CMS Launches New Power Wheelchair Initiative, To Split K0011 Code

Washington

The Centers for Medicare and Medicaid Services (CMS) has launched an aggressive three-pronged initiative focusing on power wheelchair coverage, payment and quality controls for suppliers.

The campaign was announced by recently appointed CMS Administrator Mark McClellan on April 28, and outlined by Herbert Kuhn, director of CMS' Center for Medicare Management, during a Senate Finance Committee hearing on power wheelchair fraud and abuse held the same day. The committee oversees the Medicare program and has been investigating the reasons for a dramatic increase in power wheelchair claims.

“CMS has cracked down on fraud and abuse in the wheelchair market, including the launch of Operation Wheeler Dealer last fall in collaboration with the [Department of Health and Human Services] Office of the Inspector General,” said McClellan. “Now we are moving to the next stage in strengthening our policies for power mobility devices.”

For starters, CMS plans to develop more coverage guidance on power wheelchair policy. The agency's chief medical officer will bring together clinicians from across HHS and other government agencies to refine and describe the conditions that are associated with the current coverage definition and to develop draft guidance for determining whether a patient meets the definition of “bed or chair confined.”

CMS also will address ordering requirements for mobility equipment through a proposed regulation that will, in part, implement provisions in the Medicare Modernization Act (MMA).

The second part of the plan addresses billing and payment. CMS will work with a national panel to establish a new set of codes accounting for the variety of power wheelchairs now available, with accurate individual payment ceilings to be developed for each of the new codes. Currently, most power wheelchairs are billed through the single K0011 code.

In the third part of the campaign, which deals with quality controls for suppliers, CMS will revise the supplier standards for enrolling in Medicare to include quality measures as required by MMA — revisions the agency plans to finalize in the fall of 2005. Working through the National Supplier Clearinghouse (NSC), CMS will continue to ensure thorough review of all applications for enrollment so that only qualified suppliers are allowed to bill the Medicare program.