CMS: PMD Guidance Coming

Baltimore

CMS has indicated that it will be providing more clarity on what documents and records will support power mobility claims.

Although the agency did not say when the details would be released, a fact sheet issued by CMS last month said the DMERCs will provide “guidance to DME suppliers on the documentation needed to establish medical necessity of the prescribed equipment.”

After the Interim Final Rule on power mobility devices — which eliminates the certificate of medical necessity and replaces it with a face-to-face exam and a prescription — was issued last year, HME stakeholders complained that its requirements were unclear and that physicians had not been informed of their new documentation responsibilities.

In the same fact sheet, CMS announced that physicians and treating practitioners who prescribe power mobility devices will not receive payment for supplying medical records to providers until April.

Under the IFR, 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 doctors $21.60 in addition to the office visit.

The effective date of the IFR was Oct. 25, 2005, but because a subsequent congressional directive put the rule 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.

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

The fact sheet 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 said it would issue instructions to the DMERCs “to promote consistent claims processing during this time period.”