Vendors wrestle with new power chair codes

BALTIMORE -- The migration from four billing codes for power wheelchairs to 49 has begun, and manufacturers say the journey promises to be anything but a cakewalk. CMS in March revealed that manufacturers had until Sept. 1 to test their fleet of power wheelchairs and scooters to determine which new code they fit into. That timetable has turned testing facilities into pressure cookers. While all manufacturers test their chairs to some extent, few if any have tested as rigorously as CMS now requires. Manufacturers aren't sweating most of the tests for speed, range, stability and other basic parameters. But the combination fatigue test and drop test has raised the hurdle for all manufacturers. "We have our quality control [manager] and director of safety working on this virtually full-time now, and they'll be going full-time on this until Sept. 1," said Dan Meuser, president of Pridfe Mobility Products. Why so much hurry-up? In the past, manufacturers typically tested the durability of their wheelchairs to certain thresholds on rotating drums. And they might have stopped rolling drums after 100,000 or 200,000 cycles. But now, per standards proscribed by RESNA and the American National Standards Institute (ANSI), manufacturers must roll their chairs over two or three drums in sets of 200,000 cycles until they fail, or reach 800,000 cycles. In between each set of 200,000 cycles, the manufacturer must drop a fully weighted chair from a height of about one inch in sets of 6,666. "We could do 200,000 cycles in four to five days, but now, if we run all the way up to 800,000 cycles, that could take 20 days," said Mark Greig, vice president of advanced product development for mobility products at Sunrise Medical. Manufacturers expect CMS to use the results of the fatigue and drop tests to develop new criteria for testing. That new criteria worries some. "If [CMS] demands that a type of product have a cycle count of 400,000 when the market is testing to 200,000 there could be cost implications, and will that be recognized in the development of the allowables?" said Greig. Although the 49 codes are well-defined and generally welcome among manufacturers, pigeon-holing wheelchairs will not be easy. "It's almost like what the SADMERC has done is erase the entire power wheelchair industry, and everyone is starting from a clean slate," said Mark Sullivan, vice president of Invacare's rehab category. Some migrations, at this time, look likely. Meuser expects that about half of the K0011 chairs will roll into the K0701 category, defined by CMS as a general purpose power chair with a captain's seat. But nothing is certain at this point, Meuser admits. "If the allowables come out, and they are done erroneously, if they use gap filling methodology, for example, then things might not make sense," he said. "We're not going to put out a great product where providers can't keep their doors open if they'll be getting a $3,500 or $4,000 allowable on the 700 or 701." Until manufacturers know the allowables, which nobody expects until the end of the year, and the coverage criteria guidelines, which may surface this spring, the code transitions will be educated guess-work. Until then, there's little to do but keep testing. "It's a gigantic project," said Sullivan.