Medicare Compliance & Reimbursement

Congress withholds funding to delay interim final rule's implementation.

Power wheelchairs and scooters will be moving along much more quickly than their claims reimbursement for the next six weeks.

Physicians should hold off on submitting claims for power mobility devices until April 1, 2006, the Centers for Medicare & Medicaid Services announced in a Feb. 14 fact sheet. The postponement follows a Congressional directive in the Appropriations Act (H.R. 3010) that prohibits CMS from using funds to implement its PMD interim final rule until April 1.

The interim final rule, which went into effect Oct. 25, 2005, requires physicians, physician assistants, nurse practitioners and other treating practitioners to perform a face-to-face examination on individuals requiring PMDs prior to payment. Providers must also issue a written prescription for the device and submit pertinent parts of the medical record to the durable medical equipment supplier within 30 days of the examination. Under these terms, Medicare will provide a $21.60 add-on payment for the office visit.

CMS is confident that the PMD rule is valid, and the agency will continue to process claims for PMD-related evaluation and management visits under the rule's conditions. But CMS will not adjudicate claims for the PMD add-on payment (code G0372) until it can implement the interim final rule on April 1.

After April 1, providers must submit a PMD E/M visit and the G0372 code together on the same claim. But until that time, CMS offers providers the following options for PMD claims:

• Submit the PMD E/M visit and G0372 code together on the same claim. CMS will hold payment on the entire claim until April 1.

• Submit a claim for the PMD E/M visit, but wait until April 1 to submit a separate claim for the G0372 add-on payment.

• Wait until April 1 to submit any claim that contains the G0372 code.

For more information, go to http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1780.