Monthly Archives: January 2016

It’s Included! Items that Medicare does not allow to be billed separately on a PMD

Kay Koch, OTR/L, ATP – Rehab Team Supervisor, The van Halem Group a division of VGM

Many times we are asked to review the Detailed Product Description (DPD) for a powered mobility device prior to authorization or ADMC review. There are items that may appear on the manufacturer’s quote for a powered mobility device but that are actually included in the base of the power chair.

Here’s a quick reference guide to assist you as you create your DPD’s. Sometimes, despite what is on the quote listed separately, Medicare will consider it “included.”

Basic Equipment Package

  • Items that are part of a basic equipment package cannot be separately billed on an initial issue base.
  • Basic equipment package for a POV:
    • The battery or batteries required for operation
    • Single-mode battery charger
    • Weight-appropriate upholstery and seating system
    • Tiller steering
    • Non‐expandable controller with proportional response
    • Complete set of tires
    • All accessories needed for safe operation
  • Basic equipment package for a PWC:
    • Anterior pelvic support (lap belt, pelvic belt)
    • Single-mode battery charger
    • Complete set of tires and casters, including any type of tire
    • Fixed, swing‐away or detachable non‐elevating legrests with or without calf pads
    • Fixed, swing‐away or detachable footrests or a foot platform with or without angle adjustable footplates
    • Fixed, swing‐away or detachable non‐adjustable height armrests with arm pads
    • Any weight‐specific components required by patient weight
    • Any seat width, seat depth and back width
    • Non‐expandable controller with a standard proportional joystick (integral or remote)
  • Sometimes if it’s not included, it CAN be separately billed on a PWC if it has been justified in the documentation:
    • Shoulder harness or chest belt (E0978)
    • Elevating legrests (ELR) or articulating legrests (ALR)
    • Angle adjustable footplates on a Group 3 or 5 PWC
    • Height adjustable armrests (E0973, K0020) unless provided on power tilt or recline
    • The following seat and back dimensions if provided on a Group 3 or Group 4 PWC with a sling/solid seat/back:
      • Seat width/depth or back width greater than 20″ on a standard base
      • Seat width/depth or back width greater than 22″ on a heavy duty base
      • Seat width/depth or back width greater than 24 ” on a very heavy duty base
      • No exceptions for extra heavy duty bases
    • Expandable controller, a non‐standard joystick (non-proportional, mini, compact or short throw) or other alternative control device, if appropriate

On a new PWC, you also cannot bill separately for:

  • Standard joystick or any additional features of a joystick
  • Electronic display box or hardware (included in E2310, E2311)
  • Airless inserts
  • Parts, pieces or materials used to construct custom seat (E2609) or custom back (E2617); all are included in the base code
  • Multiple line items for headrest hardware
  • Color options
  • Performance packages
  • Wheel locks
  • Anti-tippers
  • Back frame, seat frame, back posts
  • Transit options
  • Cannot charge for lateral trunk supports and hardware with E2620 or E2621 positioning back

Keeping this list in mind will also help when considering an ABN for some items, such as transit options, which are not covered.