Seating codes bring confusion

Sunday, October 31, 2004

WASHINGTON - Many seating and positioning products that were to receive new K codes and allowables by Oct. 1 have not yet been reviewed by the SADMERC. As a result, providers will not be able to supply them to beneficiaries, according to AAHomecare’s Rehab and Assistive Technology Council.

The codes went into effect July 1, but CMS gave providers a 90 day grace period before they had to start using them. By the end of the grace period, Oct. 1, the SADMERC was to have developed allowables and assigned codes to products. Because that didn’t happen, AAHomecare has asked CMS Administrator Mark McClellan to extend the grace period 180 days.

In its Sept. 21 letter, AAHomecare wrote: “Many of the products that RATC members provide to Medicare beneficiaries have not yet been reviewed. Without the SADMERC review and approval of the commonly provided, medically necessary, and physician-prescribed seating components, providers will not able to provide this equipment after October 1, 2004.”

“I’m still fuzzy,” said Scott Scobey, president of Low Country Mobility in Beaufort, S.C. “Come Oct. 1, what are we supposed to bill for and how are we supposed to do it.”

The 20 new codes cover wheelchair seating, backs and some accessories.

The more specific coverage criteria and descriptions address, among other things, height parameters and size. Notably, five new K codes have been created for products previously grouped into E0192, which covers about 90% of all wheelchair seat cushions.

At CMS’ Sept. 22 open door forum, a Medicare official said he hoped the DMERCs would have local fee schedules in place for the products by Oct. 1. In January, CMS will establish updated fee schedule amounts for products that have been classified under the new codes. If a product is not assigned a new code, it will not be billable, the official said.