Medicare revises pricing

Sunday, December 31, 2006

WASHINGTON - CMS officials made good on a promise last month to further increase pricing for power mobility devices, but they weren't as generous as the industry hoped they would be.
While CMS bumped up payment for one Group 3 power wheelchair by $1,147, it increased reimbursement for K0823 and K0825--two popular power wheelchairs in the browbeaten Group 2--by only $75.20 and $277.60, respectively. The industry had hoped for increases of up to $400 for K0823 and $600 for K0825.
"We're anxious to see the details of their calculations, so we can actually make sure these payment rates are accurate," said Seth Johnson, chairman of AAHomecare's rehab council and vice president of government affairs for Pride Mobility. "Because they were lower than we expected."
CMS's revisions, released Dec. 13, spelled out increases for all codes, with a few exceptions. Officials reduced reimbursement for the following Group 2 chairs: K0830 and K0831 by $511.80, and K0841 and K0842 by $232.90. Additionally, they reduced reimbursement for K0859, a Group 3 chair, by $552.90.
The cuts, Johnson said, "were not expected."
The new prices are retroactive to Nov. 15, meaning providers can resubmit previously paid claims for adjustment.
CMS revised prices after verifying product data and correcting technical errors in the fee schedule, the agency stated.
Only after it has received CMS's calculations--probably before the end of the year--will the industry know how to move forward, Johnson said.