CMS: Accessories not part of PMD demo

BALTIMORE - Providers want to know: how do you determine the medical necessity of a power wheelchair when you don't consider the accessories added to meet a patient's needs?

CMS had no answer to that question during last week's Open Door Forum for the PMD demonstration except to say that accessories will not be included in the prior authorization process.

"The accessories cost much more than the base," Wayne Levesque of Mobility Medical told CMS officials during the forum. "From my standpoint, if you're not considering the accessories, the prior authorization doesn't do me much good."

The prior authorization process is intended as a way for CMS to check medical necessity and other Medicare requirements before a provider delivers wheelchair. Upon receiving approval, the provider may deliver the wheelchair and submit a claim for payment.

Levesque told CMS officials that it only makes sense to consider accessories with the base. CMS officials thanked him for his comment and reiterated that only the base is subject to the demo.

Currently, providers may use the advanced determination of Medicare coverage (ADMC) process for wheelchairs and accessories. One caller asked if she could send a claim through both the ADMC and prior authorization processes. CMS officials asked her to send them an email outlining her question.

Another question revolved around whether a prior authorization would be needed for replacing a demolished wheelchair. Melanie Combs-Dyer, deputy director of CMS's Provider Compliance Group, said the answer would be available in a future FAQ at www.cms.gov.

CMS announced one change to the demo during the forum: The timeframe for contractors to reconsider resubmitted prior authorization requests is now 20 days instead of 30.

The next Open Door Forum for the PMD demo is scheduled for 3 p.m. EST July 27.