Medicare revamps power wheelchair equipment package

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Sunday, February 4, 2007

WASHINGTON - Providers can now bill separately for several power wheelchair components, according to a DME PSC Bulletin published Jan. 26.

Providers can bill separately for angle adjustable footplates for Group 3, 4 and 5 power wheelchairs for claims with dates of service on or after Jan. 1, 2007. They can also bill separately for sling/solid seat/back, non-standard seat widths and/or depths for Group 3 and 4 power wheelchairs.

"This will really help to improve total reimbursement," said Seth Johnson, chairman of AAHomeare's rehab council and vice president of government affairs for Pride Mobility.

The revised basic equipment package now includes the following items (i.e. no separate billing/payment at the time of initial use, unless otherwise noted):

* Lap or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately.
* Battery charger, single mode.
* Complete set of tires and casters, any type.
* Legrests. There is no separate billing/payment if fixed, swingaway or detachable non-elevating legrests with or without calf pad are provided. Elevating legrests may be billed separately.
* Footrests/foot platform. There is no separate biling/payment if fixed, swingaway or detachable footrests or a foot platform without angle adjustment are provided. There is no separate billing for angle adjusted footplates with Group 1 or 2 power wheelchairs. Angle adjustable footplates may be billed separately with Group 3, 4 and 5 power wheelchairs.
* Any weight specific components (braces, bars, upholstery, brackets, motors, gears, etc.) as required by patient weight capacity.
* Any seat width and depth. Exception: For Group 3 and 4 power wheelchairs with a sling/solid seat/back, the following may be billed separately:
o For Standard Duty, seat width and/or depth greater than 20 inches;
o For Heavy Duty, seat width and/or depth greater than 22 inches;
o For Very Heavy Duty, seat width and/or depth greater than 24 inches; and
o For Extra Heavy Duty, no separate billing.
* Any back width. Exception: For Group 3 and 4 power wheelchairs with a sling/solid seat/back, the following may be billed separately:
o For Standard Duty, back width greater than 20 inches;
o For Heavy Duty, back width greater than 22 inches;
o For Very Heavy Duty, back width greater than 24 inches;
o For Extra Heavy Duty, no separate billing
* Controller and Input Device. There is no separate billing/payment if a non-expandable controller and a standard proportional joystick (integrated or remote) is provided. An expandable controller, a nonstandard joystick (i.e., nonproportional or mini, compact or short throw proportional), or other alternative control device may be billed separately.
Providers should use the code K0108 to bill for nonstandard seat dimensions and nonstandard back dimensions, according to the release.

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