Home Health & Hospice Week

Expanded wheelchair HCPCS codes not far behind.

The changes will just keep coming for wheelchair suppliers in the new year.
 
In addition to new coverage guidelines (see related story, "Coverages", this issue), wheelchair providers will see a new regulation requiring physicians to examine patients face to face before prescribing mobility equipment and a new certificate of medical necessity for the devices. And new wheelchair HCPCS codes are imminent as well.
 
The Centers for Medicare & Medicaid Services will issue the face-to-face reg and the revised wheelchair CMN together as a package, a CMS official said in the Dec. 15 Home Health Open Door Forum.
 
Seth Johnson with Exeter, PA-based Pride Mobility Products Corp. expects to see these three changes in the upcoming CMN:

1) Consolidation. Instead of having a separate CMN for power wheelchairs, manual wheelchairs and scooters, CMS will have one certificate for all three items.
 
2) Tiers. The new CMN will have three tiers, asking clinicians to first consider a manual wheelchair and rule it out if appropriate, then consider a scooter, then finally a power wheelchair.
 
3) Face to face. The CMN will include a section reflecting the new face-to-face exam requirement.

CMS had to hold off on issuing the final face-to-face rule in the physician fee schedule because of the volume of comments it received on the matter (see Eli's HCW, Vol. XIII, No. 39, p. 307). When CMS does finally issue the reg, suppliers will be eager to see whether the face-to-face exam requirement applies to mobility devices only, or all durable medical equipment as proposed.

Wheelchair Reimbursement Worries Experts

The new wheelchair codes, rumored to be up to 48 separate codes for wheelchairs and scooters, should not be far behind the other wheelchair issuances. But CMS will take longer to issue the payment rates that will go along with the codes, notes Erik Sokol with the Power Mobility Coalition.
 
CMS will develop "accurate individual payment ceilings ... for each of the new codes," the agency says in a release. If the new coverage guidelines are fair but the reimbursement levels for wheelchair codes are too low, beneficiary access to equipment still will be denied, Sokol worries.
 
New code rates will likely be out a few months before the codes take effect next summer - if CMS stays on track with its timeline, Johnson notes.
 
Even farther off on the horizon for wheelchair suppliers are new supplier standards and competitive bidding. CMS hopes to finalize the supplier standards next fall, it says.

The agency "will consider which items, including power mobility devices, would meet the criteria ... for the competitive bidding program," CMS says. Power wheelchairs are widely seen as a bidding favorite, because they are individually expensive and utilization has grown significantly.