Cms Announces New, More Specific Codes For Wheelchairs

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announces new, more specific codes for wheelchairs

in its continuing effort to improve medicare coverage and payment for

power wheelchairs and scooters, while protecting the medicare program

and taxpayers from abuse, the centers for medicare & medicaid services

(cms) today released draft coverage criteria for these devices, as well

as new codes to ensure proper payment. these steps were outlined in our

modern mobility initiative announced last april.

"in taking these steps, we move closer to our goals of supporting

appropriate prescribing, making accurate payment, and providing clear

guidance to physicians and suppliers about power mobility devices," said

cms administrator mark b. mcclellan, m.d., ph.d. "this will take us a

long way toward bringing this important benefit into the 21st century.

it also makes it clear that medicare recognizes the importance of

clinically-based coverage decisions."

medicare's proposed coverage criteria would rely on clinical guidance

for evaluating whether a beneficiary needs a device to assist with

mobility, and if so, what type of device is needed. this new approach

would replace an older, more rigid standard that relied on whether a

patient was "nonambulatory" or "bed or chair confined." the analysis

begins with whether the beneficiary has a mobility limitation that

prevents him or her from performing one or more mobility-related

activities of daily living in the home. this evaluation includes

consideration of whether or not an assistive device - whether a simple

cane or a sophisticated power wheelchair or anything in between - would

improve the beneficiary's ability to function within the home. the

criteria also take into account any conditions, such as visual or mental

impairment, that would affect the beneficiary's ability to use the

mobility equipment effectively.

"the proposed coverage criteria were developed with the intention of

providing clear and consistent guidance to medicare contractors and to

clinicians to ensure that beneficiaries receive the type of mobility

device that will provide clinical benefits," said cms chief medical

officer sean tunis, m.d., who spearheaded the agency's move to a more

functional assessment of mobility needs.

cms plans to publish the final ncd in march and to provide guidance on

how to use and document the new criteria.

cms is also establishing new billing codes for power wheelchairs and

scooters to assure that medicare pays appropriately for these devices.

to better reflect the range of power mobility products now available on

the market, medicare will expand the number of codes used for billing

from 5 to 49. the more detailed coding will help facilitate getting the

right products to patients and improve medicare's ability to pay

suppliers appropriately.

"the technology, range of products, and market for power wheelchairs

have changed substantially since the hcpcs codes for power wheelchairs

were last revised in 1993," said cms center for medicare management

director herb kuhn. "currently, medicare uses only one code, k0011, to

pay for most power wheelchairs. having more codes will permit us to

more accurately reflect the different kinds of mobility products our

beneficiaries are using."

the new codes will incorporate "testing standards" in several areas

(i.e., weight capacity, fatigue testing, speed and range testing).

accurate individual payment ceilings will also be developed for each of

the new codes. the codes will go into effect on january 1, 2006.

cms plans in the near future to publish a regulation implementing

provisions in the medicare modernization act affecting power mobility

equipment. the regulation will remove the current requirement that only

certain specialists can prescribe a power scooter. in addition, the

regulation will require a face-to-face meeting between the prescribing

professional and the beneficiary before a scooter or wheelchair can be

ordered and delivered.

as mandated by the mma, cms is also developing quality and consumer

standards for all suppliers of durable medical equipment, prosthetics,

orthotics, and supplies (dmepos), as well as standards for specific

product lines, including power mobility devices. these standards will

implement strong quality controls for suppliers who play a key role in

ensuring that a particular piece of equipment is appropriate for the

individual beneficiary, and that it will be usable in the home setting.

cms intends to finalize these standards in the fall of this year and to

implement them through an accreditation process conducted by one or more

accreditation bodies to be designated at a later time.

the proposed national coverage decision will be posted on the cms

website at comments on the proposed ncd will

be accepted until march 7, 2005. a description of the new billing codes

for wheelchairs will be posted on the cms website at

cms also plans to hold an open door forum from 1 to 4 p.m. eastern time

on february 24 to allow for a dialogue with physicians, suppliers, and

beneficiaries about the proposed ncd and to clarify the issues on which

cms is seeking comment. more information about how to participate will

soon be posted at

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you can view the press release online at:

renerian, BSN, RN

5,693 Posts

Specializes in MS Home Health.

Thanks again for posting your information the way you do. It is alot to keep up with so I am a bit behind.


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