MEDICARE IMPROVES ACCESS TO POWER WHEELCHAIRS AND SCOOTERS
The Centers for Medicare & Medicaid Services (CMS) today announced new national coverage criteria for mobility assistive equipment (MAE) including power wheelchairs and scooters. The new criteria, which are effective immediately, adopt a function-based determination of medical necessity. This determination looks at the ability of the beneficiary to safely accomplish mobility-related activities of daily living, such as toileting, grooming, and eating, with and without the use of mobility equipment such as a wheelchair. The national coverage determination (NCD) addresses the full range of MAE from simple canes and walkers to sophisticated power wheelchairs.
“The steps we are taking today are part of our efforts to ensure that seniors who need mobility help will get it promptly, and that we are paying appropriately for mobility assistive equipment,” said CMS Administrator Mark B. McClellan, M.D., PhD. “The new functional criteria reflect current medical practice and mean that beneficiaries will have the freedom to live better, more mobile lives, without needing to fit into a rigid ‘bed or chair-confined’ standard.”
The new coverage criteria are part of a larger three-pronged Modern Mobility Initiative announced in April 2004 focused on improving coverage, payment and quality of suppliers of power wheelchairs and other mobility aids. In addition to developing new coverage criteria, CMS has developed new billing codes that will take effect January 1, 2006, to reflect the variety of wheelchairs now on the market. CMS expects to issue new quality standards for suppliers in 2006.
“This coverage policy ensures that a beneficiary’s functional status and individual circumstances are considered so that the most appropriate technology for each beneficiary’s personal needs is covered,” said Barry Straube, M.D., CMS’s Acting Chief Medical Officer and Acting Director of the Office of Clinical Standards and Quality. "It is also consistent with the documentation of the functional needs of the patient that should be in medical records for our beneficiaries."
CMS plans to issue additional guidance in the near future to help physicians and treating practitioners better understand the new coverage criteria and CMS’s expectations about proper documentation in the medical record. Because the new functional criteria more explicitly refer to standard clinical evaluative methods, CMS expects that the medical documentation generated during the patient evaluation will more accurately be reflected in the beneficiary’s medical record. It is CMS’s intent that this will make the power mobility device coverage process more straightforward.
“During the course of reviewing Medicare’s policies for power mobility devices, CMS came to the conclusion that there are more accurate tools to root out fraud and abuse,” said Kimberly Brandt, Director of CMS’s Program Integrity Group. “The combination of the new NCD and the planned enhanced educational outreach by Medicare to physicians and treating practitioners, as well as to suppliers, will eliminate most honest billing errors. More accurate claim submission will allow CMS to better analyze claims data and focus claims review to target abusive billers.”
Note: More information about these developments can be found at the following website: www.cms.hhs.gov/coverage under mobility assistive equipment (MAE).