CMS Moves in the Right Direction

The Centers for Medicare and Medicaid Services (CMS) announced its three-pronged initiative to address power wheelchair issues at the Senate Finance Committee's April 28 hearing on Medicare coverage and payment for power wheelchairs. Overall, CMS' initiative is a significant step in the right direction to address perceived and real issues in this area.

There are, however, several recommendations to improve and refine CMS' initiatives that will yield improved results.

• Coverage guidance development needs input from practicing clinicians at the outset. CMS' initiative to develop more coverage guidance for power wheelchairs is limited to convening clinicians from Health and Human Services (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agencies to refine and describe the conditions that are associated with the current coverage definition and to develop draft guidance for determining whether a patient meets the definition of “bed or chair confined.”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 needs, however, to include non-government clinicians actively involved in prescribing motorized wheelchairs and clinicians who evaluate and fit beneficiaries for power wheelchairs to ensure that the consumer receives the medically appropriate wheelchair and necessary components/accessories.

  Without the input of currently practicing clinicians, CMS' guidance will lack necessary and important “real life” current medical practice input.

• New codes will address many issues. CMS' second initiative is to develop a new set of HCPCS codes, in conjunction with the National Coding Panel, to better describe the wide array of available power wheelchairs and to set Medicare fee schedules that are more closely aligned with the actual product provided. This initiative should be applauded, and I strongly recommend that CMS review the industry's detailed coding recommendations for motorized wheelchairs.

  The industry's submission also provides clinical indicators for each of the six recommended new codes. These clinical indicators could serve as the basis for Medicare coverage policy descriptions. Moreover, clinical indicators, functional levels and diagnosis codes, when used together, can provide critical support for medical need.