CMS redistributes K9 equipment

Change leaves some without proper coverage
Friday, May 24, 2013

WASHINGTON – Stakeholders feel that the assortment of manual wheelchairs and bases previously included in the K0009 code doesn’t fit well in other codes, but CMS disagrees.

CMS has spent the last year reevaluating every product in the K0009 code, which is defined as “other manual wheelchairs and bases,” and redistributing the products into different HCPCS codes.

“They’ve bundled these products in these very big, generalized buckets,” said Rita Hostak, vice president of government affairs for Sunrise Medical, and who is part of an NCART workgroup assembled to address the problem.

Manufacturers were asked in April 2012 to resubmit all products classified as K0009 to Medicare’s Pricing, Data Analysis and Coding (PDAC) contractor for review. Despite industry efforts, those products were all eventually listed under other HCPCS codes—impacting access to necessary equipment, stakeholders say.

Among the affected items: a Permobil standing wheelchair, a TiLite manual wheelchair and other specialized equipment from Invacare and PTG.

That means those products no longer have proper coding, coverage and payment, says Don Clayback, executive director of NCART.

“For some products, this has significantly lowered payments and turned others from a purchased item to a capped rental,” he said.

Some products, like Sunrise’s M6 bariatric wheelchair, were tossed into a code included in Round 2 of competitive bidding.

“This was after the bidding was complete—no supplier would have considered those products in their mix,” said Hostak.

The workgroup’s efforts—including face-to-face meetings with CMS and evidence of clinical outcomes—haven’t been successful. Stakeholders will continue to fight, however, because the consequences of depopulating the K0009 code are far-reaching, including blocking access to patients life-changing equipment.

“It’s going to absolutely impact innovation,” said Hostak. “If you can’t get appropriate reimbursement, then you’re going to be constrained in terms of new technology that you’re bringing out.”