BALTIMORE--Physicians and treating practitioners who prescribe power mobility devices will not receive payment for supplying medical records to HME providers until April, CMS has announced.

Under the Interim Final Rule for power mobility devices--which eliminates the certificate of medical necessity and replaces it with a face-to-face exam and a prescription (see HomeCare Monday, Aug. 29, 2005)--physicians are required to provide medical records documenting a patient's medical necessity for a power wheelchair or scooter. In return for the extra work, CMS said it would pay the docs $21.60 in addition to the office visit.

But because a congressional directive has put the IFR on hold until April 1, CMS said that it will be unable to process claims that contain the add-on payment (code G0372) until that date.

The effective date of the IFR was Oct. 25, 2005. But HME suppliers and manufacturers complained that its requirements were unclear and that physicians had not been informed of their new documentation responsibilities. Some senators wrote CMS asking for a delay to ease the transition. And after a concerted lobby from the industry, an amendment to the HHS appropriations bill (signed into law in December) prohibited the use of funds to implement the rule until April. (See HomeCare Monday, Jan. 9.)

While it is not allowed to implement or enforce the IFR, however, CMS said this "does not affect the validity of the rule."

A fact sheet issued by the agency gives physicians and treating practitioners several options for submitting the G0372 and Evaluation and Management Code:

--submit the G0372 code and E/M now on the same claim. Payment will be held until after April 1;
--hold all claims containing the G0372 code until after April 1; or
--submit the E/M service now and bill the G0372 after April 1. The E/M service will be paid now and the G0372 code will be paid after April 1.

In the meantime, CMS said, it will continue to educate physicians and treating practitioners on their role in prescribing PMDs. The agency also will issue instructions to the DMERCs "to promote consistent claims processing during this time period."

Although it did not say when, the fact sheet also said the DMERCs will provide "guidance to DME suppliers on the documentation needed to establish medical necessity of the prescribed equipment." Since the IFR was issued, HME stakeholders have repeatedly pressed for answers about what documents and records will support power mobility claims.