CMS Updates DMEPOS Fee Schedules, Procedures & Policies for 2009

As the new year begins, the Centers for Medicare & Medicaid Services (CMS) has announced updated fee schedules, HCPCS coding procedures and policies for a range of DME.

Among the changes related to seating and mobility equipment are the following:
•    HCPCS code E2295 has been added to the HCPCS file as of Jan. 1, 2009. The code has been assigned to a “manual wheelchair accessory for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features.”
CMS adds that because it anticipates “low claims volumes” for this particular new code, “your Medicare contractor will establish local fee schedule amounts to pay claims.”
•    The 9.5-percent fee schedule reduction for DME included in round one of CMS’ now-halted competitive bidding program goes into effect Jan. 1 for items furnished on or after that date. The reductions are part of the Medicare Improvements for Patients & Providers Act of 2008 (MIPPA), which became law in July 2008 and required CMS to, among other things, stop competitive bidding and revamp the entire program.
The 9.5-percent reimbursement cuts affect a number of mobility categories, including standard power wheelchairs, scooters and accessories; complex rehab power wheelchairs and accessories; hospital beds and related supplies; walkers and related supplies; and support surfaces.
•    DME not included in competitive bidding’s first round “will receive a 5.0-percent covered item update for 2009,” CMS said in an MLN Matters bulletin released in early November.
•    In that MLN Matters bulletin, CMS also reminded providers that the HCPCS code E2399 — to upgrade from a non-expandable controller to an expandable controller at initial issue — “was intended as a temporary measure until a new code could be added to describe the electronics/cables/
junction boxes used when upgrading from a non-expandable controller at initial issue.”
On Jan. 1, 2008, CMS added HCPCS
code E2313: Power Wheelchair Accessory, Harness for Upgrade to Expandable Controller, including all fasteners, connectors and mounting hardware, each. As of that Jan. 1, 2008, date, providers were instructed to use the new E2313 code and “must no longer use code E2399 for submission of such items.”
CMS warned that claims now bearing the E2399 code for those items “are invalid and will be denied as contractor/supplier responsibility.” In such situations, CMS indicated it will use message codes M20 (Missing/Incomplete/
Invalid HCPCS code); 189 (Not otherwise classified or unlisted procedure code was billed when there is a specific procedure code for
this procedure/service); N211 (Appeal not allowed); and MA13 (You may be subject to penalties if you bill the patient for amount not reported with the Patient Responsibility [PR] group code).

This article originally appeared in the January 2009 issue of Mobility Management.

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