CMS reviews rehab codes for approval

Sunday, June 30, 2002

WASHINGTON - AAHomecare's Re/hab and Assistive Technology Council (RATC) believes it has convinced CMS not to lump 14 product codes for pediatric mobility into six codes, after pleading its case during a DME Open Meeting last month.

RATC submitted the 14 codes, along with several accessory codes, to CMS in April and attended the meeting to see whether the agency would give them its stamp of approval. CMS's preliminary recommendation was to blend the codes and reimburse them as capped rental equipment.

"After Tuesday [June 17], I feel wholeheartedly that they'll change their mind," said Rita Hostak, chairman of both RATC and its coding committee.

Hostak said CMS wanted to group lightweight pediatric wheelchairs together, for instance. RATC takes issue with that because the wheelchairs in that category can have "very different" technology, she said. Some are length adjustable, for instance; Others grow.

Keeping the codes specific is important for two reasons, Hostak said. First, it prevents CMS from paying for more than a beneficiary gets. Second, it keeps CMS from paying so little that a beneficiary misses out on the newest technology.

Furthermore, Hostak said pediatric mobility equipment is typically purchased.

RATC will not know whether its codes are approved, as submitted or changed, until Nov. 15.

Hostak said whether CMS approves RATC's first batch of codes is the "biggest step" the council's coding committee has had to take to date. The committee has been charged with overhauling the HCPCs codes for all rehab equipment by October 2003.

"This is going to set the stage for everything else we submit going forward," Hostak said. "Either we're going to gain a ton of credibility or we're going to have a really high hill to climb."

At the meeting, RATC enlisted the help of a girl named Carli Snell in swaying CMS. Although the girl couldn't attend the meeting, her mother, Theresa Snell, sent a videotape to demonstrate what a day's like for a child with a disability.

"You really needed to have been in the room to see the change it inspired," Hostak said. "The video brought it home that this isn't stuff that they should just analyze for price. It gets used."

RATC's goal is to continue submitting new codes every 60 days from here on out, until its coding project is complete. It's currently working on power mobility and seating.

Any new codes approved by CMS will go into effect Jan. 1, 2003. HME