CMS revises fees for PMDs

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Monday, April 30, 2007

WASHINGTON - The revised fee schedule for power mobility devices that CMS released March 22 contains a mixed bag of increases and some "unexpected" decreases.
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 ($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 ($11) and K0850 ($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, the new fees are effective for claims with dates of service Nov. 15, 2006, through Dec. 31, 2006, for the following codes: 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 rehab network.
At leas one manufacturer, Pride Mobility Products, was expecting CMS to correct an erroneous MSRP by increasing reimbursement for K0823, one of the most commonly prescribed wheelchairs, but that didn't happen.
"We're disappointed," said Seth Johnson, vice president of government relations for Pride.

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