Medicare permits walker upgrades

Friday, March 28, 2014

Persistence paid off in this case. Below is the final determination from Medicare since the initial HME News article (“Unbundling trips up providers,” December 2013). 

The DME Medical Directors have decided that hand brakes are different from glide-type brakes and can be billed at initial issue for some walkers (i.e., E0143 is the most common HCPCS code billed) per the related Policy Article for Walkers. Use A9270 when billing hand brakes and other enhancement accessories. It is also important to remember that suppliers should bill separate A9270 for each enhancement accessory. There should not be one claim line of A9270 and a “bulk” price for all enhancement accessories.

Recently, the Competitive Bidding Ombudsman began placing inquiries to contract suppliers in Florida for charging upgrades on the three- and four-wheeled walkers. It stated that these types of walkers fell within the recent “bundling” guidelines and that beneficiaries should not be charged.

I became directly involved and was persistent and resolute in this issue with provider outreach in multiple jurisdictions. After submitting various arguments and concerns to Dr. Hoover regarding the inconsistencies in the interpretation of the policy article, as well as manufacturer evidence that hand brakes are distinctly different from “glide type” brakes, a meeting with the Medical directors was held.    

I am happy to report that it was determined that walker upgrades will be permitted for hand brakes, color, basket or pouch and/or style and must be separately listed on your delivery ticket along with the corresponding charge for each. An ABN is not required as these are statutorily non-covered items.

—Sylvia Toscano, president, Professional Medical Administrators, Inc., 

Boca Raton, Fla.