No Delay: Capped-Rental Transition Goes Ahead

• By Laurie Watanabe
• Apr 09, 2014

Despite outcries from Medicare beneficiaries, consumer organizations and industry organizations, the Centers for Medicare & Medicaid Services (CMS) did not delay the recategorization of dozens of DME and complex rehab technology (CRT) HCPCS codes that had been in Medicare's "routinely purchased" category.

Thus on April 1, the codes were reclassified as capped-rental types of equipment.

Fifty of the codes are related to wheelchairs. Among the most troubling to CRT professionals is E1161: The adult tilt-in-space wheelchair code is now subject to capped-rental payment rules.

In an April 2 bulletin to NCART members, Don Clayback, the organization's executive director, said, "CMS did not announce a delay in the reclassification of certain CRT codes to the capped-rental payment category. As a result, the reclassifications are effective for dates of service on or after April 1."

Clayback reminded stakeholders, "If these items are provided on a complex rehab power wheelchair, they remain billable as a purchase."

But he added, "It's very unfortunate that CMS did not address the widespread concerns expressed by all CRT stakeholders and the more global request to create a legitimate classification policy."

Clayback pointed out that though CMS received more than 170 comments during the public comments period for the proposed rule, CMS had not heeded them.

More recently, the two U.S. Senators and two U.S. Representatives who introduced CRT separate benefit category bills asked CMS to postpone the capped-rental transition. Among the reasons cited by those members of Congress: The claims data used by CMS to compile its list of codes subject to recategorization was "more than 27 years old and fundamentally flawed."

A March 6 letter from Sen. Thad Cochran (R-Miss.), Sen. Charles E. Schumer (D-N.Y.), Rep. Joseph Crowley (D-N.Y.) and Rep. Jim Sensenbrenner (R-Wisc.) to Marilyn Tavenner, administrator for CMS, asked her to delay implementation till at least July 1.

Such a delay, the members of Congress added, would give Congress time to develop new and better criteria for CMS to use.

Cochran and Schumer introduced S. 948, a Senate bill that would provide a separate Medicare benefit category for CRT. Crowley and Sensenbrenner introduced H.R. 942, a House bill with the same goal.

The letter, along with concerned comments from organizations including RESNA and United Spinal Association, failed to convince CMS to postpone implementation.

"Since a delay - and subsequent removal of CRT codes - did not happen," Clayback said, "we will be working with our CRT legislation sponsors to add an amendment to provide that all CRT items be available as a purchase or with a purchase option. They have committed to doing this."

With the recategorization now in effect, Clayback urged industry professionals to note any difficulties that result.

"It is important that we track and report any problems consumers are having accessing these items," he said. "The various consumer groups will be doing likewise. Please share those details with me as they arise and encourage consumers to contact their members of Congress."