Provide K0005? You’ll need an ATP

Thursday, August 23, 2012

BALTIMORE – CMS officials don’t believe their decision to lump in K0005 ultra lightweight manual wheelchairs with complex rehab wheelchairs will have much of an impact on providers.

During an Open Door Forum Aug. 22, CMS officials clarified that K0005 wheelchairs are considered complex rehab wheelchairs and, therefore, providers must meet all quality standards and accreditation requirements for that product category. One of those requirements: having at least one assistive technology professional (ATP) on staff.

“We believe that the vast majority of providers are already in compliance and already have ATPs,” said Sandra Bastinelli, senior technical advisor in the CMS Center for Program Integrity, Medicare Program Integrity Group. “We don’t believe this is much of an issue so far as having to change your method of providing service.”

CMS officials made the clarification because, right now, Appendix B of the DMEPOS Quality Standards states that all manual wheelchairs, including K0005, fall under Section I: Manual Wheelchairs. But officials believe that K0005 wheelchairs, which are highly configurable and require individualized fitting and adjustments, should fall under Section III: Complex Rehabilitative Wheelchairs and Assistive Technology.

Providers that supply K0005 wheelchairs and don’t have ATPs on staff have until March 1, 2013, to meet the requirement, CMS officials said.

“After that date, those providing K0005 wheelchairs not in compliance with these standards must come into compliance or stop furnishing these items to Medicare beneficiaries,” Bastinelli said.

During the Q&A portion of the forum, one listener asked whether providers will have to document “direct and in-person involvement of the ATP in the selection of the wheelchair,” like they have to do for complex rehab wheelchairs.

“The requirements are the same,” Bastinelli said.

The caller also asked whether CMS officials would update the LCD to reflect the clarification on K0005 wheelchairs.

“We will be touching bases with the DME MAC medical directors,” Bastinelli said.

CMS officials also plan to publish an MLN Matters article on K0005 wheelchairs in the next month.

The next forum is Oct. 3.