In a potentially precedent-setting action, the Medicaid program for the state of Massachusetts has added procedure codes and corresponding rates to pay for shipping fee and wheelchair repair evaluations.
Issued by the Executive Office of Health and Human Services, Office of Medicaid, the notice said the new codes and rates are effective for dates of service on or after July 1, 2023. NCART made the announcement on June 30.
The notice included the addition of code A9901, at a rate of $3.00, with a description of “DME delivery, set up, and/or dispensing service component of another HCPCS code.”
The notice also listed the addition of a modifier and code combination: modifier U7, with the description “Used in conjunction with K0739 for direct service components when an in-person evaluation is performed for the repair of a mobility system RE-1 and RE-2.”
The K0739 U7 code has a rate of $46.33 and is described as “Direct Service Components (RE units) for evaluation of repair of a mobility system RE-1 and RE-2 when evaluation is performed in person. One RE unit equals one hour.”
The decision from Massachusetts Medicaid to pay for Complex Rehab Technology (CRT) repair evaluation time is critical as the industry continues to advocate for CRT repair reforms ultimately aimed at streamlining convoluted service and repair processes.
