Study: Gap filling would reduce PWC reimbursement 25%

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Friday, September 30, 2005

WASHINGTON - If CMS uses its current gap-filling methodology to determine prices for Medicare's new power wheelchair codes, the average reduction in payment will be about 25%, according to a new AAHomecare commissioned study. AAHomecare presented the Muse & Associates study to CMS Sept. 14. Gap filling employs a formula that deflates prices to 1987 levels (the base year of the DME fee schedule), then inflates prices by 4% a year to 2004. When it comes to technology developed after 1987 -- the case with many of today's wheelchairs -- gap filling often skews prices to unacceptably low levels. By adjusting gap filing to reflect more accurate pricing information, the average reduction in payments for the new power wheelchair codes would be about 9%, according to the survey.

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