CMS readies new PWC codes

Saturday, July 31, 2004

WASHINGTON - Look for CMS to reveal its new coding proposal for power wheelchairs in September with an ultimate implementation deadline of July 2005, said a CMS official in June. However, that timeline, say some industry observers, is lofty considering the undertaking that lies ahead.

“CMS mentioned July 2005 as a timeframe for implementation, which I think is very ambitious for getting it done,” said Seth Johnson, director of government affairs for Pride Mobility. “It’s going to be difficult for them to meet that targeted timeframe.”

CMS’s plan calls for a “national coding panel” to develop codes that better describe the wheelchairs available on the market.The coding initiative was revealed during Dr. Herb Kuhn’s, director of CMS’s Center for Medicare Management, testimony before the Senate Finance Committee in April and in the agency’s three-prong initiative to tackle power wheelchair coverage and payment policy.

“When [CMS] says we are working with a national panel, I think what that means is that we are going to take extra steps that we don’t normally take for a coding initiative,” said the CMS official.

The industry in recent years has clamored for a revision of the K0011 code, saying it is overly broad and does not take into account the technology that is available.

“The K0011 was put together back in 1995 without any real rhyme and reason to it because the technology was not there at the time,” said Sharon Hildebrandt, executive director of the National Coalition for Assistive and Rehab Technology. “Now what they are doing is categorizing apples and oranges within the same category. Different beneficiaries require different kinds of wheelchairs and the complexity changes the amount they cost.”

The new codes are expected to break down according to available technology, and there likely will be a jump in the overall number of power chair codes in use, said the official. CMS also identified the need for new codes to streamline the competitive bidding program, which is scheduled to begin in the 10 largest metropolitan areas in 2007.

“If you have an overly broad code it would be difficult to do the bidding,” said the official. “More codes will give us a better way of implementing and enforcing quality standards for the different types of wheelchairs for the different needs.”

Usually CMS receives coding requests from the outside for an annual HCPCS update. The requests are then reviewed by CMS and a national editorial panel before being accepted or rejected.

In this case, the SADMERC and DMERC medical directors hashed out their code set, which was then submitted to CMS for revisions. CMS will also share the proposal with other federal agencies, namely the Department of Veteran’s Affairs, to get their comments before the code set is published. CMS hopes to release the agency’s suggestion this fall, followed by a public meeting where people can make comments and suggest changes, said the CMS official.