PSCs Redefine Basic Equipment Package for Power Wheelchairs

BALTIMORE–Medicare’s DME Program Safeguard Contractors have
published a bulletin redefining the basic equipment package for
power wheelchairs, determining what accessories are and are not
separately billable.

The changes are effective for claims with dates of service on or
after Jan. 1, 2007.

“It is a pretty significant change for the advanced rehab
segment of the industry, those that provide power chairs in groups
3, 4 or 5,” said Seth Johnson, chairman of AAHomecare’s Rehab and
Assistive Technology Council and director of government affairs for
Pride Mobility.

While Medicare has indicated it will only pay for Group 3
chairs, Johnson said, the fact that the agency is breaking these
items out of the basic equipment package and noting they can be
separately billed should help improve reimbursement overall because
it sets the standard for chairs in Groups 4 and 5 for other payers
like Medicaid.

According to the Jan. 26 bulletin, the basic equipment package
includes the following:

–For Group 3, 4, and 5 power wheelchairs (PWCs), angle
adjustable footplates will be separately billable. For Group 3 and
4 PWCs (other than Extra Heavy Duty) with a sling/solid seat/back,
non-standard seat widths and/or depths will be separately billable.
The following list includes these changes and other
clarifications.

–PWC Basic Equipment Package–Each power wheelchair code is
required to include all these items on initial issue (i.e., no
separate billing/payment at the time of initial issue, unless
otherwise noted). The statement that an item may be separately
billed does not necessarily indicate coverage.

• Lap belt or safety belt. Shoulder harness/straps or chest
  straps/vest may be billed separately.
• Battery charger, single mode.
• Complete set of tires and casters, any type.
• Legrests. There is no separate billing/payment if fixed,
  swingaway, or detachable non-elevating legrests with or without
  calf pad are provided. Elevating legrests may be billed
  separately.
• Footrests/foot platform. There is no separate billing/payment
  if fixed, swingaway, or detachable footrests or a foot platform
  without angle adjustment are provided. There is no separate billing
  for angle adjustable footplates with Group 1 or 2 PWCs. Angle
  adjustable footplates may be billed separately with Group 3, 4 and
  5 PWCs.
• Armrests. There is no separate billing/ payment if fixed,
  swingaway, or detachable non-adjustable height armrests with arm
  pad are provided. Adjustable height armrests may be billed
  separately.
• Any weight specific components (braces, bars, upholstery,
  brackets, motors, gears, etc.) as required by patient weight
  capacity.
• Any seat width and depth. Exception: For Group 3 and 4 PWCs
  with a sling/solid seat/back, the following may be billed
  separately: for Standard Duty, seat width and/or depth greater than
  20 inches; for Heavy Duty, seat width and/or depth greater than 22
  inches; for Very Heavy Duty, seat width and/or depth greater than
  24 inches; for Extra Heavy Duty, no separate billing.
• Any back width. Exception: For Group 3 and 4 PWCs with a
  sling/solid seat/back, the following may be billed separately: for
  Standard Duty, back width greater than 20 inches; for Heavy Duty,
  back width greater than 22 inches; for Very Heavy Duty, back width
  greater than 24 inches; for Extra Heavy Duty, no separate
  billing.
• Controller and Input Device. There is no separate
  billing/payment if a non-expandable controller and a standard
  proportional joystick (integrated or remote) is provided. An
  expandable controller, a nonstandard joystick (i.e.,
  nonproportional or mini, compact or short throw proportional), or
  other alternative control device may be billed separately.

–Nonstandard seat dimensions and nonstandard back dimensions
should be billed with code K0108, the article said.

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