Academics join K0011 criteria fracas

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Saturday, January 31, 2004

PITTSBURGH - CMS’s so-called policy clarification for K0011 coverage at the end of 2003 garnered complaints from within in the HME industry but also received criticism from an unexpected source.

Faculty at the University of Pittsburgh’s prestigious School of Rehabilitation Services and Technology sent a letter last month to DMERC Region A Medical Director Paul Hughes outlining their objections to the clarification.

“As healthcare professionals, with no financial interest in the equipment we prescribe, and as faculty involved in teaching and research, we are very concerned with any review policies that might harm patients who legitimately need powered mobility devices,” the letter began.

The DMERC’s policy guidance, which came Dec. 9, reaffirms Medicare’s stance that power mobility recipients be nonambulatory and require the device to move around their home only. The strongest language in the policy states that recipients must otherwise be bed or chair confined to qualify.

In its letter, Pittsburgh’s faculty questions the strict interpretation of the policy and declares it “inappropriate.”

“There are no other medical or rehabilitation benefits under the Medicare program that have such coverage restrictions,” they said. “Therapists are not restricted from providing gait training until the patient is nonambulatory. A surgeon is not restricted from replacing a degenerated joint until the patient is completely unable to ambulate.”

The group also asked for further clarification on the home/residence restriction of the policy and suggests the wording be replaced with “any place a person is required to perform activities of daily living as a part of his customary daily routine.”

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