CMS Releases 64 New Power Mobility Codes

BALTIMORE–Just a few minutes before 5 p.m. on Friday, CMS
announced that it had posted information about the new HCPCS codes
to be used for power wheelchairs beginning Oct. 1.

Under the new coding structure, there are six groups of power
mobility devices with a total of 61 codes that separate the
products based on functionality and levels of performance. Each
group has sub-divisions based on weight capacity and/or powered
seating system capability. The 61 codes include not only the type
of power wheelchair base but also the options and accessories that
come standard with the chairs. Three additional “miscellaneous”
codes cover PWCs and power operated vehicles not otherwise
classified, and PMDs not coded by the SADMERC or that don’t meet
criteria.

“It is CMS’ belief that the changes made to the coding sets will
provide physicians and other practitioners with a wide range of
choices that will allow beneficiaries to be placed in the most
appropriate chair,” the agency said.

This is the third time the codes have been reworked within the
past two years (see HomeCare
Monday, Oct. 24, 2005). This most recent effort resulted
from the work of a 14-member technical expert panel–consisting of
suppliers, manufacturers, testing facilities, rehabilitation
engineers and clinicians–and the SADMERC.

Although new mobility codes were originally scheduled to take
effect Jan. 1 this year, CMS announced in October that it would
delay implementation in order to rework the codes with the panel’s
input. The goal was to “more accurately reflect the range of PMDs
currently on the market, allow for more accurate payment and …
establish testing standards to ensure only quality products are
provided to Medicare beneficiaries.”

Last fall, SADMERC Director Dr. Doran Edwards even announced
that he had suspended all other duties to devote time to the coding
project to “get it right.”

“Codes resulting from this collaborative effort allow placement
of individual devices into performance-based categories and tie
those categories to distinct patient populations,” the SADMERC
said. “The resulting interplay of codes and clinical applications
allows for a policy reflective of actual practice in PMD selection.
Downcoding and claims denial will be reduced because proper
device/patient selection will be more evident.”

Current PWC codes have been in use since 1993 and the one code
for POVs has been in use since 1986, but subsequent innovation in
the field created a need to expand both the number of categories
and the number of codes, CMS explained.

The SADMERC noted this set of codes is an interim step to allow
implementation, and that a set of “K” codes to be used for billing
will be developed by the Alpha Numeric Work Group before Oct.
1.

The SADMERC also said a revised set of test parameters to
accommodate future technological advances will be published soon.
In the meantime, all PMDs will have to be retested according to the
expanded criteria. “Policy and pricing changes will also be made as
needed,” the SADMERC said.

Based on feedback from the expert panel, the agency said CMS and
the SADMERC also have instituted some additional tests to those
already required under the previous code set to reflect “the
variety of performance and durability challenges the PMDs may
undergo during the course of a five-year lifetime.” A subset of
current Rehabilitation Engineering & Assistive Technology
Society of North America (RESNA) standards for PMDs, the new tests
include:

• Speed fall-off for slope at maximum speed;
• Static strength on foot rests;
• Impact strength on foot rests;
• Climatic test (rain test);
• Power and control systems;
• Static stability and dynamic stability; and
• Power off emergency brake test.

The agency also said it anticipates that as standards for
electromagnetic and crash tests are developed, those tests will be
phased in over time.

CMS said its timeline for implementation of the new codes and
testing standards is as follows:

• The SADMERC will apply testing results already submitted to
  place wheelchairs in the appropriate new code based on the results
  of these tests.
• The new codes will be effective for claims for items furnished
  on or after Oct. 1, 2006. The current codes will remain valid for
  items furnished before Oct. 1, 2006.
• Fee schedules for the new codes are expected to be published as
  part of the October 2006 DMEPOS update.
• Manufacturers will have until Aug. 1, 2007 (approximately 13
  months), to have their wheelchairs retested by an independent
  testing laboratory according to the new testing requirements.
• Fee schedule amounts will be revised to reflect any changes in
  product classification under the codes as a result of the retesting
  and will be implemented on Jan. 1, 2008.

The SADMERC will issue further instructions that detail the
testing requirements, and after that, an updated product
classification list with assignment of devices to the various codes
will be released.

CMS said it will hold a special Open Door Forum on the new codes
and testing requirements, and will provide information on the fee
schedule amounts for the new codes, as well as the status of local
coverage policies for PMDs, “in the near future.”

To view the new codes, visit the SADMERC Web site by
clicking here, then follow the instructions.