CMS ignores plea to revamp PWC codes

Wednesday, December 31, 2003

WASHINGTON - The industry entered 2004 with no change in Medicare coding for power wheelchairs, disappointing AAHomecare’s rehab council, which worked long and hard dividing four power codes into six.

AAHomecare’s Rehab and Assistive Technology Council proposed dividing the K0010, K0011, K0012 and K0014 codes into six new codes. The proposed codes more specifically matched a patient’s clinical indicators/condition with the appropriate power chair, said Executive Director Sharon Hildebrandt.

“Our codes would have made it easier to place patients in chairs appropriate for their levels of functioning and the technology available,” she said. “If you had this disability you would fit into this kind of chair.”

CMS has not told RATC why it denied the new power chair codes.

The largest power wheelchair code, the K0011, desperately needs revamping, say industry watchers, who call it a “dump code” because it includes low-end chairs, high-end chairs and everything in between.

“The KOO11 has an allowable of $4,600 under Medicare,” said Gary Gilberti, vice chair of RATC. “Every K0011 I do - whether it is a low-end consumer K0011, which we don’t do, or a high-end rehab chair - will get reimbursed at the same amount. I’m going to make a lot of money or lose a lot of money.”

By splitting the codes as RATC suggested and appropriately pricing high- and low-end technology CMS could reduce fraud and abuse and better monitor and control utilization, one provider said.

CMS’s failure to adopt the new HCPCS for power chairs is a double whammy. Under HIPAA, managed care companies and state Medicaid departments will use the HCPCS as part of a universal coding system. Now, all three payers will be employing inadequate power codes, say industry watchers.

In all, RATC submitted 32 new codes and CMS accepted six, including two for transfer benches and two for wheelchair accessories.