New mobility code, but same fee schedule?

Friday, June 5, 2015

WASHINGTON – While mobility stakeholders support CMS’s preliminary decision to establish a new code for center mount power elevating foot platforms with articulation, they are less enthused about the proposed reimbursement. 

CMS says the new code would continue to be paid at the allowable for power elevating leg rests (E1010)—$1,095—even though the MSRP for power articulating foot platforms is $2,945.

“It’s going to make it easier to bill once we have an established code, but the reimbursement is still going to be the same,” said Martin Szmal, founder of The Mobility Consultants. “The intent of getting a new code was to get a new allowable that was higher.”

CMS in April announced the preliminary decision in response to requests from Sunrise Medical, Pride Mobility Products, Permobil and Motion Concepts to better define the technology and adjust reimbursement.

During a May 27 CMS HCPCS Workgroup meeting, the public was invited to comment on CMS’s preliminary decision. 

“We laid out our disagreement with the payment methodology that they selected and why we disagreed with it and what our recommendation is,” said Julie Piriano, director of rehab industry affairs at Pride Mobility, who attended the meeting.

Given the pricing methodologies currently available, Rita Stanley, vice president of government relations at Sunrise Medical, says the best option for adjusting reimbursement for the code would be “gap filling.” Gap filling inflates outdated MSRPs to account for new technology.

“It’s a little convoluted and can come up short of the reimbursement that’s necessary, but I still think it would come out better than pricing the power articulating foot platforms equal to an E1010,” she said.

CMS will make its final decision about code and pricing in November. The code is scheduled to go into effect Jan. 1, 2016.