Mobility Stakeholders Say CMS Is Beginning to Get It

Baltimore

According to attendees of a special four-hour public meeting on power wheelchair coding held Sept. 1 at its headquarters, CMS is beginning to “get it.”

At the meeting, the agency introduced 33 new wheelchair codes, expanding upon an initial 18-code proposal released in August (see HomeCare, September 2004). As part of its wheelchair benefit overhaul, CMS plans to split the broad “K” codes currently in use into a variety of “E” codes.

To explain the CMS proposal, Dr. Doran Edwards, medical director for the SADMERC, provided an overview of the codes, including five for pediatric chairs, four for adult lightweight chairs, nine for standard chairs, eight for heavy-duty chairs, four for bariatric chairs and three miscellaneous codes.

More than 80 registered attendees at the meeting included representatives from AAHomecare, Invacare, The MED Group, the National Coalition for Assistive Rehab Technology (NCART), Pride Mobility, Sunrise Medical and others. Rita Hostak, president of NCART and vice president of government relations for Sunrise, presented a seven-code proposal at the meeting that NCART had submitted earlier this year.

“Dr. Edwards and his staff do seem to get it,” said Simon Margolis, NCART executive committee member and vice president of clinical and professional development for National Seating and Mobility, Chattanooga, Tenn.

“The [government’s] approach is different than the NCART proposal in that it does not use add-on codes for things like seat width and seat depth. Instead, [CMS] has decided to use individual codes for various chair configurations. The larger code set in itself is not a bad thing or a good thing; it is just a methodology for achieving our common goal of appropriate coding to assure access to power mobility technology.”

Mobility stakeholders have said the inclusion of pediatric codes in the new proposal may prove valuable for state Medicaid programs and private insurers, which, due to HIPAA, must now use HCPCS coding.

“I am very happy CMS has realized the need to add pediatric power wheelchair codes,” said Matthew Burke, director of operations for Burke Medical Equipment, Chicopee, Mass., and chairman of AAHomecare’s Rehab and Assistive Technology Council (RATC). “It is important, though, that CMS exclude pediatric codes from their fee schedule and coverage guidelines. Many state associations have worked hard to establish reasonable and fair coverage guidelines for pediatric power mobility. There is no need for CMS to interject additional criteria.”

Other industry concerns include specifics behind patient weight capacities that CMS has associated with the codes, and the fact that the agency proposes that each wheelchair should come with a basic equipment package that bundles commonly used accessories at one price.

After reviewing comments, CMS hopes to introduce a formal coding proposal in November. Pricing determinations will be made once the new codes are finalized.

Meanwhile, the government’s Interagency Wheelchair Work Group has been working separately on new wheelchair coverage policy. Recently, however, CMS announced it plans to hold a joint Open Door Forum to discuss both coding and coverage policy during the coming months. Officials said CMS hopes to have coverage guidelines finalized by Dec. 31, coding guidelines settled by late spring, and to implement the new codes by July 2005.

“That’s a pretty aggressive timeline,” said Don Clayback, vice president of networks for The MED Group. “There’s an awful lot of work that needs to go into the process,” he said. “With more codes comes more complexity…but hopefully a good coding structure will result.”

The Power Mobility Coalition, made up of mobility manufacturers and suppliers, has estimated that Medicare will pay a third less for power wheelchairs in 2004 than it did in 2003. Using data from the SADMERC, the group estimates that Medicare will pay out $760 million for power chairs in 2004, compared to $1.13 billion in 2003. While industry and consumer groups have argued that such decreases are denying power mobility equipment to beneficiaries, CMS has stated that power chair expenditures are returning to reasonable levels since K0011 payments reached record highs last year.