CMS prepares to unveil new PWC code set

Tuesday, August 31, 2004

WASHINGTON - CMS plans to reveal its new billing codes for power wheelchairs at a four-hour CMS public meeting on Sept. 1, according to a Federal Register notice posted in late July. Details of the meeting were not available at press time.

Aside from mutual agreement that changes to the K0011 are necessary, there has been little discussion between the industry and regulators on this issue.

“[CMS] hasn’t provided substantive comments, except for rejecting RATC’s and NCART’s proposal, so this is a very significant development,” said Seth Johnson, vice president of government affairs for Pride Mobility.

NCART’s most recent K-code revision was rejected for the 2004 HCPCS update, but the organization did present its recommendations during a June public meeting. NCART has also been invited to present its codes and the methodology used in formulating them during the Sept. 1 meeting.

“When [NCART] submitted its code applications back in March we included supporting documentation including the methodology we used to develop the codes. We also talked about the methodology at the public meeting on June 29,” said Sharon Hildebrant, NCART’s executive director. “It is our hope that the DMERCs and the SADMERC Medical Director Dr. [Doran] Edwards listened very carefully to what we were saying and that they have been able to review what our methodology was and that they will take it into consideration.”

NCART’s proposal broke the existing K-codes into seven new codes based on the various levels of technology available in the power chair market. Johnson said there has been some talk that CMS is looking at limiting the changes to three or four codes.

“This is going to be a preliminary proposal and hopefully they’ll listen to what the industry has to say,” said Johnson. “We are as anxious as everyone else to see what direction CMS is moving.”

CMS said the new power wheelchair codes have been established with input from the industry, SADMERC, DMERCs and other government agencies - namely the Veteran’s Administration.

“Ultimately we hope to have new codes implemented by July 2005,” said a CMS official.