National Government Services (NGS), Medicare’s Jurisdiction B DME MAC, has released the results of its 2012 second-quarter prepayment review for power wheelchairs.
The power chairs being reviewed are classified as Group 2 standard chairs with captain’s seating and weight capacities up to and including 300 pounds – also referred to as HCPCS code K0823.
NGS says it processed 802 such claims from April 1 to June 30, and examined 747 of those claims for additional documentation. The medical reviewer paid 107 claims in full. An NGS update on the review said, “The remaining claims were completely or partially denied, resulting in an 87-percent claims error rate.”
NGS added that the most common reasons for K0823 power base denials included:
- Medical records provided did not establish the beneficiary’s medical necessity: “Most often, the local coverage determination basic coverage criteria A, B and C were not met.”
- The seven-element order or detailed product description received by the reviewer was invalid or incomplete.
- Proof of a physician face-to-face examination was lacking.
- Documentation did not rule out use of a power-operated vehicle (scooter) instead of a K0823 power chair.
- The supplier did not respond to the reviewer’s request for additional supportive documentation.
