Power Mobility Devices (PMDs)

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Condition of Payment Prior Authorization - 06/06/19

Power Mobility Devices (PMDs)

Coverage

Documentation

Changing a 7-Element Order for PMDs - It is recommended that when the need for a correction to a 7-element-order for a 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
Clinician Letter - Power Wheelchairs and Power Operated Vehicles [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
Group 1 / Group 2, No Power Options Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0813 - K0816 and K0820 - K0829
Group 2 Single / Multiple Power Options Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0835 - K0840 and K0841 - K0843
Group 3 Single / Multiple Power Options Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0856 - K0860 and K0861 - K0864
Group 3 No Power Options Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0848 - K0855
POV and Push-Rim Activated Power Assist Device Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0800 - K0808, K0812 and E0986

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
Detailed Product Description (DPD)	When someone other than physician/practitioner completes detailed written order, DPD must include order date prior to sending to physician /practitioner for review, signature, and date If DPD does not contain date of order, it is considered invalid
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 Mar 19, 2019

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.