CMS: Any kind of physician can prescribe a scooter

Sunday, July 3, 2005

WASHINGTON - In a major policy change that should increase beneficiary access to scooters - and possibly reduce power wheelchair utilization - CMS has eliminated the restrictive requirement that scooters can be prescribed only by a specialist in physical medicine, orthopedic surgery, neurology or rheumatology.

Region B posted the change to its Web site last week, and Region D posted it the prior week. The policy change is effective for claims with dates of service on or after May 5.

By broadening the pool of doctors who can prescribe a scooter, CMS changed a regulation that goes back many years and was most likely intended to control scooter utilization. As times changed, however, it became easier for doctors to prescribe a $5,000 PWC than a $2,000 scooter. As a result, Medicare beneficiaries often ended up with a PWC when a less expensive scooter would have adequately served their mobility needs, say providers and industry watchers.

"It did contribute to power wheelchair utilization," said a DMERC official who asked to remain anonymous. "From a common sense point of view, if you can get item A for $3 with no fuss and item B for $1 with a lot of fuss, human nature tells you what will happen."

The change in who can prescribe a scooter or power operated vehicle (POV) also falls in line with CMS's new "algorithmic approach" to determining what mobility equipment best suits a beneficiary's needs. If a scooter serves a patient best, for example, CMS does not want a doctor to prescribe a more expensive PWC. Similarly, if a walker will suffice, CMS doesn't want the patient to receive a manual wheelchair.