CMS Delays Physician Add-On Payment for PMDs

BALTIMORE–Physicians and treating practitioners who prescribe
power mobility devices will not receive payment for supplying
medical records to HME providers until April, CMS has
announced.

Under the Interim Final Rule for power mobility devices–which
eliminates the certificate of medical necessity and replaces it
with a face-to-face exam and a prescription (see HomeCare
Monday, Aug. 29, 2005)–physicians are required to provide
medical records documenting a patient’s medical necessity for a
power wheelchair or scooter. In return for the extra work, CMS said
it would pay the docs $21.60 in addition to the office visit.

But because a congressional directive has put the IFR on hold
until April 1, CMS said that it will be unable to process claims
that contain the add-on payment (code G0372) until that date.

The effective date of the IFR was Oct. 25, 2005. But HME
suppliers and manufacturers complained that its requirements were
unclear and that physicians had not been informed of their new
documentation responsibilities. Some senators wrote CMS asking for
a delay to ease the transition. And after a concerted lobby from
the industry, an amendment to the HHS appropriations bill (signed
into law in December) prohibited the use of funds to implement the
rule until April. (See HomeCare
Monday, Jan. 9.)

While it is not allowed to implement or enforce the IFR,
however, CMS said this “does not affect the validity of the
rule.”

A fact sheet issued by the agency gives physicians and treating
practitioners several options for submitting the G0372 and
Evaluation and Management Code:

–submit the G0372 code and E/M now on the same claim. Payment
will be held until after April 1;
–hold all claims containing the G0372 code until after April 1;
or
–submit the E/M service now and bill the G0372 after April 1. The
E/M service will be paid now and the G0372 code will be paid after
April 1.

In the meantime, CMS said, it will continue to educate
physicians and treating practitioners on their role in prescribing
PMDs. The agency also will issue instructions to the DMERCs “to
promote consistent claims processing during this time period.”

Although it did not say when, the fact sheet also said the
DMERCs will provide “guidance to DME suppliers on the documentation
needed to establish medical necessity of the prescribed equipment.”
Since the IFR was issued, HME stakeholders have repeatedly pressed
for answers about what documents and records will support power
mobility claims.