DMERCs Release Draft Mobility Coverage

Baltimore

After months of waiting for additional guidance on Medicare’s power wheelchair and scooter coverage, the home medical equipment industry got what it was asking for when the DMERCs issued their draft local coverage determination in September. But some stakeholders say their questions remain unanswered — and that the power mobility policy changes are too many and coming too fast for the industry to adjust.

The LCD expands on CMS’ national coverage determination for mobility assistive equipment, issued May 5, addressing medical conditions required for coverage, proof of medical necessity, coverage of accessories and phase-out of the power mobility certificate of medical necessity.

After a comment period that ends Oct. 31, the final LCD is expected to be released in December, and is set to take effect Jan. 1, 2006, to coincide with new power mobility codes. Pricing has yet to be determined. The LCD is identical for all four DMERC regions, but there may be some discrepancy among the DMERCs in the amount of review, a CMS official said.

Both HME providers and manufacturers had looked for the LCD to give more guidance about claims documentation and other aspects of the NCD. But the LCD raises other questions, according to Seth Johnson, director of government affairs for Exeter, Pa.-based Pride Mobility.

Referring to the interim final rule, he said, “The LCD did provide some additional information, but certainly these additional documents [on coding and testing] that were released do raise significant questions and further support the need for delay in implementation for power mobility to at least April 1. We know that the LCD will not be finalized until at least December.

“How can you implement the PMD rule without the LCD being finalized [and without] additional guidance the industry needs?” questioned Johnson.