Mobility providers balk at single code system

Friday, August 8, 2014

YARMOUTH, Maine – Mobility providers aren’t lining up to support a CMS proposal to describe, and pay for, standard manual and standard power wheelchairs each under a single code.  

Ninety-five percent of the 98 respondents to a recent HME NewsPoll say they don’t like the plan. There are too many differences between wheelchairs—combining them under a single code would encourage the use of cheap products with few options, they say.

“There are too many variations based on the individual patient,” said E. Patrick Smith, president of Community Medical Supply. “You have to have a way to identify those variables.”

CMS proposed the single code system on July 11 as part of another proposal to implement bundled monthly payments for wheelchairs and other DME.

Shalon James, a coding and billing specialist for South Tyler, Texas-based Access2Mobility, is one of the 5% of respondents backing the plan, at least for standard manual wheelchairs.

“Medicare should take a page out of Texas Medicaid’s book on the manual wheelchair coding,” James wrote. “There are a lot of different codes available on the standard wheelchairs, but it cuts down on the number of line items on your claim.”

Respondents were split evenly over whether the coding system should be changed at all—49% said yes for manual wheelchairs and 47% said yes for power wheelchairs.

CMS’s last significant change to the coding system: About 10 years ago, it broke up four power wheelchair codes into 61 codes.

“(A single code) is not the answer, but 50 codes is not the answer, either,” wrote Dan Lipka, a former NRRTS president. “Changes are needed, but the July 11 proposal is like jumping out of the proverbial frying pan and into the fire.”

Other stakeholders agree it’s time for changes. One respondent says there are too many power wheelchair codes, but not enough manual wheelchair codes.

“The manual wheelchair codes are too few, are archaic and do not reflect the breadth of available technology,” the respondent said. “The power codes are too numerous.”