Surgical N95 Respirators Payment Adjustment

By Marc Levy January 3, 2025

As part of the Calendar Year 2023 Outpatient Final Rules, CMS included a provision for a payment adjustment under the IPPS and OPPS for domestic National Institute for Occupational Safety & Health (NIOSH) approved surgical N95 respirators.

CMS cites a NIOSH study in 2020 and 2021 that found that about 60% of N95S respirators that it evaluated during the COVID–19 pandemic did not meet the particulate filter efficiency requirements that they intended to meet.

CMS’s stated goal is to assist hospitals “for the additional resource costs that hospitals face in procuring domestic NIOSH-approved surgical N95 respirators.”

CMS defined NIOSH-approved surgical N95 respirators as domestic “if the respirator and all of its components are grown, reprocessed, reused, or produced in the United States.” CMS stated that for purposes of this policy all other NIOSH-approved surgical N95 respirators would be non-domestic.

CMS has indicated that a hospital may rely on a written statement from the manufacturer stating that the NIOSH-approved surgical N95 respirator that the hospital purchased is domestic. The written statement must have been certified by one of the following:

• The manufacturer’s Chief Executive Officer (CEO);
• The manufacturer’s Chief Operating Officer (COO); or
• An individual who has the delegated authority to sign for, and who reports directly to, the manufacturer’s CEO or COO.

This additional reimbursement opportunity is effective for cost report periods beginning on or after January 1, 2023, and CMS added a new cost report form into the 2552-10 cost report forms called the E95. Here is CMS’s sample calculation from the final rules:

The original table, published by CMS, can be found in the report here.

In summary, CMS is providing hospitals an opportunity to receive additional reimbursement for domestically produced N95 respirator masks. Where hospitals must ensure that the N95 respirators are produce domestically, which includes a written and signed statement from the manufacturer, we suggest that hospitals begin to work with their purchasing departments to determine whether or not they will qualify for this additional reimbursement.

If you have questions or would like to discuss these matters further, please contact Marc Levy or your BNN healthcare advisor.

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The BNN Healthcare Advisory team specializes in cost report and reimbursement across the continuum of care. If your healthcare organization is experiencing challenges with your reimbursement or revenue cycle, or interested in learning more about improving your processes, technology, and strategy, get in touch with our healthcare industry specialists today!