Reimbursement: Change Is on the Way But CMS Can't Say When
The saga of new power mobility device (PMD) codes is definitely a cliffhanger. Since implementation of the new codes was delayed in September, news on a change predestined to shake up the industry has been scarce. In fact, the last status report came from Dr. Doran Edwards, SADMERC medical director, at a Medtrade conference in October 2005.
There's an old saying that goes, "No news is good news." As the industry braces for new PMD codes that have yet to come from the Centers for Medicare & Medicaid Services (CMS), it can be said that in this case, "no news is simply no news."
When asked about the new codes, CMS's Ellen B. Griffith said, "We will be publishing an update on the codes soon. Until then, we are not able to say anything."
Though CMS may be mum on the subject, the industry certainly has not lost its voice.
First, A Recap
Though CMS declined to comment, Griffith did generate a brief timeline for the coding:
- February 2005 — CMS issued 49 new HCPCS codes for PMDs and established product testing requirements to ensure that products can be grouped together based on industry standards for performance and durability. The new codes were scheduled to be implemented on Jan. 1, 2006.
- Sept. 14, 2005 — CMS revised the new HCPCS codes, adding 13 new codes and modifying a number of the testing requirements.
- Oct. 14, 2005 — CMS delayed implementation of the new HCPCS codes pending further public consultation
That brings us up to date. Griffith said a contractor has been hired to assemble a technical expert panel to work through the issues raised by the PMD industry regarding the September changes. Once this process is complete, she says, CMS will issue the final HCPCS codes and testing requirements. Until that date, the industry is in limbo.
Dr. Edwards confirmed that a contractor will facilitate a panel of 15, comprised of the SADMERC, clinicians, technicians, engineers, scientists and industry representatives. The panel was scheduled to meet Feb. 7-9 in Rockville, Md., to begin deliberations.
"CMS typically does not publicize the list of the technical expert panels so we're not expecting anything to be posted on their Web site," says Seth Johnson, vice president of government affairs, Pride Mobility. "So, the first time we really have an understanding of who actually is on the committee will be at that first committee meeting on Feb. 7." Manufacturers Pride, Exeter, Pa.; Permobil, Lebanon, Tenn.; Sunrise, Longmont, Colo.; and Invacare, Elyria, Ohio, have all confirmed panel involvement.
Edwards says he expects the panel to finalize the details on the new codes for CMS to review shortly after the February meeting, but did not anticipate a decision before Medtrade Spring. "It's possible (by Medtrade) but that's an awful lot of work to get done in a fairly short period of time on something that's taken us two years to get where we are now. So, don't hold your breath," he says. "
This article originally appeared in the March 2006 issue of HME Business.