CMS Releases 64 PMD Codes

Baltimore

CMS released 64 new HCPCS codes last month to be used for power wheelchairs and scooters beginning Oct. 1.

Under the new coding structure, there are six groups of power mobility devices with a total of 61 codes that separate the products based on functionality and levels of performance. Each group has subdivisions based on weight capacity and/or powered seating system capability.

The 61 codes include the type of power wheelchair base and the options and accessories that come standard with the chairs. Three additional “miscellaneous” codes cover PWCs and power operated vehicles not otherwise classified, and PMDs not coded by the SADMERC or that don’t meet criteria.

“The whole purpose of revising the codes was to separate the devices into categories more like [what we see] in actual practice today,” explained SADMERC Director Dr. Doran Edwards. “This last set incorporated clinical functionalities of the devices as well as performance capabilities, and that allows for better policy development. If we know who the patients are and what the chairs are going to be used for, then we can better define which chairs should be there.”

This is the third time the codes have been reworked within the past two years. This most recent effort resulted from the work of a 14-member technical expert panel — consisting of suppliers, manufacturers, testing facilities, rehabilitation engineers and clinicians — and the SADMERC.

Because each code is targeted to a specific type of patient, adapting to the new codes “should make the world of providers simpler,” Edwards said.

Although new mobility codes were originally scheduled to take effect at the start of this year, CMS announced last October that it would delay implementation in order to rework the codes with the panel’s input.

“There are a lot of good things in the code set, but I’m not going to celebrate until we see how it plays out,” said Simon Margolis, vice president of Franklin, Tenn.-based National Seating & Mobility. “We need to see a whole lot more.”

Margolis said he is still waiting on fee schedules for the new codes, which are expected to be published as part of the DMEPOS update in October.

Seth Johnson, vice president, government affairs, for Exeter, Pa.-based Pride Mobility, said that although he is not sure what effect the new codes will have until more information is released, he thinks the Oct. 1 implementation date is a bad idea.

“There’s significant change occurring in the industry where you’re going from five PMD codes to 64 new codes, and you’re going to have new coverage policy in the [local coverage determination],” he said.

“Physicians, clinicians and suppliers are clearly going to have to become educated on these significant changes so they can provide the most appropriate equipment to the beneficiary without disruption.”