Coverage:
Prepare To Juggle 49 New Wheelchair Codes
Published on Mon Jan 10, 2005
CMS unveils new criteria for power mobility equipment.
The Centers for Medicare & Medicaid Services has released new draft coverage criteria for power wheelchairs and scooters, and the proposal is getting mixed reviews from suppliers.
The good news: CMS plans to ditch the confusing and restrictive "nonambulatory" or "bed or chair confined" standard and instead consider a beneficiary's ability to ambulate safely around the home to accomplish activities of daily living.
The bad news: The national coverage determination fails to address the "in the home" restriction on such equipment. In addition, the new coding initiative released with the NCD expands the number of codes used for billing for power equipment from five to 49 - a situation that some say could create an administrative nightmare for both suppliers and CMS.
"On the whole, we're fairly pleased with the direction of this proposal," Eric Sokol of the Power Mobility Coalition tells Eli. "But if CMS makes the system too complex, what will happen when we go to competitive bidding?" The agency would have to accept bids for 49 power wheelchairs alone, he notes.
The NCD relies on clinical guidance for evaluating whether a beneficiary needs a mobility device and what kind. The analysis first considers whether the beneficiary has a limitation that prevents him from performing one or more mobility-related activities of daily living in the home.
It also considers whether an assistive device would improve the bene's ability to function at home, and whether conditions such as visual or mental impairment affect her ability to use the equipment appropriately.
CMS' Interagency Wheelchair Working Group, which includes clinicians, researchers and policy experts from various federal agencies, recommended the functional ambulation standard after examining scientific data, expert opinion and public comments. Payment Ceilings on New Codes Yet to Come CMS developed the new set of codes by working with the Statistical Analysis Durable Medical Equip-ment Regional Carrier and the DMERCs, and by considering comments on draft wheelchair codes released last fall (see Eli's HCW, Vol. XIII, No. 31).
Rationale: The agency insists there's a good reason for the explosion in the number of codes. Expanding available codes beyond the oft-used K0011 would help CMS "more accurately reflect the different kinds of mobility products our beneficiaries are using," according to Center for Medicare Management Director Herb Kuhn.
Not all DME experts believe the increased number of codes will present big problems for suppliers. "I don't think it will affect providers that much," predicts Peggy Walker of U.S. Rehab. "But I feel sorry for the people at SADMERC who will have to go through this coding."
However, Walker notes that the revised codes still include temporary K codes, meaning more changes are possible in the future. "So this could happen to us again," she [...]
