Baltimore
Last month, the Centers for Medicare and Medicaid Services (CMS) issued a proposal that includes 18 new power wheelchairs codes. The proposal was to be discussed at a four-hour public meeting that, at press time, was scheduled for Sept. 1 at the agency's Baltimore headquarters.
Part of a broader government effort to revamp Medicare's wheelchair benefit, CMS' coding task force received input from the SADMERC, DMERC medical directors and outside consultants to come up with the proposed codes. The group also studied national power wheelchair claims data over one year.
The 18 codes are grouped into three broad categories — Standard, Heavy-Duty and Bariatric — that cover approximately 95 percent of typical code combinations currently billed under K0010, K0011, K0012 and K0014.
The groupings are divided based on patient weight capacity, and subdivided based on a chair's ability to accept various options and accessories. Most “Standard” codes refer to chairs for patients up to 300 pounds, with the exception of the “Portable Lightweight” subgroup that is limited to 250 pounds. “Heavy-Duty” codes cover patients between 301 to 450 pounds, and the “Bariatric” category covers patients between 451 and 600 pounds, representing a significant portion of claims currently billed under the K0014 code.
Some codes also carry a “Rehab” designation, reflecting chairs that can accommodate positioning needs for certain disabilities. The chairs may use alternative control devices, special electronics and expandable controllers, particularly for severely involved patients.
The coding task force also proposed that each chair come with a “basic equipment package” bundling a variety of accessories, including batteries and safety belts. According to a CMS official, the agency is proposing those bundled packages to be reimbursed at one price, as opposed to having a stripped-down base price and plugging in costs for every accessory added to the chair. The package, he added, would include the basic accessories most power wheelchair patients already order.
The official also said that pricing will be determined once the codes have been finalized, which he expects to occur by late spring 2005.
Medicare has been dealing with wheelchair coding and coverage guidance as separate issues, though the industry has argued the two should be considered together. But CMS has disagreed. According to the agency official, Medicare must first define and clarify coverage criteria, scheduled to be finalized by the end of the year. That criteria, in turn, will provide the foundation for which kinds of equipment — and associated codes — are covered and which aren't.
To view a full explanation of the proposed codes, click here.
Proposed Code Revisions
EXXX1-Portable-Lightweight, Sling/solid seat and sling/solid back (up to and including 250 pounds)
EXXX2-Portable-Lightweight, Captain's Chair (up to and including 250 pounds)
EXXX3-Standard, Sling/solid seat and sling/solid back (up to and including 300 pounds)
EXXX4 — Standard, Captain's Chair (up to and including 300 pounds)
EXXX5-Standard-Wide, Sling/solid seat and sling/solid back (up to and including 300 pounds) EXXX6 — Standard-Wide, Captain's Chair (up to and including 300 pounds)
EXXX7 — Standard-Rehab (up to and including 300 pounds)
EXXX8-Standard-Wide-Rehab (up to and including 300 pounds)
EXXX9- Standard-Rehab-High Activity (up to and including 300 pounds)
EXX10-Heavy Duty, Sling/solid seat and sling/solid back (greater than 300 pounds up to and including 450 pounds)
EXX11-Heavy Duty, Captain's Chair (greater than 300 pounds up to and including 450 pounds) EXX12-Heavy Duty-Wide, Sling/solid seat and sling/solid back (greater than 300 pounds up to and including 450 pounds)
EXX13-Heavy Duty-Rehab (greater than 300 pounds up to and including 450 pounds)
EXX14-Heavy Duty-Rehab-High Activity (greater than 300 pounds up to and including 450 pounds)
EXX15-Bariatric, Sling/solid seat and solid/sling back (greater than 450 pounds up to and including 600 pounds)
EXX16-Bariatric, Captain's Chair (equal to or greater than 450 up to and including 600 pounds)
EXX17- Bariatric, Rehab (equal to or greater than 450 pounds up to and including 600 pounds)
EXX18-Power Wheelchair, Not Otherwise Classified
Coverage Getting the Onceover, Too
Beyond coding, Medicare's wheelchair coverage guidance is also being revamped. The Interagency Wheelchair Work Group, consisting of experts from across several government agencies, is set to finalize new wheelchair coverage criteria by Dec. 31. In a white paper presented in mid-July to CMS' Office of Financial Management, the mobility industry's RAMP (Restore Access to Mobility Partnership) coalition stated, among other things, that licensed clinicians such as physical and occupational therapists should be the primary determinate of coverage for power wheelchairs. “The best-trained person in prescribing [a power wheelchair] is [often] not the physician,” said Cara Bachenheimer, vice president, government relations, for coalition member Invacare, Elyria, Ohio. “[Physicians] are not trained to forward the type of information Medicare is looking for.”
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