Guidelines for appropriate billing of wheelchair mounting hardware are provided

• If a beneficiary discontinues use of a rental PMD, supplier may not continue to bill Medicare for that item
• Supplier records must clearly demonstrate ongoing monitoring and use of rental item by beneficiary, if audited

Requirements and coverage criteria for Group 3 Power Wheelchairs, HCPCS K0848-K0864, are provided

There is no requirement for a supplier to perform a new PMD home evaluation to reassess a beneficiary's home in event that a beneficiary changes residence. Medicare will not start a new capped rental period if new residence will not accommodate PMD beneficiary is currently renting and a different base (same HCPCS code) is required. If supplier elects to provide a different wheelchair base (different HCPCS), a new WOPD is required but a new face-to-face examination (F2F) is not necessary. If a beneficiary with a PMD moves and his/her new home will no longer accommodate PMD, Medicare will not pay for a new wheelchair. Medicare covers a replacement only if an item is lost, stolen, irreparably damaged, or reaches five-year reasonable useful lifetime. Medicare covers a different item only if there is a change in beneficiary's medical condition

If beneficiary goes into a hospital or skilled nursing facility for an extended stay, supplier may elect to pick up PMD. Upon returning home, if supplier chooses to provide a different model PMD within same HCPCS, a new WOPD must be obtained. A F2F examination is not needed in this situation. If beneficiary is receiving same type of PMD (same HCPCS) on discharge that they previously had, then rental period resumes where it left off. If beneficiary qualifies for a different type of PMD on discharge because of a change in his/her medical condition, all requirements for a new PMD must be met (i.e., F2F exam and WOPD). A new capped rental period will begin only if there has been a break in medical necessity of at least 60 days plus days remaining in last paid rental month

DMEPOS suppliers may ensure appropriate billing of power wheelchair electronics, such as motors, controllers, harnesses and interfaces by considering clarifications provided

• There is no payment for repair of rented items under any circumstances during a PMD capped rental period
• If supplier believes that a repair is required because of malicious damage or culpable neglect by beneficiary, supplier can present information to DME MAC for investigation. If DME MAC, in consultation with CMS, agrees that beneficiary is responsible for damage, supplier can charge him/her. Supplier can call the Contact Center to address this issue
• When a PMD has a service issue, supplier is required to provide a loaner item that meets beneficiary's medical needs. Monthly billing will continue while rental PMD is being repaired. There should be no separate billing and/or payment for loaner wheelchair during 13 month capped rental period

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 wheelchair selection for patient