- December 23, 2025
- Posted by: Josh Knoll
- Category: DME Billing
The entire DME billing is changing rapidly and 2026 is going to be a vital year of changes for your DME supply business. The new changes will affect how you bill, how much you get reimbursed and how closely CMS monitors your work. Especially when the late-2025 updates like the CY 2026 Home Health Prospective Payment System Final Rule and the return of competitive bidding, are reshaping the way DME billing works. You can expect new rules to be implemented on cost control and for targeting fraud but here your goal should be staying compliant, protecting revenue and avoid denials in 2026. Let’s know more about the potential changes in 2026.
Potential DME billing changes in 2026:
The following are the crucial changes in 2026 that you need to know so that you would be able to stay on top of your billing game.
The return of competitive bidding:
CMS is officially bringing back the DMEPOS Competitive Bidding Program (CBP. You need to remember that it is not a soft relaunch. It is broader, more digital, and more aggressive than before.
Related Reading: Powerful DME Billing Services Possible with The Sunknowledge Edge
New product categories:
You should be ready for the expanded competitive bidding into new, high-growth categories, including:
- Continuous Glucose Monitors
- Insulin Pumps
- Urological and ostomy supplies
If you bill for any of these items, competitive bidding is no longer optional. Winning a bid will directly determine whether you can serve Medicare beneficiaries in those areas.
A new centralized billing mechanism:
CMS is also modernizing the bidding process. Everything is now consolidated into a single secure portal called Connexion Instead of juggling two systems like before, meaning to reduce confusion, but it also means there is less room for error. Supplier enrollment, documentation, and bid submissions must be accurate and timely. One mistake can cost you contract eligibility.
Updated rules for Single Payment Amounts:
SPAs were based on the maximum winning bid but CMS is changing the calculation in 2026. SPAs will now be based on the 75th percentile of winning bids. The goal is to create more predictable and stable reimbursement rates. But for suppliers, this means tighter margins and less flexibility if your cost structure is not under control. This is where strong billing analysis and pricing strategy become critical.
Remote Item Delivery is a new competitive category:
The launch of Remote Item Delivery, or RID, as a new bidding category, is one of the biggest changes. RID covers DME items that are shipped, not delivered in person. These items do not need in-home setup, training, or installation. This includes many supplies, monitoring devices, and certain accessories. Unlike past bidding rounds that were limited to specific areas, RID will roll out nationwide across all states and territories. If you win an RID contract, you must supply these items to patients no matter where they live, as long as the item qualifies for remote delivery. This creates major challenges for billing and operations, especially around shipping, proof of delivery, and keeping documentation consistent.
Annual accreditation is the new normal:
A big change that you must be aware of is the move from three-year accreditation cycle to annual surveys as CMS is doing this tighten oversight and reduce fraud. You need to meet quality standards all the time, not just during the renewal years. It obviously means more costs and pressure for you. Make sure that you are always ready for yearly accreditation, keep policies updated, train staff regularly, and keep documentation audit-ready at all times.
Prior authorization exemptions for some high-performing suppliers:
Not all the changes are restrictive. CMS is rolling out a “Gold Card” style prior authorization exemption for compliant suppliers. If you keep a provisional affirmation rate of 90% or higher during CMS reviews, you may not need prior authorization for certain items. This leads to faster claims, fewer delays, and better cash flow. But the exemption is not permanent. If non-payable claims go above 10%, CMS can take it away. This means your billing must stay accurate, your documentation must stay strong, and your internal audits must stay consistent, because even a short run of bad claims can erase years of good performance.
Medicare advantage is shrinking:
Another major change in 2026 is happening with payers. Medicare Advantage enrollment is declining as large insurers like UnitedHealthcare, Humana, and Aetna exit more than 100 counties each. This is expected to be the first drop in Medicare Advantage enrollment in over 20 years. For you, this may mean fewer MA patients and more patients moving back to Traditional Medicare. It also means changes in authorization and documentation workflows. We all know that Medicare Advantage and Traditional Medicare plans follow different billing regulations and you will face denials and payment delays. The reason is simple here as Medicare Advantage and Traditional Medicare plans follow different guidelines.
New rules for CGMs and Insulin Pumps in 2026
CMS is changing how CGMs and insulin pumps are paid from 2026. These devices will move to a monthly rental model instead of upfront or supply-based billing. The monthly payment will cover the device, all required supplies, and related accessories. You would be allowed to bill up to three months in advances being a contract supplier. It would you improve the overall cash flow but also increase the compliance risk. It is also important to carefully track the monthly rentals, perform eligibility checks, usage verification to avoid any possible billing errors.
Together, these changes make DME billing much harder. You now face competitive bidding pressure, nationwide delivery responsibilities, yearly audits, performance-based exemptions, changing payer mixes, and new rental billing rules. Managing all of this in-house, with limited staff and higher compliance risk, is where many DME providers begin to lose revenue without even noticing it.
The good thing is that you still can avoid all these hassles by hiring a professional DME billing company like SunKnowledge Inc.
Related Reading: DME Billing Updates: How To Bill for DME Claims?
SunKnowledge: Your dependable DME billing partner
The right partner always matters with so many DME billing changes coming in 2026. We bring real experience and deep DME billing expertise here. We help you adjust to the new rules smoothly and stay confident, compliant, and paid as a trusted DME billing company.
We handle DME rentals, HCPCS codes, equipment delivery, verification, and documentation with care. Our DME billing services focus on reducing errors and cutting down claim denials. We help you plan finances, track reimbursement changes, and adjust operations early. We also manage claims, denials, and AR recovery to make the transition smooth. Our team is ready to scale for RID and multi-state operations, and with pricing at just $7 per hour, you can reduce operational costs by up to 80%.