Home Health & Hospice Week

Implementation on codes, LCD delayed until Nov. 15.

Medicare will still pay for a Group 2 power mobility device (PMD) when appropriate, say the feds in a recent "clarification" from the Centers for Medicare & Medicaid Services.

A Fact Sheet issued by CMS on Sept. 20 clarifies the point, saying that many have "misinterpreted" a local coverage determination (LCD) that was set to go into effect Oct. 1. The LCD was widely held to mean that Medicare would deny many claims for Group 2 (general use) power wheelchairs.

"Unless they require special seating, people needing a power wheelchair will only receive coverage for what many wheelchair users call a 'junk wheelchair,' a device that has no ability to ride over even the smallest bump and has extremely limited battery power," protested the Medicare Rights Center, an advocacy organization with offices in New York City and Washington, DC, in a statement issued earlier this month, before the clarification.

The LCD does not call for such a blanket down-coding of Group 2 (general use) to Group 1 (light weight) power wheelchairs, assures CMS Office of External Affairs.

"We commend [CMS] for recently issuing a Fact Sheet/Press Release and revision of its Local Coverage Determination in an effort to ensure that Medicare beneficiaries receive the most appropriate power mobility devices to meet their medical needs," said Mike Pfister, president of the New Braunfels, TX-based firm The Scooter Store, in a statement released Sept. 26.

Implementation delay: As result of that change and other, relatively minor tweaks, the effective date for the new codes and LCD will be changed to claims with dates of service on or after Nov. 15, 2006.

Next step: The feds will amend the local coverage determination issued by the DME Medicare Administrative Contractors, making the interpretation official and binding.

"The LCD will be modified to incorporate this and other changes so that there will be no confusion surrounding the basic intent of Medicare's policy," according to CMS.

The clarified LCD will be issued by the durable medical equipment (DME) Program Safeguard Contractor (PSC) Medical Directors, says CMS, adding that the clarified LCD, has been adopted by the DME Medicare Administrative Contractors (MACs).

In addition, CMS says it will issue the long-awaited fee schedule corresponding to the new HCPCS codes "in the near future."

Reminder: Use HCPCS codes E1230, K0010, K0011, K0012, and K0014 as appropriate for PMD claims with dates of service prior to Nov. 15, 2006. Note: Look for the clarified policy at the following Web sites: www.trustsolutionsllc.com/DRAFT_LCD_Status.asp, www.tricenturion.com, and www.edssafeguardservices.eds-gov.com/providers/dme/lcd.asp. • Leslie V. Norwalk has been named the acting chief of CMS, federal officials announced Sept. 25. Norwalk, 40, a lawyer who has served in both Bush administrations, is now the deputy administrator at [...]