2026 DME Regulatory Roundup: 5 Changes Every Provider Needs to Know

2026 has been one of the busiest regulatory years for DME suppliers in nearly a decade. Competitive bidding is coming back, documentation requirements are expanding, a new enrollment moratorium is in effect, and a long-running reimbursement gap is still unresolved. If you furnish DMEPOS, several of these changes will touch your cash flow, your compliance workload, or both before the year is out.

Here's a plain-English roundup of the five developments that matter most—what changed, when it takes effect, and what to do about it.

1. The CY2026 Fee Schedule Is in Effect

The Medicare DMEPOS fee schedule update took effect for dates of service on or after January 1, 2026. The update factors break down by item type:

• +2.0% for general (non-competitive-bidding) items—a 2.7% CPI-U increase minus a 0.7% productivity adjustment
• ~2.7–2.8% for former competitive bidding items (the rate varies between former competitive bidding areas and non-bid areas)
• +2.7% for lymphedema compression items

Keep in mind these update factors are applied before the standing 2% Medicare sequestration reduction, which still comes off the back end. If you haven't already loaded the new rates into your billing system and confirmed your contracts reflect them, do it now—billing stale rates is a common, avoidable source of denials and underpayments.

2. Competitive Bidding Is Back: "Round 2028"

This is the headline. After a pause that began in December 2023, CMS used its CY2026 Home Health and DMEPOS final rule (CMS-1828-F, released November 28, 2025) to restart the DMEPOS Competitive Bidding Program as Round 2028. There are several big structural changes:

A new nationwide Remote Item Delivery model

Round 2028 introduces a Remote Item Delivery (RID) model. Instead of bidding by local competitive bidding area, contract suppliers in these categories must furnish items to beneficiaries nationwide, regardless of geography. That fundamentally changes the calculus for who can realistically compete.

The product categories—and what's notably excluded

The final rule lists seven bidding categories under the RID model:

• Class II continuous glucose monitors (CGMs) and insulin pumps
• Urological supplies (included for the first time in program history)
• Ostomy supplies (also a first)
• Hydrophilic urinary catheters
• Off-the-shelf back braces
• Off-the-shelf knee braces
• Off-the-shelf upper-extremity braces

Just as important is what's not on the list: oxygen, CPAP, standard wheelchairs and mobility, hospital beds, walkers, and enteral nutrition are all excluded from this round.

New pricing methodology

CMS is changing how the single payment amount (SPA) is calculated. Instead of using the maximum winning bid, the SPA for each lead item will be set at the 75th percentile of winning bids, with an annual CPI-U inflation update applied to multi-year contracts. In practice, that should produce somewhat more sustainable rates than past rounds.

The timeline—and what to do now

CMS has published a target timeline, and issued follow-up guidance on April 2, 2026:

• Late spring/early summer 2026: CMS announces the final product categories, lead items, and the number of contracts per category
• Late summer/early fall 2026: bidder registration and the bid window open
• 2027: contracts awarded and single payment amounts announced
• No later than January 1, 2028: contracts and pricing take effect, with a six-month beneficiary transition period

Suppliers planning to bid will need to budget for a $50,000 bid bond and confirm their accreditation and licensure are airtight well before the window opens. If you furnish CGMs, urological, ostomy, catheters, or off-the-shelf braces, now is the time to start modeling whether you'll bid—and what happens to your patient base if you don't win a contract. Note that CMS retains authority to adjust the categories, so treat the list as final-but-confirmable until the summer announcement lands.

3. Expanded Prior Authorization and Face-to-Face Rules (Effective April 13, 2026)

On January 13, 2026, CMS published a rule updating the DMEPOS Master List, the Face-to-Face/Written-Order-Prior-to-Delivery (F2F/WOPD) list, and the Required Prior Authorization list. The changes took effect April 13, 2026 (MACs began accepting the new prior authorization requests on March 30, 2026).

Eight oxygen codes added to the face-to-face / written-order list

CMS added eight oxygen-related HCPCS codes—E0424, E0431, E0433, E0434, E0439, E1390, E1391, and E1392—to the F2F/WOPD list, citing oxygen's high improper-payment rate (roughly 11.3% in 2024 CERT data). If you furnish oxygen, the face-to-face encounter and a written order must now be documented before delivery for these codes.

Seven codes added to the required prior authorization list

Seven codes now require prior authorization: five orthoses (L0651, L1844, L1846, L1852, L1932) and two pneumatic compression devices (E0651, E0652). CMS cited improper-payment rates ranging from 35% to nearly 79% for these items.

The upside: a new prior authorization exemption

It's not all added burden. The same rulemaking created a prior authorization exemption for suppliers that achieve a 90% or higher affirmation rate on their prior authorization requests—modeled on the existing hospital outpatient department exemption. Hit that threshold and you can be relieved of the prior auth requirement for those items (subject to MAC post-payment review and a 60-day notice if your exemption is withdrawn). In other words, clean documentation now pays off directly in reduced administrative friction.

All of this raises the stakes on documentation discipline. If your face-to-face notes, written orders, and proof of delivery aren't captured cleanly at the point of service, these changes will surface as denials. Our guide on preparing for RAC, UPIC, and MAC audits walks through how to build that discipline into daily operations.

4. A New Enrollment Moratorium on DMEPOS "Medical Supply Companies"

Effective February 27, 2026, CMS imposed a six-month nationwide temporary moratorium on new Medicare enrollment of one specific DMEPOS supplier subtype: "medical supply companies." The moratorium is extendable in six-month increments.

Importantly, it's narrowly targeted. It does not apply to pharmacies, home health agencies, nursing facilities, hospitals, or physician offices whose principal function isn't DMEPOS provision. But if you were planning to enroll a new medical-supply-company location or are acquiring one, this directly affects your expansion timeline. Because it's extendable, check its status before making enrollment-dependent plans—the initial term runs into roughly August 2026.

5. The 75/25 Blended Rate Is Still Unresolved

Finally, the long-running reimbursement question hasn't been answered. The 75/25 blended rate—which provided higher Medicare reimbursement in non-rural, non-competitive-bidding areas—expired at the end of 2023, and standard adjusted rates have applied since.

The DMEPOS Relief Act of 2025 (H.R. 2005), introduced March 10, 2025 with bipartisan sponsorship, would restore that relief. As of mid-2026, the bill has not been enacted—it remains in the legislative process while industry groups continue to push for it. For suppliers in affected areas, that means the reduced rates remain in effect for now. It's worth tracking, but don't build your 2026 budget around relief that hasn't passed.

What This Means for Your Operation

Step back and a theme emerges across all five changes: documentation and data discipline are now the difference between getting paid and getting denied. Expanded prior authorization and face-to-face rules reward suppliers with clean records (and now offer a formal exemption for them). Competitive bidding rewards suppliers who understand their cost structure and can operate at scale. And the fee schedule and reimbursement landscape leave no margin for billing errors.

The suppliers who navigate 2026 well will be the ones whose orders, documentation, delivery records, and billing live in one connected system—so a prior authorization request, an audit response, or a competitive-bid cost analysis is a few clicks away rather than a fire drill. If you're not sure whether your current setup is ready for what's coming, this is the year to find out.

This article is for general informational purposes and reflects developments as of June 15, 2026. Regulatory dates and details—particularly the Round 2028 categories and timeline—are subject to change. Confirm current requirements with CMS, your DME MAC, or qualified counsel before making compliance or business decisions.