Upgrades to Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886)

Posted April 29, 2011

Recent revisions to the Power Mobility LCD eliminating Least Costly Medically Necessary Alternative classified the denials for Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886) as statutorily noncovered. This determination caused the unintended consequence of making these items ineligible for the Advanced Beneficiary Notice (ABN) upgrade process. The LCD and Policy Article are being revised to indicate that Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886) are considered durable medical equipment but are not reasonable and necessary. This change will be effective for dates of service on or after June 01, 2011.

In addition to capabilities that allow Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886) to be used in the home, they also have certain performance characteristics that are not reasonable and necessary for use in the home such as (not all-inclusive):

• robust frames

• motors with increased torque/power

• suspensions with enhanced vibration-dampening or obstacle climbing capabilities

The revised Power Mobility Devices LCD and related Policy Article will reflect that claims for Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886) will be denied as not reasonable and necessary. As a result, Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886) are eligible for the ABN upgrade provisions as set out in the recently published bulletin article on the use of upgrade modifiers as a result of changes due to elimination of least costly alternative.

Refer to the LCD, Policy Article, and Supplier Manual for additional information on upgrades and Power Mobility devices.

The Power Mobility Devices LCD and Policy Article revisions will be published in the near future.

Last Updated May 25 , 2017