BALTIMORE--Just a few minutes before 5 p.m. on Friday, CMS announced that it had posted information about the new HCPCS codes to be used for power wheelchairs beginning Oct. 1.

Under the new coding structure, there are six groups of power mobility devices with a total of 61 codes that separate the products based on functionality and levels of performance. Each group has sub-divisions based on weight capacity and/or powered seating system capability. The 61 codes include not only the type of power wheelchair base but also the options and accessories that come standard with the chairs. Three additional "miscellaneous" codes cover PWCs and power operated vehicles not otherwise classified, and PMDs not coded by the SADMERC or that don't meet criteria.

"It is CMS' belief that the changes made to the coding sets will provide physicians and other practitioners with a wide range of choices that will allow beneficiaries to be placed in the most appropriate chair," the agency said.

This is the third time the codes have been reworked within the past two years (see HomeCare Monday, Oct. 24, 2005). This most recent effort resulted from the work of a 14-member technical expert panel--consisting of suppliers, manufacturers, testing facilities, rehabilitation engineers and clinicians--and the SADMERC.

Although new mobility codes were originally scheduled to take effect Jan. 1 this year, CMS announced in October that it would delay implementation in order to rework the codes with the panel's input. The goal was to "more accurately reflect the range of PMDs currently on the market, allow for more accurate payment and ... establish testing standards to ensure only quality products are provided to Medicare beneficiaries."

Last fall, SADMERC Director Dr. Doran Edwards even announced that he had suspended all other duties to devote time to the coding project to "get it right."

"Codes resulting from this collaborative effort allow placement of individual devices into performance-based categories and tie those categories to distinct patient populations," the SADMERC said. "The resulting interplay of codes and clinical applications allows for a policy reflective of actual practice in PMD selection. Downcoding and claims denial will be reduced because proper device/patient selection will be more evident."

Current PWC codes have been in use since 1993 and the one code for POVs has been in use since 1986, but subsequent innovation in the field created a need to expand both the number of categories and the number of codes, CMS explained.

The SADMERC noted this set of codes is an interim step to allow implementation, and that a set of "K" codes to be used for billing will be developed by the Alpha Numeric Work Group before Oct. 1.

The SADMERC also said a revised set of test parameters to accommodate future technological advances will be published soon. In the meantime, all PMDs will have to be retested according to the expanded criteria. "Policy and pricing changes will also be made as needed," the SADMERC said.

Based on feedback from the expert panel, the agency said CMS and the SADMERC also have instituted some additional tests to those already required under the previous code set to reflect "the variety of performance and durability challenges the PMDs may undergo during the course of a five-year lifetime." A subset of current Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) standards for PMDs, the new tests include:

• Speed fall-off for slope at maximum speed;
• Static strength on foot rests;
• Impact strength on foot rests;
• Climatic test (rain test);
• Power and control systems;
• Static stability and dynamic stability; and
• Power off emergency brake test.

The agency also said it anticipates that as standards for electromagnetic and crash tests are developed, those tests will be phased in over time.

CMS said its timeline for implementation of the new codes and testing standards is as follows:

• The SADMERC will apply testing results already submitted to place wheelchairs in the appropriate new code based on the results of these tests.
• The new codes will be effective for claims for items furnished on or after Oct. 1, 2006. The current codes will remain valid for items furnished before Oct. 1, 2006.
• Fee schedules for the new codes are expected to be published as part of the October 2006 DMEPOS update.
• Manufacturers will have until Aug. 1, 2007 (approximately 13 months), to have their wheelchairs retested by an independent testing laboratory according to the new testing requirements.
• Fee schedule amounts will be revised to reflect any changes in product classification under the codes as a result of the retesting and will be implemented on Jan. 1, 2008.

The SADMERC will issue further instructions that detail the testing requirements, and after that, an updated product classification list with assignment of devices to the various codes will be released.

CMS said it will hold a special Open Door Forum on the new codes and testing requirements, and will provide information on the fee schedule amounts for the new codes, as well as the status of local coverage policies for PMDs, "in the near future."

To view the new codes, visit the SADMERC Web site by clicking here, then follow the instructions.