Q. Does the new ATS requirement apply to scooters and standard power wheelchairs?
A. Medicare policy as of April 1, 2008, is fairly straightforward. For dates of service on or after April 1, any supplier providing a Group 2 single power option or multiple power option power wheelchair (PWC), any Group 3 or Group 4 PWC, or a push rim activated power assist device for a manual wheelchair must employ a RESNA-certified ATS or ATP who specializes in wheelchairs and has direct involvement in the wheelchair selection for the patient. As far as PWC codes are concerned, this means anything coded K0835 and above will require the supplier to involve an ATS/ATP; any power chair coded below K0835 will not.
Two other aspects are also worth mentioning. For those PWCs listed above, the policy had required that an independent evaluation be performed by an ATP specializing in wheelchairs or by a physician who is board-certified in physical medicine and rehabilitation. The American Occupation Therapy Association, the American Physical Therapy Association, AAHomecare and NCART all sent letters to the DME PSC medical directors expressing concern that there are not enough ATPs throughout the country to satisfy the requirement. The medical directors agreed and, for the time being, have removed the requirement.
One other requirement currently in the policy remains: Any patient receiving PWCs coded K0835 and above must have “a specialty evaluation that was performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for the wheelchair and its special features. The PT, OT, or physician may have no relationship with the supplier.”
The bottom line is this: Code K0835 is your cutoff code. HME
Paul Komishock is general manager of government affairs for Pride Mobility Products in Exeter, Pa. Reach him at firstname.lastname@example.org or (800) 800-8586 ext.1293