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Issue Number - Name
0053 - Group 3 Power Wheelchair Options Underpayments
Review Type
Automated
Claim Type
DME Supplier and DME by Physician
Region and State
RAC 5
All States
Date Approved
2017-05-17

Description

Section 2 of the Patient Access and Medicare Protection Act (PAMPA) mandates that adjustments to the 2016 Medicare fee schedule amounts for certain DME based on information from competitive bidding programs not be applied to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs. Group 3 complex rehabilitative power wheelchair bases are currently described by codes K0848 through K0864. Although this PAMPA change is effective January 1, 2016, Medicare could not implement changes to claims processing systems prior to July 5, 2016.  Until then, payment for these items will be based on the adjusted fee schedule amounts. This issue recovers the incorrect reductions owed to suppliers for claims for these items for DOS 1/1/2016 - 6/30/2016.

Affected Code(s)

  • Please contact the RAC mailbox for full list of codes 

Applicable Policy References

  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 20, Section 30.9