs, and CPAP. Rates shown reflect non-CBA indexed contracts unless otherwise noted.

⚠

Prior Authorization Burden

High prior auth burden codes (E1399, L0650, K0001) may constrain billing volume independent of contracted rate. Factor prior auth approval rates into your opportunity estimates before initiating renegotiation.

// Top HCPCS Allowed Amount Gaps

Allowed amount gap = your indexed contracted rate vs. peer-50 benchmark from federal TiC filings. Monthly impact = gap x monthly unit volume. All figures illustrative example.

HCPCS

Description

Allowed (You)

Benchmark P50

Gap

Payer

Mo. Units

Mo. Impact

Confidence

Data Basis

E0601

CPAP Device

$248.00

$312.40

-$64.40

Aetna

40 units

-$2,576/mo

High

Exact TiC Rate

E1399

Custom Power Chair

$1,840.00

$2,210.00

-$370.00

Blue Shield

4 units

-$1,480/mo

Moderate

Benchmark Est.

A4253

Blood Glucose Monitor Strips

$24.80

$31.20

-$6.40

Cigna

180 units

-$1,152/mo

High

Exact TiC Rate

L0650

TLSO Brace

$890.00

$1,040.00

-$150.00

UHC

8 units

-$1,200/mo

Moderate

Benchmark Est.

K0001

Standard Wheelchair

$142.00

$168.00

-$26.00

Anthem

12 units

-$312/mo

Low Confidence

Thin Sample

A6216

Wound Dressing

$8.40

N/A

Unavailable

Cigna

200 units

—

Unavailable

—

Confidence: High Exact TiC rate on file for this payer + HCPCS combination Moderate Benchmark estimate from peer cohort, limited direct matches Low Confidence Thin TiC sample, treat with caution Unavailable Insufficient public data to compute benchmark

// Allowed Amount Variance by Payer illustrative example

Your allowed amount vs. peer-50 benchmark. Bar width represents allowed amount as a proportion of benchmark maximum across these four payers.

Allowed Amount Comparison — Top 4 Payers vs. Peer-50 Benchmark

Aetna

You: $248 Benchmark: $312 -20.6%

Your allowed amount Peer-50 benchmark

Blue Shield

You: $1,840 Benchmark: $2,210 -16.7%

Your allowed amount Peer-50 benchmark

Cigna

You: $24.80 Benchmark: $31.20 -20.5%

Your allowed amount Peer-50 benchmark

UHC (UnitedHealthcare)

You: $890 Benchmark: $1,040 -14.4%

Your allowed amount Peer-50 benchmark

// Recommended Next Steps illustrative example

Review E0601 CPAP allowed amount with Aetna

E0601 $2,576/mo opportunity Aetna High Confidence

Exact TiC rate on file. Aetna is paying you $64.40 below the peer-50 benchmark per unit. At 40 units per month, this is your highest-confidence single-code opportunity.

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Request prior auth exemption review for high-burden codes

E1399 L0650 K0001

Prior auth burden on power mobility and orthotics can suppress your effective volume. Confirm approval rates before initiating rate negotiation to avoid overstating recoverable opportunity.

Review

Generate payer-ready leverage memo for top 3 HCPCS codes

E0601 A4253 L0650 Aetna · Cigna · UHC

A combined memo covering E0601, A4253, and L0650 across three payers captures an estimated $4,928/mo in documented opportunity using exact TiC and benchmark data.

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// Product Categories

Respiratory Equipment

E0601 E0470

Mobility

K0001 E1399 L0650

Diabetes Supplies

A4253 A4258

Wound Care

A6216 A6219

Orthotics / Prosthetics

L0650 L3960

Legend

CODE Gap identified

CODE No gap / no data

// Take Action

Turn your HCPCS gap data into payer-ready leverage.

Your rate intelligence is indexed. The next step is converting documented allowed amount gaps into formal counteroffer memos backed by federal TiC data. A full DME portfolio audit covers your HCPCS codes, payer panel, locations, and commercial contract exposure with the Founder's Promise: $10,000/mo in documented opportunity or we refund your fee.
All figures above are illustrative examples.

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