Update on Repairs and Replacements on PMDs damaged in Hurricane Sandy

For a power operated vehicle (POV) or power wheelchair (PWC) to be covered, the treating physician must conduct a face-to-face examination of the patient before writing the order and the supplier must receive a written report of this examination within 45 days after completion of the face-to-face examination and prior to delivery of the device. If the requirement is not met, the claim will be denied as non-covered.

Exceptions are:    

  1. If this examination is performed during a hospital or nursing home stay, the supplier must receive the report of the examination within 45 days after discharge.
  2. If the POV or PWC is a replacement during the 5 year useful lifetime of an item in the same performance group that was previously covered by Medicare, a face-to-face examination is not required.
  3. Replacement during an item’s useful lifetime is limited to situations involving loss or irreparable damage from a specific accident or natural disaster [e.g., fire, flood, etc.].

Replacement due to catastrophic loss (fire, flood, etc.):

•    A dispensing order is not required.

•    A detailed written order is required before the claim is submitted except for those items which require a written order prior to delivery.

•    The supplier must maintain records documenting the cause for replacement.

Beneficiaries residing in the affected counties, supplier must:

•    Add the CR modifier to each item billed as a replacement, including recurring supplies for all dates of service on or within 60 days after November 7th, 2012  

•    The HCPC must include any other applicable modifier in addition to the CR modifier

•    Suppliers who are submitting claims for beneficiaries who reside in the affected areas must use the word “Sandy” in the narrative section with an explanation why the equipment/supplies are being replaced

•    Remember the RA modifier is always required on the claim for a replacement item.

Also, PMDs requiring prior authorization review under the demo project in the affected counties of New York are not required to submit a prior authorization for PMDs for dates of service on or within 60 days after November 7th, 2012.