PMD codes: Some relief could be under way

Sunday, October 22, 2006

WASHINGTON - The rehab industry learned last week that CMS has agreed to look into adjusting pricing for two important power mobility devices: the group 2 standard power wheelchair and group 3 single power wheelchair.

Shortly after CMS released new pricing Oct. 2, the industry pointed out to agency officials that the rate of inflation they used to determine pricing for the two wheelchairs was inconsistent with the rate used for the other PMDs. The result: Pricing was about 8% and 9% lower than it should have been for the group 2 standard power wheelchair (K0823) and group 3 single power wheelchair (K0856), respectively.

"CMS recognizes that we have a valid concern, and it plans to issue as prompt a response as possible," said Dan Meuser, president of Pride Mobility Products. "They're important codes."

To determine new pricing, CMS used a methodology known as gap filling. It deflated prices to 1987 levels--the base year of the DME fee schedule--then inflated them using CPI increases.

Pride officials met with members of the powerful Senate Finance Committee last week to express their concerns with CMS's new pricing, particularly pricing for K0823 and K0856. The committee members agreed to contact CMS on the industry's behalf.

If CMS adjusts pricing for the two wheelchairs, it'll be a step forward, but Meuser acknowledged that the new pricing still represents cuts of up to 40% for some PMDs.

"It's going to be impossible for providers to provide some of these wheelchairs to Medicare beneficiaries," he said. "You can drown in 25 feet of water as easily as you can drown in 250 feet of water."

CMS plans to implement new pricing Nov. 15. The industry has mounted a campaign to stop the pricing from going into effect. Last week, Pride officials even met with President Bush and some of his senior advisors to discuss the impact the new pricing will have on the industry and beneficiaries.