CMS Continues Revisions to PMD Fee Schedule

BALTIMORE–CMS continues to revise its PMD fee schedule, upping
reimbursements for some Group 3 power wheelchairs, among other
changes.

The agency bumped reimbursements for codes K0857 and KO859,
which it said had been incorrectly posted. The fee for K0857 rose
by nearly $500 to $5,673. Reimbursement for code KO859 rose more
than $600 to $7,091. Another change will allow separate billing for
expandable controllers on chairs in Groups 3, 4 and 5.

In an e-mail sent Tuesday to some industry representatives, CMS
said the correct prices for the K0857 and KO859 chairs would be
posted on the agency’s Web site as soon as possible.

The e-mail also said articles will be posted on CMS contractor
Web sites clarifying that suppliers can bill separately for
expandable controllers furnished with Group 3 (codes K0861 through
K0864), Group 4 (codes K0884 through K0886) and Group 5 (K0891)
multiple power option wheelchairs.

The code to be used for expandable controllers furnished with
these wheelchairs will be K0108 for claims with dates of service
from Oct. 1, 2006, through Dec. 31, 2006, and E2377 for claims with
dates of service on or after Jan. 1, 2007, CMS said.

The changes will be retroactive to Nov. 15, when the fee
schedule officially took effect.

Stakeholders said the revisions resulted from industry feedback,
as was the case in the agency’s decision last week to increase
payments for some Group 2 and Group 3 power wheelchairs (see
HomeCare Monday, Nov. 13).

On Thursday, Pride Mobility officials met with HHS Secretary
Mike Leavitt, Acting CMS Deputy Administrator Herb Kuhn and Sens.
Arlen Specter and Rick Santorum to discuss the fee schedule. In
addition to the latest revisions, Pride said CMS is considering an
adjustment to the K0823 code (Group 2 Standard, Captain’s Chair),
since gap-fill data CMS used to set the fee may not have been
accurate.

CMS also is considering correcting allowables for code K0825
(Group 2 Heavy Duty, Captain’s Chairs). According to Pride, “CMS
clearly recognized that there are additional costs for
manufacturing heavy duty power wheelchairs above those for standard
power wheelchairs.”

In a string of statements released last week, the power mobility
sector’s major manufacturers, providers and patient advocate groups
applauded CMS’ willingness to work with the industry on refinements
to the fee schedule.

According to Portland, Maine-based Black Bear Medical President
Jim Greatorex, who is also a board member of the National Coalition
for Assistive and Rehab Technology, “I wouldn’t say that we’re
living in a perfect reimbursement arena now–and there still are
cuts involved with the fee schedule–but we certainly have left the
brink of complete disaster.”