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Uncovered DME services drive higher workers’ comp costs, WCRI finds
In 2025, durable medical equipment billed without a fee schedule rate accounted for 62% of total DME workers’ comp payments, up from 58% in 2019, according to WCRI.
Durable medical equipment and certain professional services that fall outside workers’ compensation fee schedules are taking a larger share of payments, the Workers Compensation Research Institute found.
WCRI reported that in 2025, half of durable medical equipment services billed in workers’ compensation had no assigned fee schedule rate, yet those uncovered services represented 62% of total DME payments. The research organization said the gap suggests services outside fee schedule coverage tend to cost more than the average covered service.
Analyzing billing data from January 2019 through June 2025 across 43 jurisdictions with workers’ compensation fee schedules, WCRI found that a small number of billing codes drove much of the uncovered spending. It said two codes alone, the catch-all miscellaneous DME code E1399 and the intermittent limb compression device code E0676, accounted for half of all DME payments without fee schedule rates in 2025.
WCRI found the median state’s DME expenditure share without fee schedule rates rose from 58% in 2019 to 63% in 2025, while the utilization share increased from 41% to 48%. It also reported wide state variation in 2025, with uncovered DME expenditure share ranging from 36% in Arizona to 92% in Connecticut, and 10 states where the share reached 100%. The institute attributed much of the overall growth to code E1399, which made up 26% of the median state’s uncovered DME spending in 2025, up from 18% in 2019, and it estimated average rental prices of about $300 per day for E1399 devices and about $1,862 per day for E0676 devices in 2025, according to WCRI.