Details on new PWC codes continue to trickle in

Sunday, June 18, 2006

WASHINGTON - The industry began to see CMS's new power mobility codes in sharper focus last week, when the SADMERC posted a document on its Web site that provided additional details on code descriptions and testing requirements.

The SADMERC released the 64 codes, which go into effect Oct. 1, 2006, in early June. The industry's immediate response: We need additional information on testing requirements, coverage criteria and pricing.

While it's still far from seeing the whole picture, the industry now knows what CMS expects providers to supply for each code. A K0007, for example, is described as "power wheelchair, Group 1 standard duty, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds."

Those descriptions also give manufacturers an idea of where CMS will plug in their products.

As for the testing requirements: The document states that CMS plans to publish a new set of requirements soon. Those requirements will incorporate existing standards from RESNA and ANSI, as well as future technological advancements--something the industry pushed for last year when CMS released its last version of codes and testing requirements.

Unfortunately, the document also states that manufacturers will have to have their products retested in an independent testing facility. That doesn't make sense, said industry sources, because most major manufacturers already have their own testing facilities.

"We have several concerns: Testing is a tremendous expense that we already incur, and there aren't enough independent testing facilities to test all the products," said Cara Bachenheimer, vice president of government relations for Invacare.

Industry sources can see why CMS wants the testing done by an independent facility--some manufacturers claim their products have passed ANSI and other tests, but, right now, there's no real way of knowing.

"Now we'll be able to compare apples to apples, oranges to oranges and junk to junk," said Mark Schmeler, a faculty member at the University of Pittsburgh who sat on a 14-member technical panel that provided CMS with recommendations for the new codes.

CMS could achieve its goal, Bachenheimer said, by conducting audits--or have a third party conduct audits--to make sure that testing performed by manufacturers is "up to snuff."

At the end of the day, until the industry sees coverage criteria and pricing, it remains "a little nervous," Schmeler said.