Finally!

Last month, CMS announced two important national Medicare policy developments related to mobility devices including power wheelchairs, scooters/POVs and manual wheelchairs. CMS is proposing to use a series of functional criteria as the national coverage policy for wheelchairs, and has announced a set of 49 new HCPCS codes for power wheelchairs and scooters, or power-operated vehicles (POVs).

On Feb. 3, CMS released proposed coverage criteria for mobility assistance equipment on its Web site. The agency stated that it plans to issue the final National Coverage Determination (NCD) in late March, although it is unclear how quickly CMS will implement the new national policy.

In December, CMS announced its initiation of the NCD process for mobility equipment, including power wheelchairs, POVs and manual wheelchairs. After a 30-day comment period that ended Jan. 14, CMS posted the draft NCD, which proposes to delete the “bed or chair confined” criterion currently used to determine if a wheelchair is reasonable and necessary. Instead, beneficiary eligibility for coverage of mobility equipment would be based upon an assessment of a person's ability to functionally ambulate.

CMS is proposing to use the following sequential clinical criteria to “provide clinical guidance for the prescription” of equipment. The document does not say, however, whether it is the prescribing physician, another clinician such as a physical or occupational therapist or other individual who responds to these questions for a beneficiary.

1. Does the beneficiary have a mobility limitation causing an inability to perform one or more mobility-related activities of daily living in the home?

2. Are there other conditions that limit the beneficiary's ability to perform mobility-related activities of daily living at home?

3. If these other limitations exist, can they be ameliorated or compensated sufficiently such that the additional provision of mobility equipment will be reasonably expected to materially improve the beneficiary's ability to perform mobility-related activities of daily living in the home?

4. Does the beneficiary demonstrate the capability and the willingness to consistently operate the device safely?

5. Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker?

6. Does the beneficiary's typical environment support the use of wheelchairs or scooters/POVs?