Mobility Stakeholders Say CMS Is Beginning to Get It

Baltimore

According to attendees of a special four-hour public meeting on power wheelchair coding held Sept. 1 at its headquarters, CMS is beginning to “get it.”

At the meeting, the agency introduced 33 new wheelchair codes, expanding upon an initial 18-code proposal released in August (see HomeCare, September 2004). As part of its wheelchair benefit overhaul, CMS plans to split the broad “K” codes currently in use into a variety of “E” codes.

To explain the CMS proposal, Dr. Doran Edwards, medical director for the SADMERC, provided an overview of the codes, including five for pediatric chairs, four for adult lightweight chairs, nine for standard chairs, eight for heavy-duty chairs, four for bariatric chairs and three miscellaneous codes.

More than 80 registered attendees at the meeting included representatives from AAHomecare, Invacare, The MED Group, the National Coalition for Assistive Rehab Technology (NCART), Pride Mobility, Sunrise Medical and others. Rita Hostak, president of NCART and vice president of government relations for Sunrise, presented a seven-code proposal at the meeting that NCART had submitted earlier this year.

“Dr. Edwards and his staff do seem to get it,” said Simon Margolis, NCART executive committee member and vice president of clinical and professional development for National Seating and Mobility, Chattanooga, Tenn.

“The [government's] approach is different than the NCART proposal in that it does not use add-on codes for things like seat width and seat depth. Instead, [CMS] has decided to use individual codes for various chair configurations. The larger code set in itself is not a bad thing or a good thing; it is just a methodology for achieving our common goal of appropriate coding to assure access to power mobility technology.”

Mobility stakeholders have said the inclusion of pediatric codes in the new proposal may prove valuable for state Medicaid programs and private insurers, which, due to HIPAA, must now use HCPCS coding.

“I am very happy CMS has realized the need to add pediatric power wheelchair codes,” said Matthew Burke, director of operations for Burke Medical Equipment, Chicopee, Mass., and chairman of AAHomecare's Rehab and Assistive Technology Council (RATC). “It is important, though, that CMS exclude pediatric codes from their fee schedule and coverage guidelines. Many state associations have worked hard to establish reasonable and fair coverage guidelines for pediatric power mobility. There is no need for CMS to interject additional criteria.”