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Power Mobility Devices (PMDs)

Coverage

Documentation

Document Type Description
Changing a 7-Element Order for PMDs To minimize possible misunderstanding, it is recommended that when the need for a correction to a 7-element-order for a Power Mobility Device (PMD) is identified, the supplier should request that the physician who completed the original 7-element-order complete and submit a new 7-element-order.
Group 1/Group 2, No Power Options Documentation Checklist [PDF] This checklist is for HCPCS codes K0813 – K0816 and K0820 – K0829
Group 2 Single/Multiple Power Options Documentation Checklist [PDF] This checklist is for HCPCS codes K0835 – K0840 and K0841 – K0843
Group 3 Single/Multiple Power Options Documentation Checklist [PDF] This checklist is for HCPCS codes K0856 – K0860 and K0861 – K0864
Group 3 No Power Options Documentation Checklist [PDF] This checklist is for HCPCS codes K0848 – K0855
POV and Push-Rim Activated Power Assist Device Documentation Checklist [PDF] This checklist is for HCPCS codes K0800 – K0808, K0812 and E0986
Physician Letter - Power Wheelchairs and Power Operated Vehicles [PDF] This letter may be sent to physicians to assist in obtaining documentation

 

Reviews/Audits

Review Type Description

Advance Determination of Medicare Coverage (ADMC)

  • ADMC Overview
  • Eligible HCPCS List
  • Request Form
  • Preventing Duplicate ADMC Requests
Medical Review View notifications and findings of pre and post claim reviews completed by Noridian Medical Review Staff
Prior Authorization Demonstration View eligibility HCPCS codes, upcoming educational outreach, CMS resources, and all applicable publications.

 

Reminders

Topic Reminder
Billing Reminder for Mounting Hardware - HCPCS E1028 Guidelines for appropriate billing of wheelchair mounting hardware are provided.
Discontinued Use If a beneficiary discontinues use of a rental PMD, the supplier may not continue to bill Medicare for that item. Although Medicare does not have specific guidelines on how a supplier should monitor and document use, each claim submitted may be subject to review. Supplier records must clearly demonstrate ongoing monitoring and use of the rental item by the beneficiary if audited.
Group 3 Power Wheelchair Requirements Requirements and coverage criteria for Group 3 Power Wheelchairs, HCPCS K0848-K0864, are provided
Home Assessment There is no requirement for a supplier to perform a new PMD home evaluation to reassess a beneficiary's home in the event that a beneficiary changes residence. Medicare would not start a new capped rental period if the new residence will not accommodate the PMD the beneficiary is currently renting and a different base (same HCPCS code) is required. If the supplier elects to provide a different wheelchair base (different HCPCS code), a new signed and dated detailed product description (DPD) is needed but a new face-to-face examination (F2F) or 7-element order (7EO) is not needed. If a beneficiary with a PMD moves and their new home will no longer accommodate the PMD, Medicare will not pay for a new wheelchair. Medicare covers a replacement only if an item is lost, stolen, irreparably damaged, or reaches the five year reasonable useful lifetime. Medicare covers a different item only if there is a change in the beneficiary's medical condition.
Hospital, Skilled Nursing Facility During a PMD capped rental period, if a beneficiary goes into a hospital or skilled nursing facility for an extended stay, the supplier may elect to pick up the PMD. Upon returning home, if the supplier chooses to provide a different model PMD within the same HCPCS code, a new DPD must be obtained. A F2F examination 7EO is not needed in this situation. If the beneficiary is receiving the same type of PMD (same HCPCS code) on discharge that they previously had, then the rental period resumes where it left off. If the beneficiary qualifies for a different type of PMD on discharge because of a change in their medical condition, all the requirements for a new PMD must be met (i.e., F2F exam, 7EO, etc.). A new capped rental period will begin only if there has been a break in medical necessity of at least 60 days plus the days remaining in the last paid rental month.
Power Wheelchair Electronics Clarification DMEPOS suppliers may ensure appropriate billing of power wheelchair electronics, such as motors, controllers, harnesses and interfaces by considering the clarifications provided in this article.
Repair of Rented Items There is no payment for the repair of rented items under any circumstances during a PMD capped rental period. Reimbursement for repairs is included in the rental payments. If the supplier believes that a repair is required because of malicious damage or culpable neglect by the beneficiary, the supplier can present the information to the DME MAC for investigation. If the DME MAC, in consultation with the CMS, agrees that the beneficiary is responsible for the damage, the supplier can charge the beneficiary. The supplier can call the Contact Center to address this issue. When a PMD has a service issue, the supplier is required to provide a loaner item that meets the beneficiary's medical needs. Monthly billing would continue while the rental PMD is being repaired. There should be no separate billing and/or payment for the loaner wheelchair during the 13 month capped rental period.
Supplier Assistive Technology Professional Involvement The supplier of a rehab PMD must employ a RESNA-certified Assistive Technology Professional who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the patient.

 

Last Updated May 31, 2017

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