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Power Mobility Devices (PMDs)

The Standard Written Order (SWO) requirements are in affect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.

Coverage

Documentation

Reviews/Audits

  • Medical Review Results - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
  • Pre-Claim Review - View Advance Determination of Medicare Coverage (ADMC), Power Mobility Device (PMD) Prior Authorization Demonstration, and Required Prior Authorization Programs information

Tips

Topic Details
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, 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
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 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 signed and dated detailed product description (DPD) is required but a new face-to-face examination (F2F) or 7-element order (7EO) 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
Hospital, Skilled Nursing Facility
  • 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 DPD must be obtained. A F2F examination 7EO 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, 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 days remaining in 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 clarifications provided
Repair of Rented Items
  • 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
RT/LT Modifiers Effective for claims with dates of service (DOS) on/after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 UOS on each claim line. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding. See Correct Coding - RT and LT Modifier Usage Change for more information
Supplier Assistive Technology Professional Involvement
  • 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

 

Last Updated Thu, 04 Jun 2020 15:27:42 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

paginationType noridian
The Wheelchair Cushion Lookup Tool is Now Available 11/30/2020
Mobility Assist Equipment (MAE) DME on Demands 05/11/2020
Change to Resubmission Request Responses for Prior Authorization of PMD 04/16/2020
Prior Authorization Details Available within NMP 12/03/2019
HCPCS E1028: Accessory HCPCS Required for Dates of Service on/after March 1, 2020 10/17/2019
LCD and Policy Article Revisions Summary for December 3, 2015 DMD   12/03/2015
Denial for PMD Claim from a Supplier of DMEPOS When Ordered By a Non-Authorized Provider - Revised CR8239   09/29/2015
Medicare Demonstration Allows for Prior Authorization for Certain PMDs - Revised SE1231   08/12/2014