Study: Gap-Filling Method Problematic for Power Wheelchairs

WASHINGTON–CMS’ gap-filling methodology, if it is used to set
prices for power wheelchair codes, could result in an average
payment reduction of 25 percent, according to a new study conducted
by Muse & Assoc.

AAHomecare, which commissioned the study, presented the findings
during a meeting with CMS officials last Wednesday.

The gap-filling formula is used by CMS to price new DME codes by
estimating what the price would be if it were on the Medicare fee
schedule in 1987. That price is then trended forward to 2004 using
actual increases in fee schedule payments.

The study recommends that CMS use 1992 as the historic pricing
year for all power wheelchair equipment, since much of the
technology for today’s wheelchairs was developed after 1987. The
study found that of the power wheelchair products that were
examined, only nine had historic price information before the year
2000.

To view an executive summary of the study, visit www.aahomecare.org.