CMS debuts 64 codes for PWCs, scooters

Friday, June 30, 2006

WASHINGTON - When CMS released 64 new power mobility codes last month, it provided so few other details that the industry wasn't quite sure what to make of them.
What's still missing: additional testing requirements, coverage criteria and pricing.
"I think what we've got here is a skeleton," said Simon Margolis, who sat on a 14-member technical panel that provided CMS with recommendations for the new codes. "We have to see what happens when they start hanging some flesh on it."
The codes, which go into effect Oct. 1, 2006, are organized into six wheelchair and two scooter groupings based on functionality and performance. Each group has sub-divisions based on "patient weight capacity and/or powered seating system capability."
Additionally, the codes--61 codes plus three miscellaneous codes for a total of 64--include not only the type of "base" but also options and accessories.
It won't be until the testing requirements, the coverage criteria and pricing are released, however, that the industry will be able to put the new codes into context, said Cara Bachenheimer, vice president of government relations for Invacare.
"It's a good overall framework, but we can't really assess the final impact on beneficiaries and their ability to access these products until these holes are filled in," she said.
There's still enough information in the new codes to give the industry some pause. The codes are "sliced and diced" pretty thinly, said Sharon Hildebrandt, executive director of NCART. For example, one of the few differences between the codes in two of the groups is speed and range, industry sources said.
"The question, from a medical policy standpoint is, how do you distinguish that much between those two levels of products?" Bachenheimer asked.
On the plus side, the codes seem to be set up in way that, when CMS applies gap-filling methodology, it should come out with appropriately priced products, Margolis said.
"Because there's a difference between a standard captain's chair and a standard sling seat and back chair, for example, we won't get underpaid for the sling seat and overpaid for the captain's chair," said Margolis, vice president for clinical and professional development for National Seating & Mobility. "Right now, with the K0011 code, everything is lumped in together, and if there's no differentiation, it goes to the least-common denominator."