Manufacturers and suppliers of power wheelchairs assailed cuts of 21% to 41% in Medicare payments for power wheelchairs, saying the reductions would force suppliers out of business, cause lay-offs throughout the industry, and restrict access to mobility equipment for senior citizens and people living with disabilities.

The reimbursement cuts, announced by the Centers for Medicare & Medicaid Services (CMS), Washington, DC, hit particularly hard at the most sophisticated mobility equipment, which is needed by people with the most severe physical disabilities. For instance, a supplier who has been receiving a $6,500 reimbursement from Medicare for one such wheelchair will only receive $3,800 after the new pricing is effective November 15.

“The problem that CMS doesn’t understand is that we don’t have anything to cut,” says Carol Gilligan, president of Health Aide, Cleveland. “At these reduced rates, the cost of acquiring a wheelchair, fitting the patient, servicing the chair and doing the documentation paper work will exceed the amount that Medicare will pay for the chair. We can’t stay in business operating in the red. Patients are not going to have outlets to get the mobility equipment that they need.”
Industry officials say the underlying problem is that as the American society ages, there has been a significant increase in demand for power wheelchairs and scooters by a population that wants to remain as independent and as mobile as possible. CMS has reported a 2,700% increase in utilization over the past eight years. However, over the last 3 years CMS has responded to the increased demand for mobility equipment with a series of policy, rule and pricing changes that appear to be aimed at restricting beneficiary access to mobility equipment, crippling the industry that supplies it, and restraining costs.

“What we have is a regulatory body that has been focused on restricting access to the benefit,” said Scott Meuser, CEO of Pride USA. “Now, they have gone too far. The message from these price cuts is that CMS no longer wants the most physically disabled person in our society to have access to a power wheelchair through Medicare that will help him or her perform essential daily activities, such as grooming, preparing food and going to the bathroom. Medicare is turning their backs on the people who need help the most.”

Meuser maintained that Congress and the Administration will hear strong protests from advocates for people with disabilities, as well as clinicians and physicians.

“We expect serious access issues for consumers with severe disabilities, as well as seniors with mobility impairments,” says Mal Mixon, chairman and CEO of Invacare Corp. “We have an Americans with Disabilities Act that is supposed to ensure the highest quality of life possible for people living with disabilities. Yet, this Administration’s payment policy for power wheelchairs will effectively prevent people with disabilities from being able to obtain the power wheelchair they need to get around in their homes, as well as in their communities.”   

Moreover, stakeholders say that CMS has taken a very shortsighted view because Medicare beneficiaries with power mobility equipment save the Medicare system millions of dollars because they require less homecare, hospitalization and emergency treatment from falls, and fall related injuries. Studies show that people living with physical impairments who do not have power wheelchairs cost the Medicare system an average of $14,000 more per person than those with a power wheelchair or scooter.    

The most immediate impact from the new pricing schedule will be felt by people like Paul Bergantino, president of ATG Connecticut Rehab, Newington, Conn.

Bergantino has been supplying power wheelchairs for 16 years. But now he worries not only about whether his business can continue, but how senior citizens and people living with disabilities in his community will get access to power wheelchairs.

“Clearly, CMS does not understand the human side of this issue,” Bergantino says. “Our business is about providing a high level of skilled care to those in society whom require power mobility and other assistive technologies. There is a cost to providing such a complex product, evaluations, fittings, technical service, and in documenting it all in a highly compliant manner. Nevertheless, we love our patients and the outcome of our work. The really sad thing is this: we likely won’t be here to give them that level of care.  Medicare has abandoned them.”  

[SOURCE: Frisby & Associates Inc, October 6, 2006]

The new PMD codes, fee schedule amounts, and LCDs were originally scheduled to take effect October 1, 2006. In order to allow for additional time to prepare for implementation of the fee schedule amounts and LCDs, these changes will be effective November 15, 2006. The 2006 PMD fee schedule ceiling and floor amounts have been calculated and are listed below. 

HCPCS = Healthcare Common Procedure Coding System Code; NU = Purchase New; RR = Rental; UE = Purchase Used; KF = Class III Item

HCPCS    Modifier 1    Modifier 2    Ceiling        Floor 
K0800      NU                                    $1,292.77    $1,098.85
K0800      RR                                     129.28         109.89
K0800      UE                                     969.58         824.14        
K0801      NU                                    2,084.22     1,771.59
K0801      RR                                     208.40        177.14
K0801      UE                                     1,563.15     1,328.68
K0802      NU                                    2,358.66      2,004.86
K0802      RR                                    235.86         200.48
K0802      UE                                    1,769.01     1,503.66
K0806      NU                                   1,563.91     1,329.32
K0806      RR                                    156.39        132.93
K0806      UE                                    1,172.93     996.99
K0807      NU                                    2,373.05     2,017.09
K0807      RR                                    237.30        201.71
K0807      UE                                    1,779.80     1,512.83
K0808      NU                                    3,671.60     3,120.86
K0808      RR                                    367.150      312.08
K0808      UE                                    2,753.69     2,340.64
K0813      RR                                    232.09        197.28
K0814      RR                                   311.32         264.62
K0815      RR                                   314.77         267.55
K0816      RR                                   321.45         273.23
K0820      RR                                   264.40         224.74
K0821      RR                                   318.21         270.48
K0822      RR                                   395.31         336.01
K0823      RR                                   362.68         308.28
K0824      RR                                   463.61         394.07
K0825      RR                                   385.05         327.29
K0826      RR                                   589.91         501.42
K0827      RR                                   511.10         434.44
K0828      RR                                   661.92         562.63
K0830      RR                                   479.45         407.53
K0831      RR                                   452.64         384.74
K0835      RR                                   400.07         340.06
K0836      RR                                   395.13         335.86
K0837      RR                                   460.68         391.58
K0838      RR                                   394.74         335.53
K0840      RR                                   845.90         719.02
K0841      RR                                   482.85         410.42
K0842      RR                                   482.85         410.42
K0843      RR                                   514.36         437.21
K0848      RR                                   375.17         318.89
K0849      RR                                   372.15         316.33
K0850      RR                                   432.22         367.39
K0851      RR                                   470.27         399.73
K0852      RR                                   721.37         613.16
K0853      RR                                   706.47         600.50
K0854      RR                                   698.25         593.51
K0856      RR                                   380.02         323.02
K0857      RR                                   423.72         360.16
K0858      RR                                   414.60         352.41
K0860      RR                                   979.25         832.36
K0861      RR                 KF             598.72         508.91
K0861      RR                                   553.83         470.76
K0862      RR                                   596.86         507.33
K0868      RR                                   455.73         387.37
K0869      RR                                   455.73         387.37
K0877      RR                                   400.27         340.23
K0879      RR                                   540.55         459.47
K0880      RR                                   845.90         719.02
K0884      RR                                   611.08         519.42
K0885      RR                                   603.90         513.32
K0886      RR                                   557.75         474.09
K0890      RR                                   919.75         781.79
K0891      RR                                   1,218.04      1,035.33  

The fee schedule amounts for all States is available in a public use file at:    http://www.cms.hhs.gov/DMEPOSFeeSched/LSDMEPOSFEE/list.asp

[SOURCE: CMS, October 2006]