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Spike in power wheelchair utilization? Not exactly.

Spike in power wheelchair utilization? Not exactly.

If you're like me,  and you follow the Medicare Market Marker on our Databank page each month (mostly because I have to put it together, but partly because I find it interesting), you probably raised an eyebrow while reviewing the September issue.

For K0823, your standard power wheelchair, the number of allowed beneficiaries skyrocketed. For example, in Region C (why haven't we changed that to Jurisdiction C, by the way), that number increased from 5,411 (February) to 9,498 (March) to 12,525 (April). Check out the yellow line below.


But before you get the wrong idea—let me rephrase that. Before CMS gets the wrong idea, let's think about this.

Is there something that happened in January that would cause the number of allowed beneficiaries for a standard power wheelchair to skyrocket?

Well, starting Jan. 1, the first-month purchase option was eliminated for all standard power wheelchairs. That means they're 13-month capped rental items. That means, as I understand it, that providers must bill Medicare for each month a beneficiary is using a standard power wheelchair up to 13 months.

And that means that same beneficiary is counted each month, instead of, when there was a first-month purchase option, only once at the time of purchase.

Hopefully, you noticed the disclaimer—let me rephrase that. Hopefully, CMS noticed the disclaimer that we added to the K0823 graph in the October issue. It says:

On Jan. 1, 2011, standard power wheelchairs, including K0823, became 13-month capped rental items, resulting in higher-than-normal utilization.

I'm going to keep an eye on this, and I'm sure CMS will, too, but as far as I can tell, there's no need to investigate further.

Case closed.

Liz Beaulieu


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