E1010: Providers can't afford it

Tuesday, November 23, 2010

WASHINGTON - Thanks to some tricky moves on CMS's part, center elevated leg rests are nearly impossible for providers to put on power wheelchairs.

It all starts with a change to the code for power elevated leg rests, E1010. CMS changed the definition for the code from "each" to "pair," but it didn't change the reimbursement. So providers started getting paid half of what they used to for two leg rests.

Then CMS lumped center elevated leg rests into E1010. Because there's not two but one leg rest, providers started getting paid half of the already halved reimbursement.

"When (Medicare) pays about $600 for something that costs about $2,800, that's, effectively, a denial," said Darren Jernigan, director of government affairs for Permobil. "It's so low, providers can't afford it."

Industry stakeholders are meeting with the medical directors at the DME MACs to try and rectify the situation.

Part of the industry's argument: Even though a center elevated leg rest is one leg rest doesn't necessarily mean it should get reduced reimbursement, stakeholders say.

"The bottom line is that it's lifting both legs not just one leg," said Elizabeth Cole, director of clinical rehab services for U.S. Rehab. "The actuator has to be more robust; it has to be more durable. Some of them actually have two actuators."

It's a shame, stakeholders say, because patients can benefit from center elevated leg rests. The leg rests make it easier, for example, for wheelchair users to get close to tables and desks.

"There are differences in the technology and different clinical indicators for each," said Laura Cohen, co-coordinator of The Clinician Task Force.