CMS beneficiaries who need certain types of power mobility devices will be required to meet with qualified rehabilitation technology specialists before suppliers can deliver the equipment under a Sept. 14 local coverage determination draft.

Released concurrently by the four durable medical equipment regional carriers, the draft says that reimbursement for high-activity, specific-use and specialized-use power wheelchairs will be provided only after patients have been evaluated by an assistive technology provider certified by the Rehabilitation Engineering & Assistive Technology Society of North America.

CMS authored the draft LCD in conjunction with the four regional carriers, each of which will accept comments on the draft until Oct. 31.

Power Mobility Coalition Director Eric Sokol said in an interview that the new evaluation requirement "could lead to access issues, especially in rural areas where accessibility to RESNA-certified ATPs might not be all that readily available."

In an "open door" forum held by CMS Sept. 13, power wheelchair and scooter suppliers opposed the new reimbursement system, which requires physicians to submit documents from a patient's medical history rather than the Certificate of Medical Necessity form used in the past ¹ Also see "Power Wheelchair Suppliers Spar With CMS Over New Regs" - Medtech Insight, 19 September, 2005., p. 9).

They said the subjective nature of the medical history documents would make it easy for regional carriers to deny reimbursement to suppliers.

The newly released LCD specifies the documents that should be submitted with a physician's prescription for a mobility device. The list includes a physical exam, a clinical history of the patient's condition and an assessment of the patient's ability to function in the home.

But Mike Pfister, CEO of the Scooter Store, argues that the guidance does not change the subjective nature of the documents themselves.

"We've got to have some level of confidence that we'll get paid, without guessing on a claim-by-claim basis whether the DMERC reviewing nurse will agree with our interpretation," Pfister said.

Wheelchair Reimbursement Policy Requires Patient Evaluation By An Expert

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