Power Mobility Devices (PMDs) - JD DME
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Power Mobility Devices (PMDs)
Coverage
- Mobility Assistive Equipment (MAE) (280.3) National Coverage Determination (NCD)
- Power Mobility Devices Local Coverage Determination (LCD)
- Power Mobility Devices Policy Article
- Wheelchair Options/Accessories Local Coverage Determination (LCD)
- Wheelchair Options/Accessories Policy Article
- Wheelchair Seating Local Coverage Determination (LCD)
- Wheelchair Seating Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Power Mobility Devices [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Power Operated Vehicle (POV) [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Push-Rim Activated Power Assist Device [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Medicare Prior Authorization Condition of Payment for Certain Power Mobility Devices [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Clinician Letter - Power Wheelchairs and Power Operated Vehicles [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Group 1, Group 2, and Group 3 No Power Options Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0813 - K0816, K0820 - K0829, and K0848 - K0855
- Group 2 and Group 3 Single / Multiple Power Options Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation for HCPCS K0835 - K0840, K0841 - K0843, K0856 - K0860, and K0861 - K0864
- Documentation Checklist for Power Mobility Devices [PDF] - Checklist to ensure suppliers gather all documentation for power mobility devices
- 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
Prior Authorization Timelines
| Policy | Initial Review Decision Timeframe |
Expedited Review Decision Timeframe |
PAR Decision Valid |
|---|---|---|---|
| PMD | 10 business days | 2 business days | six months |
Tips
| Topic | Details |
|---|---|
| Advance Determination of Medicare Coverage (ADMC) | Power Wheelchairs described by HCPCS K0890, K0891, and K0013 are eligible for ADMC |
| Billing HCPCS Code K0108 - Wheelchair Component or Accessory, Not Otherwise Specified | Guidelines for appropriate billing of HCPCS Code K0108 |
| Billing Reminder for Mounting Hardware - HCPCS E1028 |
Guidelines for appropriate billing of wheelchair mounting hardware are provided |
| Capped Rental Items | Guidelines on rental and/or purchase items. Standard Power Wheelchairs (HCPCS codes K0813-K0831 and K0898) must be rented. Complex Rehabilitative Power Wheelchairs (HCPCS codes K0835-K0843 and K0848-K0864) and Wheelchair Options/Accessories Furnished for Use with a Complex Rehabilitative Power Wheelchair can be either rented or purchased |
| Discontinued Use |
|
| 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 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 |
| 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 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 |
| KU | The KU modifier is used to receive the unadjusted fee schedule amount and was implemented for a variety of wheelchair accessories and seat back cushions used with K0005, E1161, E1231-E1238 and K0008 |
| KE | Append to accessory code for contract and non-contract suppliers when beneficiary resides in a competitive bidding area (CBA) HCPCS codes K0005, K0009, K0898, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, and E1239) |
| KY | Append when billing for competitively bid (Round 2 or subsequent Round) wheelchair accessories used with certain non-competitively bid wheelchair base units for beneficiaries residing in Round 2 (or subsequent Round) competitive bidding areas (CBAs) |
| Modifier BP | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item. Example: K0861NUKXBP |
| Modifier BR | The beneficiary has been informed of the purchase and rental options and has elected to rent the item. Example: K0848RRKHKXBR |
| 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 |
| Prior Authorization for Power Mobility Devices | Prior Authorization Requests (PAR) are required for items listed on the Required Prior Authorization List. Request may be submitted to review eligible PMD accessory HCPCS codes on a voluntary basis when a PAR for the required PMD base is submitted. PMDs replaced due to lost, stolen, or irreparable damage must receive a PAR decision and an expedited PAR request should be submitted for replacement PMD items. |
| Repair of Rented Items |
|
| Replacement | Supplier that transfers title to a capped rental item, such as a power wheelchair, to a beneficiary remains responsible for furnishing replacement equipment at no cost to the beneficiary or to the Medicare program for the 5-year reasonable useful lifetime for the equipment. In making this determination, the DME MACs may consider whether the accumulated costs of repair exceed 60 percent of the cost to replace the item. |
| 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 |
| Seat Elevation Systems as an Accessory to Power Wheelchairs | E2298 (complex rehabilitative power wheelchair accessory, power seat elevation system, any type) is covered for Group 5 and complex rehabilitative power-driven wheelchairs. For coverage criteria review the Original Consideration for Seat Elevation Systems as an Accessory to Power Wheelchairs (Group 3) within the Mobility Assistive Equipment (MAE) (280.3) National Coverage Determination (NCD). |
| 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 |
| Warranties | Payment may be made for reasonable and necessary charges for maintenance and servicing of beneficiary-owned equipment. Reasonable and necessary charges are those made for parts and labor not otherwise covered under a manufacturers or supplier’s warranty. Suppliers must maintain copies of any manufacturer or supplier warranties for equipment being repaired and furnish this documentation upon request. |
Resources
- CMS Change Request (CR) 13610 - Replacement Wheelchair Equipment When the Manufacturer Exits Wheelchair Business
