National Government Services (NGS), the Jurisdiction B DME MAC, has announced that it will launch a widespread prepayment probe review for certain power wheelchairs in Minnesota and Wisconsin.
The HCPCS code involved is K0816, defined as a Group 1 standard power wheelchair with captain’s seating and a user weight capacity of up to and including 300 lbs.
NGS indicated it was launching the prepayment probe due to a rise in the number of claims submitted for the K0816 code.
In the December 12 announcement, NGS said providers filing affected claims will be given an additional documentation request (ADR) that will ask for the signed and dated seven-element order; the written, detailed product description of the power chair base and separately billed options and accessories; physician notes from the face-to-face examination and accompanying notes from the occupational or physical therapist, if applicable; other documentation supporting medical necessity, such as physicians’ office records or lab reports; the on-site home assessment; and proof of delivery.
If the provider filled out an Advance Beneficiary Notice of Noncoverage, NGS wants a copy of that included as well.