Revision to the ABN Upgrade option for specific power mobility bases

Revision to the ABN Upgrade option for specific power mobility bases

         Individuals who rely on assistive technology and medical equipment to live their lives independently got a break Tuesday (April 26) when it was announced that because of industry concerns the Least Costly Alternative policy was reinstated by CMS.

The official release will be out in the next few days.

The issue now is that the effective date will become June 1, 2011.

               The Advance Beneficiary Notice will be reinstated for the items that were previously to be denied as statutorily non-covered, according to Peggy Walker, RN, VGM Group reimbursement adviser.         

Equipment covered by the reinstatement includes upgrades to:

Group 4 power wheelchairs will be upgradable from the Group 3 power wheelchair codes

Group 2 POV/scooters will be upgradable from the Group 1 POVs /Scooters

(CAUTION: Mobility base provided MUST still meet medical necessity for use within the home.)


                U.S. Rehab and other industry groups expressed concerns to CMS about the elimination of the LCA policy. In letters to CMS, Greg Packer, U.S. Rehab vice president, noted that the policy eliminated patient choice and caused individuals to “lose the freedom to maintain an independent, active lifestyle.”

                Reinstating the ABN allows those who wish to upgrade their equipment by paying the difference between the “medically necessary” item and one that is better suited to their disability and lifestyle.