The Centers for Medicare & Medicaid Services (CMS) is making refinements to the new power mobility device (PMD) fee schedule issued on October 2, 2006. These changes are designed to improve the accuracy of Medicare pricing, support high quality and service, provide value for Medicare and its beneficiaries, and insure that Medicare beneficiaries who need mobility assistance receive the modern medical care they need.
Over the last three years, the CMS has been working on a number of important initiatives related to the prescription, coding and coverage of PMDs. This effort was initiated in response to numerous instances of fraud and abuse, and significant growth in expenditures for these items under the Medicare program. CMS has developed a comprehensive strategy to address timely and appropriate coding, payment, and coverage of PMDs. CMS has made substantial progress in implementing this strategy including the more effective oversight and rational coverage policies to ensure beneficiaries receive the right mobility technology to meet their needs. Key elements in this process have been: a National Coverage Decision for mobility assistive equipment that more closely ties the Medicare coverage for a PMD to a beneficiary’s medical condition and ability to function in the home; final regulations that establish the requirement that the treating practitioner conduct a face-to-face examination of the beneficiary and provide a written prescription for a PMD; quality standards for durable medical equipment (DME) suppliers that will be applied by independent accreditation organizations; and local coverage determinations issued by CMS’ contractors that ensure that beneficiaries will receive the right technology to meet their mobility needs.
CMS worked closely with the Congress, GAO, and OIG to develop this strategy for reform. Revising the price structure for PMDs (i.e., separate codes and fees for different levels of standard and special purpose PMDs) is the final part of CMS’ strategy for reforming the power mobility benefit. New billing codes describing the range of mobility technology currently on the market were released, after thorough industry review and input, in June of 2006. These new codes are tied to industry standards of performance and durability, are designed to support accurate payment and coverage decisions, and replace out-of-date codes that do not adequately describe current technology. Fee schedule amounts for the new codes were originally issued on October 2, 2006. The October 2 fee schedule was preceded by a posting in early August of MSRP information. CMS shared its data and calculations for the new fees with manufacturers and suppliers. After receiving comments and feedback, CMS has performed a comprehensive review of the data and decided to make several refinements to the calculations. They are described below.
For more information on the CMS strategies, go to http://www.cms.hhs.gov/DMEPOSFeeSched/01a_Power_Mobility_Devices.asp