CMS has implemented payment adjustments for hospitals in relation to NIOSH-approved surgical N95 respirators, as per the OPPS & IPPS policy. Biweekly interim lump-sum payments will be provided based on the estimated difference in the reasonable cost incurred by the hospital for domestic NIOSH-approved surgical N95 respirators purchased during the cost reporting period compared to other NIOSH-approved surgical N95 respirators purchased during the same period.

These payment adjustments are applicable for cost reporting periods beginning on or after January 1, 2023. MACs will determine the interim lump-sum biweekly payment amount based on information submitted by the hospital, reflecting the cost differential that will be included on the N95 supplemental cost reporting form.

To request these biweekly interim lump-sum payments, any IPPS and/or OPPS provider that has purchased domestic NIOSH-approved surgical N95 respirators can do so as provided under 42 CFR 413.64 and 42 CFR 412.116(c). The provider must submit a similar type worksheet/form with supporting documentation to their MAC if they elect to get interim payments.

In order for the domestic NIOSH-approved surgical N95 respirators purchased during a cost reporting period to be reimbursable by Medicare, it must be wholly made in the United States as per the Berry Amendment. The IPPS and OPPS payment adjustment amounts will be calculated using the new supplemental worksheet added into the hospital cost reporting form and other collected information. CMS has also indicated that a hospital may rely on a written statement from the manufacturer stating that the NIOSH-approved surgical N95 respirator is domestic.

Payment Adjustments for Domestic N95 RESPIRATOR OVERVIEW CMS Hospitals Payor Mix by Hospital