CMS Extends PMD Demonstration Project Into 2018

The Centers for Medicare & Medicaid Services (CMS) has extended the length of its power mobility device (PMD) demonstration project, which uses a prior authorization process.

The Medicare demo will now continue till Aug. 31, 2018, in the 19 states that were already participating. The project began in September 2012 for California, Florida, Illinois, Michigan, New York, North Carolina and Texas. An October 2014 expansion added 12 more states to the list of participants: Arizona, Georgia, Indiana, Kentucky, Louisiana, Maryland, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Washington.

While CMS indicated states were chosen “based upon their history of having high levels of improper payments and incidents of fraud related to PMDs,” industry funding experts have largely lauded the program for helping providers to determine Medicare beneficiaries’ eligibility for PMDs before providers actually purchase and deliver the vehicles.

CMS’s Web site shows the demonstration was officially extended on July 15, but DME MACs were still getting the word out to stakeholders last week.

The demonstration project involving the first seven states originally included a first-phase prepayment review requirement, which was eliminated in response to public comments. A revised version of the demo started Sept. 1, 2012, and included just the prior authorization format.

Most scooters and power wheelchairs are included in the demonstration:

-- Power-operated vehicles (aka, scooters): HCPCS codes K0800-K0802 and K0812.

-- Standard power chairs: HCPCS codes K0813-K0829.

-- Group 2 complex rehab power chairs: HCPCS codes K0835-K0843.

-- Group 3 complex rehab power chairs without power options: HCPCS codes K0848-K0855.

-- Pediatric power chairs: K0890-K0891.

-- Miscellaneous power wheelchairs with HCPCS code K0898.

Group 3 complex rehab power chairs with power options are excluded from the demonstration.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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