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Power Mobility Device (PMD) Prior Authorization

On September 1, 2012, CMS implemented a Prior Authorization Request (PAR) process for designated Power Mobility Devices (PMDs) for Medicare beneficiaries residing in seven high population states including California, Illinois, Michigan, New York, North Carolina, Florida, and Texas.

On October 1, 2014, the PAR demonstration expanded to an additional twelve states including Washington, Missouri, Arizona, Pennsylvania, Maryland, New Jersey, Indiana, Louisiana, Tennessee, Georgia, Ohio and Kentucky.

On September 1, 2015, the PAR demonstration was extended for an additional three years and will end August 31, 2018. See Prior Authorization of PMD Demonstration This link will take you to an external website. on the CMS website for more information.

Noridian Healthcare Solutions processes PARs for beneficiaries residing in Maryland, New Jersey, Pennsylvania and New York. 

PMD Coverage Resources

Policy Number Title
NCD 280.3 This link will take you to an external website. National Coverage Determination (NCD) for Mobility Assistive Equipment
L33789 and A52498 [PDF] Power Mobility Devices Local Coverage Determination (LCD) and Policy Article

 

The prior authorization process under this demonstration is available for the following Healthcare Common Procedure Coding System (HCPCS) codes for Medicare payment:

Description HCPCS
Group 1 Power Operated Vehicles K0800, K0801, K0802, K0812
All Group 2 complex rehabilitative power wheelchairs K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843
Pediatric power wheelchairs K0890, K0891
All standard power wheelchairs K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829
All Group 3 complex rehabilitative power wheelchairs without power options K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855
Miscellaneous power wheelchairs K0898

 

Resources

Last Updated Jul 07, 2016