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Power Mobility Devices (PMDs)

Coverage

Documentation

Reviews/Audits

Reminders

Topic Reminder
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, the supplier may not continue to bill Medicare for that item. Although Medicare does not have specific guidelines on how a supplier should monitor and document use, each claim submitted may be subject to review. Supplier records must clearly demonstrate ongoing monitoring and use of the rental item by the 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 the event that a beneficiary changes residence. Medicare would not start a new capped rental period if the new residence will not accommodate the PMD the beneficiary is currently renting and a different base (same HCPCS code) is required. If the supplier elects to provide a different wheelchair base (different HCPCS code), a new signed and dated detailed product description (DPD) is needed but a new face-to-face examination (F2F) or 7-element order (7EO) is not needed. If a beneficiary with a PMD moves and their new home will no longer accommodate the PMD, Medicare will not pay for a new wheelchair. Medicare covers a replacement only if an item is lost, stolen, irreparably damaged, or reaches the five year reasonable useful lifetime. Medicare covers a different item only if there is a change in the beneficiary's medical condition.
Hospital, Skilled Nursing Facility During a PMD capped rental period, if a beneficiary goes into a hospital or skilled nursing facility for an extended stay, the supplier may elect to pick up the PMD. Upon returning home, if the supplier chooses to provide a different model PMD within the same HCPCS code, a new DPD must be obtained. A F2F examination 7EO is not needed in this situation. If the beneficiary is receiving the same type of PMD (same HCPCS code) on discharge that they previously had, then the rental period resumes where it left off. If the beneficiary qualifies for a different type of PMD on discharge because of a change in their medical condition, all the 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 the days remaining in the 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 the clarifications provided in this article.
Repair of Rented Items There is no payment for the repair of rented items under any circumstances during a PMD capped rental period. Reimbursement for repairs is included in the rental payments. If the supplier believes that a repair is required because of malicious damage or culpable neglect by the beneficiary, the supplier can present the information to the DME MAC for investigation. If the DME MAC, in consultation with the CMS, agrees that the beneficiary is responsible for the damage, the supplier can charge the beneficiary. The supplier can call the Contact Center to address this issue. When a PMD has a service issue, the supplier is required to provide a loaner item that meets the beneficiary's medical needs. Monthly billing would continue while the rental PMD is being repaired. There should be no separate billing and/or payment for the loaner wheelchair during the 13 month capped rental period.
Supplier Assistive Technology Professional Involvement The 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 the wheelchair selection for the patient.

 

Last Updated Mar 28, 2018

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.