DMERCs release 'bridge' LCD

Sunday, October 23, 2005

COLUMBIA, S.C. -- TriCenturion posted a "bridge" local coverage determination on its Web site early Wednesday morning, following CMS's decision to delay implementing the new power wheelchair and scooter codes that were scheduled to go into effect Jan. 1, 2006.

TriCenturion, the Program Safeguard Contractor (PSC) for Region A, posted the LCD at midnight. The document is meant to "carry us through" until the new codes are released, Claudia Amortegui, president of the Orion Group, told Medtrade attendees at a Thursday session called "Unraveling the Mystery: Medicare and the New World of Power."

Without the new codes, the draft LCD was an "empty document," she said.

The LCD is based on the national coverage determination and other regulatory changes, but it doesn't include any changes to the HCPCS code set, TriCenturion stated on its Web site.

Moreover, it doesn't include a requirement that was ruffling feathers in the draft LCD: that patients needing "specific use or high activity use" power wheelchairs have a face-to-face exam with an assistive technology practitioner (ATP) to meet coverage criteria. The industry estimates that, with only 1,500 ATPs in the United States, there aren't enough certified professionals to go around, especially in rural areas.

Just because the requirement was omitted from the "bridge" LCD doesn't mean it won't show up in the draft LCD, Amortegui said. "There's a good chance they'll put something back in there," she said.

One item in the "bridge" LCD that rehab providers will want to "pay attention" to involves the K0005 wheelchair, Rita Hostak told Medtrade attendees at a Wednesday session called "NCART Update." Hostak, vice president of government relations for Sunrise Medical, said the LCD deems the ultra-lightweight wheelchair medically unnecessary.

There's no comment period for the "bridge" LCD. The rehab industry has until to Dec. 31 to comment on the draft LCD, Hostak said.