Could K0821 help ease bid wounds?

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Friday, March 1, 2013

WASHINGTON – There are only two things that separate the K0823 and K0821 power wheelchairs—and they could make all the difference for mobility providers in Round 2 competitive bidding areas.

The two power wheelchairs both fall into Group 2, are intended for patients who weigh up to 300 pounds and feature captain’s seats. They even have the same coverage criteria, according to industry stakeholders.

But K0821 is portable, and the reimbursement for this power wheelchair didn’t get slashed under Round 2 like K0823, they say.

“The K0823 is the most heavily utilized power wheelchair included in the Round 2 competitive bidding codes, and its reimbursement was reduced by nearly 50%,” said Seth Johnson, vice president of government affairs for Pride Mobility.

In Akron, Ohio, for example, the reimbursement for K0823 will be $1,800 under Round 2. K0821 will be $2,582. In Albany, N.Y., it’s $1,848 vs. $2,128, respectively.

Because of this, providers may turn to K0821 and even possibly K0816, a Group 1 power wheelchair, both of which now have higher reimbursements than K0823 and can still meet a patient’s mobility needs, stakeholders say.

“The documentation for the bases are the same,” said Martin Szmal, founder of The Mobility Consultants. “There’s no reason you wouldn’t be able to provide K0821 instead.”

The heavy utilization rates for K0823 may have led to its downfall and opened the door for comparable codes to fare much better, says Szmal.

“People weren’t as competitive in their bids for these power chairs, because they don’t really provide them,” he said. 

This means mobility providers could have some options—something they are searching high and low for since standard manual and power wheelchairs saw an average cut of 36% as part of Round 2.

“The rates are shockingly low, so providers are looking at all kinds of angles,” said Johnson. “They’re asking, ‘Is this in any way workable, and, if so, how?’”