Claims for scooters and most types of power wheelchairs for Medicare beneficiaries in seven states will be subject to prepayment and prior authorization scrutiny starting early next year, the Centers for Medicare & Medicaid Services (CMS) announced.
California, Florida, Illinois, Michigan, New York, North Carolina and Texas were chosen for the demonstration project because of “high populations of fraud- and error-prone providers,” according to a news announcement from CMS on Nov. 15.
Large ranges of power mobility devices (PMD) are affected by the prepayment reviews and prior authorization requirements, including the following:
— Power-operated vehicles (aka, scooters): HCPCS codes K0800-K0805 and K0809-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 and Group 4 power chairs: HCPCS codes K0887-K0891.
— Miscellaneous power wheelchairs with HCPCS code K0898.
Group 3 chairs with powered seating options – with HCPCS codes K0856-K0864 – are not included in the prepayment review or prior authorization requirements.
The demonstration project, slated to last three years, will roll out in two distinct phases, according to CMS’s initial announcement.
CMS described the first phase as lasting “the first three to nine months” and said this period would consist of Medicare Administrative Contractors conducting prepayment reviews.
The second phase, defined as lasting “the remainder of this three-year demonstration,” will consist of prior authorization, described by CMS as “a tool utilized by private-sector health care payors to prevent improper payments and deter fraudulent provision of items or services.”
CMS said the goal of the demonstration projects would be to “strengthen Medicare by aiming at eliminating fraud, waste and abuse.”
