ATLANTA — In late February, the DME MACs issued a new billing and payment policy for wheelchair repairs based on standardized labor times that left providers with a number of questions. Last week, the MACs answered with an FAQ on the policy, which took effect April 1.
Among the questions the MACs addressed:
Question: If a beneficiary refuses to bring their equipment to the supplier location, can they be charged a fee for this service?
Answer: No, Medicare's payment for repairs, i.e., parts and labor, is all-inclusive. There is no separate payment for travel time, service charges, fuel surcharges, etc. On an assigned claim, suppliers may not charge a beneficiary for these costs. On a nonassigned claim, the beneficiary will be responsible for the difference between the submitted charges for the repairs and the amount Medicare pays.
Question: The reasonable useful lifetime for durable medical equipment is 5 years. If an item that is less than 5 years old needs to be repaired because of "wear and tear" (rather than a specific incident) and a thorough evaluation reveals that the cost to repair the equipment exceeds the cost to replace the equipment would Medicare consider payment for a replacement piece of equipment?
Answer: No, according to Medicare statute, during an item's reasonable useful lifetime, payment can only be made for repairs up to the cost of replacement.
Question: If the equipment has been repaired on several different occasions, is in need of repair again, and no single repair has exceeded the cost to replace the equipment but the cumulative repair costs will exceed the replacement cost, would Medicare consider payment for a replacement piece of equipment?
Answer: No, according to Medicare statute, during an item's reasonable useful lifetime, payment can only be made for repairs up to the cost of replacement.
Question: What percentage of repair to replacement cost would Medicare consider acceptable to deem the purchase of a replacement item more cost effective?
Answer: There is no provision for replacement due to "wear and tear" prior to the end of the item's useful lifetime.
Under the billing policy, one unit of service equals 15 minutes. A table in the policy notice contains repair units of service allowed for commonly repaired items. Read the policy notice on the Cigna (Jurisdiction C) Web site.
Read the full Complex Rehab Repair FAQ.
