Stakeholders reject proposed misc codes

Tuesday, August 25, 2015

WASHINGTON – CMS’s proposal to revise HCPCS codes for miscellaneous DME, many used for wheelchairs, has stakeholders concerned over reimbursement. 

HCPCS codes E1399 and K0108 are currently used to bill for inexpensive items; however, CMS proposes to replace them with six new codes for expensive and inexpensive DME items, effective Jan. 1, 2016.

The agency says the changes will reflect a more accurate payment of Medicare claims. 

“The way CMS has it set up is there would be certain codes for miscellaneous items based on their dollar amount and previous billing history,” said Martin Szmal, founder of The Mobility Consultants. “Some of the reimbursements are based on 1986 and 1987 levels, when some of the items weren’t even around at that time.”

Under the current system, miscellaneous codes are individually considered based on supplier charges.

While stakeholders support CMS’s goal to further segregate miscellaneous codes, they say the way CMS is going about it is problematic.

“This really came out of the blue,”said Don Clayback, executive director of NCART. “It was posted just to the CMS website and then we had a very small time frame to respond.”