DME MACs Announce Addition of K0900 Customized Code
- By Laurie Watanabe
- Jan 29, 2014
In a new MLN Matters article - number 8158, revised - the Centers for Medicare & Medicaid Services (CMS) and their DME MACs announced the addition of a HCPCS code for customized durable medical equipment.
The K0900 code is defined as "custom durable medical equipment, other than wheelchairs."
K0900 joins two other custom HCPCS codes: K0008 (custom manual wheelchair/base) and K0013 (custom motorized/power wheelchair base).
The MLN Matters bulletin warns providers, "Make sure that you only use these codes for items that meet the definition of 'customized item' that is used specifically for Medicare payment purposes only. Very few items meet the Medicare regulatory definition of customized items."
The effective date for using the custom codes, including K0900, was July 1, 2013.
"Claims for items billed using these codes will be manually processed and evaluated to ensure that the item furnished meets the Medicare definition of customized item," the bulletin said.
The article referenced 42 Code of Federal Regulations Section 414.224(a), which defines customized DME as "(1) Uniquely constructed or substantially modified for a specific beneficiary according to a physician's description and orders; and (2) So different from another item used for the same purpose that the two items cannot be grouped together for pricing purposes."
The article did not give an example of the type of item that would qualify for the K0900 code, and at press time, CMS had not replied to a Mobility Management request for comment and clarification.
But the MLN Matters article did give an example of a custom wheelchair, citing one that had been "custom fabricated, or substantially modified, so that it can meet the needs of wheelchair-confined, conjoined twins facing each other." Such a chair, the article said, would be "unique and cannot be grouped with any other wheelchair used for the same purpose. It is a one-of-a-kind item, fabricated to meet specific needs."
The article also said that "custom fitted items" that are "measured, assembled, fitted or adapted in consideration of a patient's body size, weight, disability, period of need or intended use" would not meet CMS's definition of customized items.
"These items are not uniquely constructed or substantially modified and can be grouped with other items for pricing purposes," the bulletin said.
Payment for a customized item would be given as a lump-sum payment "based on the Medicare contractor's individual consideration and judgment of a reasonable payment for each item," the article said. The contractor would consider documentation of costs, including materials, design, fabrication and labor, as well as the skills needed to fabricate the equipment.
Laurie Watanabe is the editor of Mobility Management. She can be reached at firstname.lastname@example.org.