CMS' interim final rule on power wheelchairs and mobility assist equipment marks the culmination of almost two years of initiatives to reduce fraud by modifying coverage and payment requirements.

The ^FDL-1 rule, issued Aug. 26, delineates CMS' coverage modifications to replace the requirement that beneficiaries be "bed- or chair-confined" with clinical criteria based on their ability to accomplish basic, daily living activities (¹ Also see "Mobility-Assist Device National Coverage To Rely On Clinical Criteria" - Medtech Insight, 7 February, 2005., p. 13).

Under the new regulation, physicians are required to submit both a written prescription and supporting documents from the patient's medical history, instead of the Certificate of Medical Necessity (CMN) that was previously required.

According to an Aug. 23 release, officials at the agency found that "CMN did not work as well as originally hoped, because important functional details in the medical record have frequently not been included in the CMN."

The rule also requires that beneficiaries have a face-to-face examination with a physician before receiving a prescription, as stipulated under the Medicare Modernization Act.

The document implements another MMA provision by extending the power to order wheelchairs and scooters to non-physician practitioners, including physician assistants and nurse specialists. The provision will become effective Oct. 25.

To compensate physicians and practitioners for the additional paperwork they must submit on behalf of patients, CMS announced that they will receive a new payment of $21.60, adjusted by geographical area.

In comments submitted to CMS last August, AdvaMed stated that the "face-to-face" requirements outlined in MMA should apply to power wheelchairs only, and not all durable medical equipment, prosthetics, orthotics and supplies ² Also see "DME Physician Exam Criteria Exceed Scope Of Medicare Law – AdvaMed" - Medtech Insight, 6 September, 2004., p. 16).

Comments on the reg are due Nov. 25. CMS contractors will not fully implement the change until April 2006, according to the agency.

CMS Overhauls Wheelchair Reimbursement In Interim Final Rule

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