CMS revises fee schedule for PMDs

 - 
Sunday, March 25, 2007

WASHINGTON - The revised fee schedule for power mobility devices that CMS released last week contains a mixed bag of increases and some "unexpected" decreases, said industry sources.

The biggest increase came for K0825. CMS bumped up reimbursement for the Group 2 power wheelchair with captain's chair from $4,229.60 to about $4,433.20 or about $204. Other chairs with increases: K0859 (an increase of about $174) and K0851 (about $152).

The biggest decrease came for K0848. CMS cut reimbursement for the Group 3 power wheelchair with seat/back from $5,433.60 to $5,284.40 or about $149. Other chairs with decreases: K0835 (a decrease of about $75), K0838 (about $40), K0822 (about $11) and K0850 (about $10).

"There were unexpected decreases in several codes," said Cara Bachenheimer, vice president of government relations for Invacare.

The new fees are effective for claims with dates of service on or after Jan. 1, 2007. Beginning April 2, 2007, suppliers may submit previously processed claims for these codes with dates of service on or after Jan. 1, 2007.

Additionally, for the following codes, the new fees are effective for claims with dates of service Nov. 15, 2006, through Dec. 31, 2006: K0825, K0850, K0851 and K0859.

To make a full assessment of the new fees, industry stakeholders plan to ask CMS for its calculations, said Don Clayback, who heads up The MED Group's National Rehab Network.

At least one manufacturer, Pride Mobility Products, was expecting CMS to correct an erroneous MSRP by increasing reimbursement for K0823, but that didn't happen.

"We're disappointed," said Seth Johnson, vice president of government relations for Pride. "We're not sure why that wasn't corrected."

Johnson, who also chairs AAHomecare's rehab council, had a call scheduled with CMS for late last Friday.

Links: