Ask the DMERC MDs

Friday, June 30, 2006

This month we are back to a favorite topic--power mobility. Over the past month, we have seen the release of the new set of HCPCS codes as well as the publication of information addressing how the power mobility equipment face-to-face requirement should be documented. In addition, we have released information about how Advance Determination of Medicare Coverage (ADMC) requests need to be documented.
Q. How were the new power wheelchair codes developed?
A. The codes presented reflect the recommendations made by a Technical Expert Panel (TEP) commissioned by CMS. The TEP was comprised of representatives from the technical, scientific, manufacturing, supplier, testing, and clinical sectors of the power mobility industry. The TEP recommendations were presented to CMS, the SADMERC, and the DME Program Safeguard Contractor (PSC) medical directors. The new code set was created based upon those recommendations. Codes resulting from this collaborative effort allow placement of individual devices into performance-based categories.
Q. What happens to the products that were reviewed last year based upon the original group of proposed codes?
A. All devices previously submitted for coding under the February 2005 parameters will be assigned a code. Code assignments will be based on the performance testing data provided to the SADMERC for code assignment under the February 2005 code criteria. Remember, assignment of a HCPCS code does not indicate coverage or payment for the item. This current set of temporary codes is an interim step to allow code revision implementation in a step-wise and timely fashion.
Q. What future changes are planned for power wheelchair codes?
A. A revised set of test parameters was suggested by the TEP in response to CMS needs to allow for incorporation of future technological advances. These standards will be published soon, along with a timetable for completion. All PMDs will have to be retested, in an independent testing facility, according to the redefined and expanded criteria. Test results will be submitted to the SADMERC and a new coding verification process will be conducted.
Q. Now that the regulation for power mobility is final, what documentation changes should we be aware of?
A. The final rule is similar to the interim final rule, which became effective for claims with dates of services on or after Oct. 25, 2005--with one significant change. The final rule states that the physician's order for a power mobility device and a copy of the report of the face-to-face evaluation of a patient's mobility needs must be received by the supplier within 45 days following the completion of the face-to-face evaluation. The previous requirement was that these documents be received by the supplier within 30 days following the face-to-face examination.
Q. The power mobility policy revisions published in June 2006 added a "date stamp" requirement for the face-to-face exam documentation. Why was this added?
A. The Final Rule allows up to 45 days for the supplier to receive the order and report of the face-to-face exam. These documents contain the starting date for the period. A date stamp requirement was added to allow for the accurate determination of the time span. The policy states:
In order to document that the order and the report of the face-to-face examination was received by the supplier within 45 days after the date of the face-to-face examination, the supplier must use a date stamp or equivalent on the documents.
Remember to monitor your region's Program Safeguard Contractor web site for additional information.