Different take on unbundling

Friday, December 20, 2013

In response to your story “Unbundling trips up providers” (HME News, December 2013), I would like to draw your attention to the following clarification from the Jurisdiction B DME MAC:

“Hand operated brakes are considered an enhancement (with the exception of those described in code HCPCS E0147). An enhancement accessory is one which does not contribute significantly to the therapeutic function of the walker. Suppliers are to bill HCPCS code A9270 when an enhancement accessory for a walker is billed.Therefore when billing for hand brakes with walker code E0141, E0143 or E0149, use code A9270 to bill. Upon initial issue of an E0141, E0143 and E0149, charges for glide brakes are included in the reimbursement for the walker and may not be billed separately to the DME MACs or the beneficiary.”

You may charge the patient for the hand brakes, color and basket portion, and collect the rest from Medicare for the walker and seat if applicable.

When a patient chooses a walker with enhancement accessories, such as a three-wheeled or four-wheeled walker with hand brakes (aka “rollator”), a contract supplier can collect additional money directly from the Medicare beneficiary because these items are considered statutorily non-covered.

Since these types of walkers typically cost more than the single payment amount, a contract supplier is not forced to provide these models at a substantial loss when requested by a beneficiary or prescriber.

—Sylvia Toscano, president, Professional Medical Administrators, Boca Raton, Fla.