Baltimore
While it's still not exactly what the industry might call a charm, the third version of the local coverage determination for power mobility devices addresses some stakeholder concerns with the original document.
Last month, the Medicare DME Program Safeguard Contractors issued a newly revised LCD, removing the “unable to independently stand and pivot to transfer” requirement for Group 3 chairs.
The revised coverage states that mobility limitation must be due to “a neurological condition, myopathy or congenital skeletal deformity.”
Many in the rehab community had previously expressed concerns that the interpretation of “independent transfer” could include people who face a severe struggle to transfer themselves without assistance.
Stakeholders also said that the first LCD would put patients in the cheapest and lowest-quality equipment. In response, the PSCs delayed implementation of the LCD from Oct. 1 to Nov. 15. It also was revised to eliminate the “least costly alternative” determination, which would have resulted in automatic downcoding to a Group 1 chair for patients not meeting coverage for Group 2 or higher chairs.
The third LCD goes a step further. In this version, single power option or multiple power option wheelchairs in Groups 2 through 5 are eligible for Advance Determination of Medicare Coverage, regardless of whether a power seating system will be provided at the time of initial issue.
