Codes taking longer than expected

Wednesday, May 31, 2006

WASHINGTON - Predictions that CMS would implement new codes for power mobility devices in July or October could turn out to be wishful thinking.
"July is almost impossible, because we're in May and we have no codes," said Seth Johnson, vice president of government affairs for Pride Mobility. "I'm hearing the earliest is October, and it could even be January."
ECRI, a company that CMS contracted to oversee the coding project, forwarded a report to the SADMERC in late March. The report contained recommendations from a technical panel, whose members included manufactures and providers.
CMS must now review the report and develop new codes.
Last year, CMS released two sets of new codes--49 codes in February and then, replacing those, 63 codes in September. In October, however, CMS delayed implementing the codes so it could review stakeholder input.
CMS will probably consider September's codes a draft and, when it's ready, release final codes, said Cara Bachenheimer, vice president of government relations for Invacare.
When CMS releases new codes, the process should speed up from there, especially when it comes to testing products based on the codes, Bachenheimer said. "We've already submitted testing data, and we've been told that would be taken into consideration," she said.
After the codes are released, CMS will set a fee schedule and the DMERCs will release a new local coverage determination (LCD). Those developments, however, will come with more challenges.
For example, the industry fears CMS will use gap filling to set prices for the new codes. That methodology would reduce payment, on average, by about 25%, according to an AAHomecare study sent to CMS in September.