BALTIMORE--Medicare's DME Program Safeguard Contractors have published a bulletin redefining the basic equipment package for power wheelchairs, determining what accessories are and are not separately billable.

The changes are effective for claims with dates of service on or after Jan. 1, 2007.

"It is a pretty significant change for the advanced rehab segment of the industry, those that provide power chairs in groups 3, 4 or 5," said Seth Johnson, chairman of AAHomecare's Rehab and Assistive Technology Council and director of government affairs for Pride Mobility.

While Medicare has indicated it will only pay for Group 3 chairs, Johnson said, the fact that the agency is breaking these items out of the basic equipment package and noting they can be separately billed should help improve reimbursement overall because it sets the standard for chairs in Groups 4 and 5 for other payers like Medicaid.

According to the Jan. 26 bulletin, the basic equipment package includes the following:

--For Group 3, 4, and 5 power wheelchairs (PWCs), angle adjustable footplates will be separately billable. For Group 3 and 4 PWCs (other than Extra Heavy Duty) with a sling/solid seat/back, non-standard seat widths and/or depths will be separately billable. The following list includes these changes and other clarifications.

--PWC Basic Equipment Package--Each power wheelchair code is required to include all these items on initial issue (i.e., no separate billing/payment at the time of initial issue, unless otherwise noted). The statement that an item may be separately billed does not necessarily indicate coverage.

• Lap belt or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately.
• Battery charger, single mode.
• Complete set of tires and casters, any type.
• Legrests. There is no separate billing/payment if fixed, swingaway, or detachable non-elevating legrests with or without calf pad are provided. Elevating legrests may be billed separately.
• Footrests/foot platform. There is no separate billing/payment if fixed, swingaway, or detachable footrests or a foot platform without angle adjustment are provided. There is no separate billing for angle adjustable footplates with Group 1 or 2 PWCs. Angle adjustable footplates may be billed separately with Group 3, 4 and 5 PWCs.
• Armrests. There is no separate billing/ payment if fixed, swingaway, or detachable non-adjustable height armrests with arm pad are provided. Adjustable height armrests may be billed separately.
• Any weight specific components (braces, bars, upholstery, brackets, motors, gears, etc.) as required by patient weight capacity.
• Any seat width and depth. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed separately: for Standard Duty, seat width and/or depth greater than 20 inches; for Heavy Duty, seat width and/or depth greater than 22 inches; for Very Heavy Duty, seat width and/or depth greater than 24 inches; for Extra Heavy Duty, no separate billing.
• Any back width. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed separately: for Standard Duty, back width greater than 20 inches; for Heavy Duty, back width greater than 22 inches; for Very Heavy Duty, back width greater than 24 inches; for Extra Heavy Duty, no separate billing.
• Controller and Input Device. There is no separate billing/payment if a non-expandable controller and a standard proportional joystick (integrated or remote) is provided. An expandable controller, a nonstandard joystick (i.e., nonproportional or mini, compact or short throw proportional), or other alternative control device may be billed separately.

--Nonstandard seat dimensions and nonstandard back dimensions should be billed with code K0108, the article said.

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