Medicaid relents on stander accessories

Thursday, July 22, 2010

ATLANTA - It seems like, even when rehab providers here make progress, it's often a good-news, bad-news scenario.

The good news: Rehab providers recently convinced the state's Medicaid program to resume paying for stander accessories. The bad news: Medicaid is in the middle of switching to a new claims processor and, until that's over, its hands are tied.

"It might be a year before providers are able to bill for accessories again," said Laura Cohen, co-coordinator of The Clinician Task Force, which is based in Georgia.

Medicaid stopped paying for stander accessories in January. That's when it eliminated E1399, a miscellaneous code used by providers to bill Medicaid for accessories.

The move had quite an impact, because most standers require accessories, Cohen said.

"They're not useful without them," she said. "A quad can't use a stander without back and chest supports."

Since January, providers have either stopped providing standers  or limited the number of standers they provide, says provider Weesie Walker.

"There's a fairly large market for them, not only for kids but also adults," said Walker, who manages the National Seating & Mobility branch in Atlanta.

Medicaid has agreed to allow providers to use what's called a U modifier--basically, a local code, Cohen said--to bill for stander accessories.

If all goes as planned in Georgia, "we'll try to do the same thing on a bigger level--having CMS share instructions with different state Medicaid programs," she said.