Medicare Revises Wheelchair Cushion Fees

Baltimore

CMS announced an interim wheelchair cushion fee schedule in October that initiated substantial reimbursement cuts for certain cushion codes. But after an outcry from providers and manufacturers, CMS demonstrated unprecedented responsiveness, industry sources say, as agency officials announced new code policy to replace the interim allowables.

Under the interim fee schedule, which was to be effective Oct. 1 through Dec. 31, it was going to be “a really painful three months,” said Rita Hostak, vice president of government relations for Longmont, Colo.-based Sunrise Medical, and president of the National Coalition for Assistive and Rehab Technology (NCART). Hostak explained that with reimbursement cut by more than a quarter, as the interim schedule dictated for certain products, the new allowables were inadequate and could create access issues.

Experts said allowables for adjustable skin protection products were skewed low since a wide range of low-end foam and high-end adjustable cushions were lumped together in the same code. “We had products that were $50 in the same code of products with a $500 retail price,” said Dave McCausland, senior vice president of planning and government affairs for The Roho Group, Belleville, Ill.

But on Oct. 25, CMS announced that products assigned to adjustable skin protection and combination cushion codes, including K0652 and K0656, will be reassigned to the K0108 miscellaneous code and will be reimbursed under individual consideration.

“It’s to [CMS’] credit,” said McCausland. “They recognized they had a problem, and they responded to it very quickly in what I consider to be a very positive fashion.”

He added that industry groups such as NCART “lobbied hard” with CMS and the SADMERC to “come up with a short-term solution that seems to be equitable. It ensures patient access and ensures the suppliers get a fair and equitable price for what they deliver.”

CMS said it will develop new codes for the adjustable products, along with new product tests in order to determine which products can be classified as “adjustable,” he explained.

Earlier this year, CMS announced 20 new cushion codes in an effort to split the broad E0192 code.