Eli's Rehab Report

Published on Thu Feb 28, 2008 PDF

For a couple of years now, a sticky provision has existed in all durable medical equipment contractors' local coverage determinations for power mobility devices. That is, the LCDs required an additional -- and rare -- certification for therapists performing evals for higher-end PMDs.

But that's finally changed, according to a Dec. 11, 2007, press release from the American Occupational Therapy Association. AOTA reimbursement and regulatory policy staff convinced CMS to eliminate a requirement that an evaluating therapist have a RESNA-certified ATP (assistive technology practitioner) credential in these higher-end PMD cases.

Advocates and providers across the country were worried that patient access would suffer because such a small number of therapists have an ATP credential.

And therapists, especially OTs, had grounds to back up their argument, because any wheelchair evaluation "is clearly within the scope of occupational therapy practice," said Christina A. Metzler, AOTA chief public affairs officer, in the release.

The policy was set to take effect April 1, 2008, but local DME Medicare contractors will publish an article on their individual Web sites that notifies providers of their new decision.

Still the rule: A licensed/certified medical professional such as an OT or PT, or a physician who has specific training and experience, must perform the specialty wheelchair evaluation. And as usual, the evaluation must document the medical necessity for the wheelchair and its special features, AOTA clarified.