Reimbursement for bariatric systems takes hit

Friday, May 24, 2013

WASHINGTON – Medicare has changed its policy article for wheelchair options and accessories, and providers who offer bariatric tilts should take notice. 

The new definition for power seating systems (E1002), announced in March and effective Jan. 1, 2013, changes the requirements for bariatric tilt from 45 degrees to 20 degrees, effectively doing away with the need for K0108, a miscellaneous code that providers had been using to bill for bariatric power seating systems. 

The problem: Bariatric systems are more expensive for manufacturers to make and for providers to supply, and the allowable for E1002—$3,800—is typically less than the allowable for the miscellaneous code—70% of the manufacturer’s suggested retail price.

“They’re not going to pay more for a bariatric tilt like they were in the past,” said Szmal, founder of The Mobility Consultants. “They’re only going to pay for the allowable for the E1002.”

Use of K0108 to bill for additional heavy-duty or other bariatric features is now considered bundling and is not allowed. Szmal said he hasn’t yet seen whether CMS would apply the policy article changes retroactively.

Other changes to the policy article include: 

• Power operated vehicles (POVs), commonly known as scooters, must now include lap belts.

• E1161, the adult manual tilt in space, is now classified as complex rehab. Providers must have an ATP on staff and a specialty evaluation must be performed before the chair can be provided. 

Szmal said the POV update should mainly affect manufacturers, and the E1161 change shouldn’t cause too many problems. 

“Typically, a provider who’s doing E1161 is already a complex rehab provider with an ATP on staff, and the patients typically get special evaluations, anyway,” said Szmal.