November 15th: Implementation of PMD Policies in Effect

CMS has elected to move forward with the November 15th implementation of the new PMD Fee Schedules, Coding and LCD (Local Coverage Determination).

Over the past several months, CMS has demonstrated their willingness to work with the industry to address important policy, coding and pricing issues for PMDs. Industry stakeholders are generally pleased that CMS acknowledged some of the errors and discrepancies contained in the coverage policy and fee schedule, yet issues with the fee schedule still remain and need to be corrected.

PMD Updates as of 1-8-2007

As a result of industry patrons working with representatives of CMS and elected officials, CMS has indicated that the following will take place:

· Over the next few days, corrections will be made to the fee schedule and will be released to the CMS contractors and posted on their respective websites. All corrections made to the fee schedule will be retroactive to Nov. 15.

· One important correction is that CMS plans to remove the expandable controller from the Basic Equipment Package (BEP) for the multiple power option codes and will continue to provide separate reimbursement for this item. The expected code to use for expandable controllers furnished with these chairs will be K0108 for claims with dates of service from October 1, 2006 thru December 31, 2006 and E2377 for claims with dates of service on or after January 1, 2007.

· CMS is currently reviewing information provided by several manufacturers specific to the HD options. CMS clearly recognizes that there are additional costs associated with the manufacture of heavy-duty power wheelchairs as compared to their standard duty lines. We expect changes to be made specifically to the K0825 code.

CMS has indicated that they are committed to working with the industry and reviewing all information provided to them that identifies any errors or anomalies that may exist in their calculations. The progress that has been made is truly a tribute to the efforts by industry stakeholders, CMS and our elected officials. The fact that we have the opportunity to work with CMS on these corrective measures is a positive note for our industry.

We recommend that providers continue to move forward and comply with the November 15th effective date for PMD policies, fees and coding. If you have any questions, please contact U.S. Rehab at 800-987-7342