PMD demo: CMS may change stance on accessories

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Friday, July 27, 2012

WASHINGTON – The newest draft version of an operations guide for the power mobility device (PMD) demonstration project includes a word providers have been hoping to see: accessories.

A note in the guide, "Accessories: reserved for future use," which is listed with the PMD codes that will be included in the demo, is a placeholder, CMS officials stated during an Open Door Forum July 27.

"At this point in time, we have not made a decision," said Doris Jackson, a health insurance specialist at CMS, during the call. "Once we have made a decision we will surely let the industry know."

During the last forum for the PMD demo, providers questioned how CMS could determine the medical necessity of a power wheelchair if the accessories that are added to meet a patient’s needs aren’t included in the process.

Until CMS makes a decision, providers should continue to follow local coverage determinations (LCDs), stated Melanie Combs-Dyer, deputy director of CMS's Provider Compliance Group. When the LCD requires that wheelchair bases be submitted with accessory documentation, providers should do so, she said.

During the question-and-answer period of the forum, numerous stakeholders, including Don Clayback of NCART and Seth Johnson of Pride Mobility Products, commented on the need for more physician education and for tools to help physicians complete documentation. Combs-Dyer stated CMS will send informational letters to physicians prior to the start of the demo, and it will issue a MedLearn Matters article sometime soon.

Dyer also stated that detailed denial letters will be “excellent educational opportunities” for physicians.

The newest draft guide is available here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Prog...

The next Open Door Forum for the PMD demo is scheduled for 2 p.m. EST Aug. 8.