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Workers Comp Unwrapped Episode 504: Getting Paid for DME in 2026, What the New Medicare Q2 Fee Alignment Means for Your WC Billing
Description
The DWC's April 1, 2026 DMEPOS update didn't grab headlines the way the UR overhaul did — but for any provider billing durable medical equipment, prosthetics, orthotics, or supplies in a California WC claim, it changes real numbers on real invoices. In this episode, Aneeq and Angela break down how the DWC's fee schedule adjustment order adopts the Medicare Q2 2026 DMEPOS update, what the 120%-of-Medicare formula actually means at the line-item level, the rural-versus-non-rural zip code split that quietly changes reimbursement math, and where billing teams are most likely to leave money on the table — or get flagged for overbilling — if they don't rebuild their fee tables on time.
The conversation explores:
- Why DME billing gets a fresh fee schedule every quarter, and why April is the one people miss
- The 120%-of-Medicare formula, and what "CA (NR)" and "CA (R)" actually mean on the file
- What happens when a patient's zip code is misclassified between rural and non-rural
- Why last quarter's fee table is the single most common cause of underpayment disputes
- What changed between the January 2026 update and the April Q2 update, and why both matter
- The IBR risk hiding in a stale fee table
- A practical rebuild checklist for billing teams before the next quarterly cycle
Key takeaway: This isn't a headline regulation — it's a quiet, recurring one, which is exactly why it causes so much silent underpayment. Providers who don't automate their fee table refresh are running April's claims against January's numbers, and neither side of that transaction — provider or payer — is likely to catch it without a deliberate audit.
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