Cigna Medical Devices & DME
Compare Cigna's contracted rates for medical devices & dme services against national averages and other major payers. Use these benchmarks to identify underpaid codes, prepare for contract renegotiations, and validate your reimbursement strategy.
Cigna's commercial rates often follow a percentage-of-Medicare structure, with year-over-year adjustments tied to RBRVS updates and network-specific reimbursement multipliers.
Introduction
Durable medical equipment (DME) reimbursement is governed by HCPCS Level II codes and is subject to the Medicare DMEPOS Competitive Bidding Program, which has significantly reduced reimbursement rates in many product categories. Commercial payer rates for DME are often benchmarked against Medicare fee schedules but negotiated independently, creating wide variation.
DME products span respiratory equipment, orthopedic supports, mobility devices, wound care supplies, and diabetes management systems. Understanding payer-specific reimbursement by product category is critical for DME suppliers, hospital supply chain departments, and home health agencies that bill for equipment provided to patients.
Respiratory Equipment
PAP Devices & Respiratory Support
CPAP, BiPAP, nebulizers, and oxygen delivery systems. Respiratory DME is one of the highest-volume equipment categories with significant per-unit reimbursement variation between rental and purchase models.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| E0601 | Continuous positive airway pressure (CPAP) device | 0292 | DME - rental | $803.54 |
| E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) | 0292 | DME - rental | $1,572.40 |
| E0570 | Nebulizer, with compressor | 0292 | DME - rental | $86.80 |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 0292 | DME - rental | $960.36 |
Orthopedic Devices
Braces & Orthoses
Prefabricated and custom orthopedic supports for knee, ankle, wrist, lumbar, and cervical conditions. Orthotic reimbursement is tiered by whether the device is prefabricated or custom-fabricated, with custom devices carrying significantly higher rates.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| L1833 | Knee orthosis (KO), adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf | 0274 | Prosthetic/orthotic devices | $605.92 |
| L1906 | Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf | 0274 | Prosthetic/orthotic devices | $159.46 |
| L3908 | Wrist hand orthosis (WHO), wrist extension control cock-up, non molded, prefabricated, off-the-shelf | 0274 | Prosthetic/orthotic devices | $93.18 |
| L0650 | Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | 0274 | Prosthetic/orthotic devices | $1,087.47 |
Mobility Equipment
Wheelchairs, Walkers & Beds
Mobility aids and home medical equipment including manual and power wheelchairs, walkers, crutches, and hospital beds. Power mobility devices require prior authorization from most payers and face the strictest utilization review in the DME category.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| K0001 | Standard wheelchair | 0291 | DME - purchase | $334.01 |
| K0004 | High strength, lightweight wheelchair | 0291 | DME - purchase | $643.44 |
| K0856 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds | 0291 | DME - purchase | $11,956.51 |
| E0143 | Walker, folding, wheeled, adjustable or fixed height | 0291 | DME - purchase | $69.85 |
Wound Care & Supplies
Wound Management Devices & Supplies
Negative pressure wound therapy (wound VAC), skin substitutes, surgical dressings, and compression systems. Wound care DME has seen significant reimbursement changes with skin substitutes under particular scrutiny from CMS and commercial payers.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| E2402 | Negative pressure wound therapy electrical pump, stationary or portable | 0623 | Surgical dressings | $10,045.15 |
| A2014 | Omeza collagen matrix, per 100 mg | 0623 | Surgical dressings | $61.00 |
| A6021 | Collagen dressing, sterile, size 16 sq. in. or less, each | 0623 | Surgical dressings | $34.77 |
| A6448 | Light compression bandage, elastic, knitted/woven, width less than 3 inches, per yard | 0623 | Surgical dressings | $1.98 |
Diabetes Management
Insulin Pumps & Glucose Monitors
Insulin delivery systems, continuous glucose monitors (CGMs), and blood glucose testing supplies. Diabetes technology reimbursement has evolved rapidly with CGM coverage expanding across commercial payers, but coverage criteria and reimbursement rates remain inconsistent.
| Billing Code | Description | Revenue Code | Description | Avg. National Cigna Rate |
|---|---|---|---|---|
| E0784 | External ambulatory infusion pump, insulin | 0292 | DME - rental | $6,488.08 |
| E2103 | Non-adjunctive, non-implanted continuous glucose monitor or receiver | 0292 | DME - rental | $334.06 |
| E0607 | Home blood glucose monitor | 0292 | DME - rental | $112.46 |
| A4224 | Supplies for maintenance of insulin infusion catheter, per week | 0292 | DME - rental | $22.32 |
What is a fee schedule?
A fee schedule is a list of negotiated prices that healthcare providers charge for specific services. These prices vary by payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the applicable fee schedule helps providers optimize billing for accurate reimbursement and helps patients anticipate out-of-pocket costs.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts.
Private Insurance Rates
Negotiated rates between providers and insurance companies.
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
View medical devices & dme fee schedules for other major payers
What is Price Transparency?
The federal Price Transparency Rule took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public. Read more here.
PayerPrice gives you access to the actual prices that insurers are legally required to publish under the Price Transparency Rule. We deliver this data exactly as reported in the insurers' machine-readable files, giving you an accurate view of negotiated rates. While insurers occasionally report incomplete or inaccurate data, our platform ensures you see the same information that insurers have made publicly available.
Bring your top codes and we'll show you how you compare in 15 minutes or less.