ATP Series

A Funding Headache

Look for head positioning equipment options in a complex rehab technology exhibit hall, and you’ll find a wide array of hardware and pads in different sizes and shapes, capable of varying positions and movements to answer the needs of individual clients.

Look at those same choices through the eyes of the Centers for Medicare & Medicaid Services (CMS), though, and you’ll see something entirely different.

Rita Hostak, VP of government affairs for Sunrise Medical (see her comments about the K0009 code and ultralightweight wheelchairs starting on page 12), points out ongoing funding challenges for head positioning. The issue is caused in part, she says, by CMS’s decision to add the words “any type” to various code descriptors.

As an example of the eff ects of those changes, Hostak says, “I’ll just use the headrests because it’s my sorest spot. We’ve tried for 10 years to get a unique HCPCS code for the various arrays of headrests. You can have a headrest that just has a single flat pad that’s on a single piece of hardware that really is just there as a headrest if somebody reclines or tilts. Or you can have a very complex headrest with multiple pads, swingaway hardware, adjustable in multiple planes, that can hold and adjust and support the most profound child with tone issues and all sorts of things.

“Those fit in the same code, same level of reimbursement. And the reimbursement is less than what it cost the supplier to acquire the parts.”

So suppliers can actually lose money by providing complex headrests according to Medicare’s current allowables, and Hostak adds that consumers pay the price.

“I can assure you that the access to those devices just based on our utilization has been impacted,” she says. “To me, the individuals with the most profound disabilities are the ones impacted the most.”

This article originally appeared in the June 2013 issue of Mobility Management.

Rolling Dynamics, Rolling Resistance &  Optimizing Wheeled Prosthetics