DMERCs Issue ‘Bridge’ LCD

DMERCs Issue ‘Bridge’ LCD ATLANTA–The DMERCs issued revised
draft local coverage determinations for mobility devices on
Tuesday, bringing current codes into step with CMS’ national
coverage determination issued in May.

The LCD was originally scheduled to be implemented Jan. 1, 2006,
but will be delayed to take effect at the same time as the agency’s
new power mobility codes, CMS announced on Oct. 14 (see
HomeCare Monday, Oct. 17).

While there is no definite timeframe associated with the delay,
SADMERC Medical Director Dr. Doran Edwards told Medtrade attendees
last week that he anticipates the new PMD codes could possibly be
ready by sometime in mid-2006. According to Edwards, “The length of
time for wheelchair manufacturers to do the test we require,
whatever that turns out to be, will drive when the codes become
effective.”

A CMS technical advisory panel on the codes (see story above)
has three interim deadlines for completing its work, according to
Edwards. The first–April 1, 2006–is “not going to happen,” he
said, and a July 1 date is “iffy but possibly doable.” But a target
of October 1 “has real potential.”

In the meantime, the revised LCD will function as a bridge
policy for continued use of the current codes–K0010, K0011, K0012,
K0014 and E1230–based on the NCD until the new codes become
effective. As providers have been requesting since the NCD was
issued May 5, the revision includes claims documentation guidance
based on CMS’ new algorithmic approach to coverage of mobility
assist equipment.

Edwards noted, however, that the existing LCD still has an open
comment period. “Even though it is now withdrawn,” he pointed out,
“that policy will very likely be the one that [CMS] will go back
and use as the template to tie to the new codes whenever we finish
those, so your comments are important.”

He urged all stakeholders to “go ahead and turn your comments in
before the deadline.”

To view the revised LCD, visit www.tricenturion.com.

Interim Final Rule Takes Effect Tomorrow While most
industry-watchers viewed the revised LCD and power code delays as
good news, some pointed out that CMS’ interim final rule on power
mobility is still scheduled to take effect Oct. 25 (tomorrow) as
planned–unless an effort by the Power Mobility Coalition to delay
its implementation is successful.

The organization filed suit against the government Oct. 13 and
is asking for a preliminary injunction that would delay the rule,
which eliminates the certificate of medical necessity for Medicare
reimbursement of power wheelchairs and scooters.

According to the PMC, the rule “would decrease beneficiary
access to PMDs, increase the regulatory burdens placed upon
physicians and irreparably harm suppliers of PMDs.” The rule also
includes a requirement that physicians or other treating
practitioners conduct a face-to-face examination of patients when
prescribing PMDs, and expands the types of physicians and
practitioners who may prescribe power operated vehicles or
scooters. (See
HomeCare Monday, Aug. 29.)

“Since the rule is scheduled to take effect a full month before
comments are due, it is difficult to believe that CMS could
consider public comment and modify the rule at a later date,”
stated PMC Director Eric Sokol.

A court hearing on the matter is scheduled tomorrow.