CMS Proposes 18 New Codes For Power Wheelchairs

Baltimore

Last month, the Centers for Medicare and Medicaid Services (CMS) issued a proposal that includes 18 new power wheelchairs codes. The proposal was to be discussed at a four-hour public meeting that, at press time, was scheduled for Sept. 1 at the agency's Baltimore headquarters.

Part of a broader government effort to revamp Medicare's wheelchair benefit, CMS' coding task force received input from the SADMERC, DMERC medical directors and outside consultants to come up with the proposed codes. The group also studied national power wheelchair claims data over one year.

The 18 codes are grouped into three broad categories — Standard, Heavy-Duty and Bariatric — that cover approximately 95 percent of typical code combinations currently billed under K0010, K0011, K0012 and K0014.

The groupings are divided based on patient weight capacity, and subdivided based on a chair's ability to accept various options and accessories. Most “Standard” codes refer to chairs for patients up to 300 pounds, with the exception of the “Portable Lightweight” subgroup that is limited to 250 pounds. “Heavy-Duty” codes cover patients between 301 to 450 pounds, and the “Bariatric” category covers patients between 451 and 600 pounds, representing a significant portion of claims currently billed under the K0014 code.

Some codes also carry a “Rehab” designation, reflecting chairs that can accommodate positioning needs for certain disabilities. The chairs may use alternative control devices, special electronics and expandable controllers, particularly for severely involved patients.

The coding task force also proposed that each chair come with a “basic equipment package” bundling a variety of accessories, including batteries and safety belts. According to a CMS official, the agency is proposing those bundled packages to be reimbursed at one price, as opposed to having a stripped-down base price and plugging in costs for every accessory added to the chair. The package, he added, would include the basic accessories most power wheelchair patients already order.

The official also said that pricing will be determined once the codes have been finalized, which he expects to occur by late spring 2005.