An upcoming revision to the local coverage determination (LCD), policy article and supplier manual will allow Advanced Beneficiary Notices (ABNs) to be used for Group 2 POVs and Group 4 power wheelchairs, according to bulletins issued by multiple DME MACs on Friday, April 29.
Group 2 POVs (coded K0806-K0808) and Group 4 power wheelchairs (coded K0868-K0886) are currently classified by Medicare as “statutorily non-covered.” But classifying the vehicles that way caused an unexpected conflict with ABN usage.
“This determination caused the unintended consequence of making these items ineligible for the Advanced Beneficiary Notice upgrade process,” the bulletin said.
Revisions to the policy article and LCD, the bulletin says, will “indicate that Group 2 POVs (K0806-K0808) and Group 4 PWCs (K0868-K0886) are considered durable medical equipment, but are not reasonable and necessary. This change will be effective for dates of service on or after June 1, 2011.”
While the Centers for Medicare & Medicaid Services (CMS) acknowledge that scooters and power chairs within the mentioned HCPCS codes can be used in beneficiaries’ homes, CMS says the vehicles “also have certain performance characteristics that are not reasonable and necessary for use in the home, such as robust frames, motors with increased torque/power, (and) suspensions with enhanced vibration-dampening or obstacle-climbing capabilities.”
The bulletin added that this list of product features was not all inclusive.
The policy revisions will continue to deem products in the aforementioned codes as not medically necessary, but will allow use of ABNs to attain them. After the revisions, the vehicles would, CMS says, be “eligible for the ABN upgrade provisions as set out in the recently published bulletin article on the use of upgrade modifiers as a result of changes due to elimination of the least costly alternative.”
The bulletin issued last week says the revisions “will be published in the near future.”