CMS proposes new wheelchair coverage criteria; PWC codes

Sunday, February 6, 2005

February 7, 2005

WASHINGTON - Medicare issued proposed new coverage criteria for wheelchairs and scooters Friday. The department also announced Friday that to better reflect the range of power mobility products now available on the market, Medicare will expand the number of codes used for billing from 5 to 49.
If implemented, the new coverage criteria would require CMS to rely more on clinical-based coverage decisions and replace the existing “more rigid standard” that relies on whether a patient is bed or chair confined.
 “In taking these steps, we move closer to our goals of supporting appropriate prescribing, making accurate payment, and providing clear guidance to physicians and suppliers about power mobility devices,” said CMS Administrator Mark B. McClellan. “This will take us a long way toward bringing this important benefit into the 21st century. It also makes it clear that Medicare recognizes the importance of clinically-based coverage decisions.”
CMS plans to publish the final coverage criteria in March and to provide guidance on how to use and document the new criteria.
Besides reflecting the range of power mobility products now on the market, more detailed coding will help facilitate getting the right products to patients and improve Medicare’s ability to pay suppliers appropriately.
“The technology, range of products, and market for power wheelchairs have changed substantially since the HCPCS codes for power wheelchairs were last revised in 1993,” said CMS Center for Medicare Management Director Herb Kuhn. “Currently, Medicare uses only one code, K0011, to pay for most power wheelchairs. Having more codes will permit us to more accurately reflect the different kinds of mobility products our beneficiaries are using.”
The new codes will incorporate “testing standards” in several areas (i.e., weight capacity, fatigue testing, speed and range testing). Accurate individual payment ceilings will also be developed for each of the new codes. The codes will go into effect on Jan. 1, 2006.