Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1445 Date: December 5, 2014

Transcription

1 anual ystem Pub One-Time Notification epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 1445 ate: ecember 5, 2014 hange Request 8566 Transmittal 1362, dated arch 25, 2014, is being rescinded and replaced by Transmittal 1445 dated ecember 5, 2014 to add a caret ^ to code 2378 in the table of Attachment A denoting this is an item which can be billable with complex rehabilitative wheelchair codes K0835 K0864. All other information remains the same. UBJT: Rescind and Replace of R 8409: Reclassification of ertain urable edical quipment from the Inexpensive and Routinely Purchased Payment ategory to the apped Rental Payment ategory I. UARY O ANG: This one-time notification provides instructions regarding the reclassification of certain urable edical quipment () from the inexpensive and routinely purchased (IN) payment category to the capped rental (R) payment category for the ealthcare ommon Procedure oding ystem (P) codes listed in Attachment A. TIV AT: April 1, 2014 IPLNTATION AT: April 7, 2014 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. ANG IN ANUAL INTRUTION: (N/A if manual is not updated) R=RVI, N=NW, =LT-Only One Per Row. R/N/ APTR / TION / UBTION / TITL N/A III. UNING: or edicare Administrative ontractors (As): The edicare Administrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the A statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. IV. ATTANT: One-Time Notification

2 *Unless otherwise specified, the effective date is the date of service. Attachment - One-Time Notification Pub Transmittal: 1445 ate: ecember 5, 2014 hange Request: 8566 Transmittal 1362, dated arch 25, 2014, is being rescinded and replaced by Transmittal 1445 dated ecember 5, 2014 to add a caret ^ to code 2378 in the table of Attachment A denoting this is an item which can be billable with complex rehabilitative wheelchair codes K0835 K0864. All other information remains the same. UBJT: Rescind and Replace of R 8409: Reclassification of ertain urable edical quipment from the Inexpensive and Routinely Purchased Payment ategory to the apped Rental Payment ategory TIV AT: April 1, 2014 IPLNTATION AT: April 7, 2014 I. GNRAL INORATION A. Background: This one-time notification provides instructions regarding the reclassification of certain urable edical quipment () from the inexpensive and routinely purchased (IN) payment category to the capped rental (R) payment category for the ealthcare ommon Procedure oding ystem (P) codes listed in Attachment A. and accessories used in conjunction with are paid for under the benefit and in accordance with the rules at section 1834(a) of the Act. The edicare definition of routinely purchased durable medical equipment () set forth at 42 R (a)(2) specifies that routinely purchased equipment means equipment that was acquired by purchase on a national basis at least 75 percent of the time during the period July 1986 through June A review of expensive items that have been classified as routinely purchased equipment since 1989, that is, new codes added to the P after 1989 for items costing more than $150, showed inconsistencies in applying the definition. As a result, a review of the definition of routinely purchased was published in the ederal Register (-1526-) along with notice of items (codes) requiring a revised payment category. Also in the rule, established that wheelchair accessories that are capped rental items furnished for use as part of a complex rehabilitative power wheelchair (wheelchair base codes K0835 K0864) are payable under the lump sum purchase method. The complex rehabilitative power wheelchair base codes and options/accessories are payable under the lump sum purchase method set forth at 42 R (a)(5) and section 1834(a)(7)(A)(iii) of the Act. B. Policy: In order to align the payment category with the required regulatory definition, certain P codes listed in Attachment A shall reclassify from the inexpensive and routinely purchased (IN) payment category to the capped rental (R) payment category. Instructions for billing capped rental items can be found at edicare laims Processing anual (Pub ), chapter 20, section along with other sources listed on the and contractor websites. Note: The effective date is April 1, 2014 for P codes not included in a ompetitive Bidding Program (BP) as shown in Attachment A. A forthcoming change request will address the codes that are reclassifying to the R payment category effective July 1, 2016 and January As shown below, P codes for items included under the Round 2 and/or Round 1 Recompete PO competitive bidding programs (BP) shall transition to the capped rental payment category in stages.

3 Payment ategory Transition ffective ates April 1, 2014: P codes not included in a BP are reclassified from IN to R in all areas. July 1, 2016: P codes included in a BP are reclassified from IN to R in all areas except the 9 Round 1 Recompete BAs, where items furnished to beneficiaries residing in these areas will remain in IN through ecember 31, January 1, 2017: P codes included in a BP are reclassified from IN to R in the 9 Round 1 Recompete BAs or the P codes that are not included in either a Round 2 or Round 1 Recompete BP, the effective date for the reclassification from routinely purchased to capped rental in all areas (i.e. competitive bidding areas (BAs) and non-bas) is April 1, or the P codes that are included under a Round 2 BP and/or a Round 1 Recompete BP the effective date for the transition to capped rental shall be July 1, 2016, except for items furnished in the 9 Round 1 Recompete BAs. When the P codes listed below are furnished in BAs in accordance with contracts entered into as part of the Round 1 Recompete BP, the payment category transition from inexpensive and routinely purchased to capped rental is effective January 1, P for Items Reclassified to apped Rental ategory ffective July 1, 2016* upport urfaces 0197 Walkers Wheelchairs Options/Accessories K0015 K0070 Wheelchair eating 0955 * Items furnished in accordance with Round 1 Recompete contracts reclassify effective January 1, 2017 omplex Rehabilitative Power Wheelchair Accessories ffective April 1, 2014, for wheelchair accessory codes classified under the capped rental payment category and furnished for use with a complex rehabilitative power wheelchair (that is, furnished to be used as part of the complex rehabilitative power wheelchair), the supplier must give the beneficiary the option of purchasing these accessories at the time they are furnished. These accessory items would be considered as part of the complex rehabilitative power wheelchair (codes K0835 K0864) and associated lump sum purchase option set forth at 42 R (a)(5). If the beneficiary declines the purchase option, the supplier must furnish the items on a rental basis and payment shall be made on a monthly rental basis in accordance with the capped rental payment rules. II. BUIN RQUIRNT TABL "hall" denotes a mandatory requirement, and "should" denotes an optional requirement. Number Requirement Responsibility A/B A hared- ystem aintainers A B A I V W Other

4 Number Requirement Responsibility A/B A hared- ystem aintainers ontractors shall recognize Inexpensive/Routinely Purchased (IN) items reclassified to apped Rental (R) category identified with the P codes in Attachment A. The effective date is April 1, 2014 for P codes not included in a ompetitive Bidding Program (BP) as shown in Attachment A. A forthcoming change request will address the codes that are transitioning to the R payment category effective July 1, 2016 and January 1, A B A I V W Other ffective for claims with dates of service on or after April 1, 2014, payment shall be made for codes identified in Attachment A with transition effective dates of April 1, 2014 on a capped rental (R) basis. The R payment category requires payment of 10 percent of the purchase price for the first three months and 7.5 percent for each of the remaining rental months 4 through 13. Payment amounts shall be based on the lower of the supplier s actual charge and the fee schedule amount ffective for claims with dates of service on or after April 1, 2014, the contractors shall cease any IN rental payments for codes in BR and start payment under the apped Rental (R) payment category applying a determination of the number of rental months paid which cannot exceed 13 rental months combined from dates of service before and after April 1, The W shall revise the payment category for the P codes identified in Attachment A with transition effective dates of April 1, 2014 from W category (04) Inexpensive/Routinely Purchased to W category (1) apped Rental, effective April 1, A forthcoming change request will address the codes transitioning to the R payment category effective July 1, 2016 and January 1, ffective April 1, 2014, contractors shall process and pay claims for capped rental wheelchair accessories on a lump sum purchase basis when used with complex rehabilitative power wheelchairs (wheelchair base codes K0835 K0864). X X The applicable contractor(s) shall update the existing X

5 Number Requirement Responsibility A/B A hared- ystem aintainers V shared system maintainer PO ee chedule load process to create the new and used pricing for capped rental wheelchair accessory P defined by as eligible for payment on a lump sum purchase basis when used with complex rehabilitative power wheelchairs (wheelchair base codes K0835 K0864). The purchase price (NU modifier) of these accessories shall be calculated as the rental price times ten; the fee for used accessories (U modifier) shall be 75 per cent of the purchase fee. A B A I V W Other III. PROVIR UATION TABL Number Requirement Responsibility LN Article : A provider education article related to this instruction will be available at Network-LN/LNattersArticles/ shortly after the R is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in the contractor s next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. A/B A A B A I

6 IV. UPPORTING INORATION ection A: Recommendations and supporting information associated with listed requirements: N/A "hould" denotes a recommendation. X-Ref Requirement Number Recommendations or other supporting information: ection B: All other recommendations and supporting information: N/A V. ONTAT Pre-Implementation ontact(s): Anita Greenberg, Anita.Greenberg@cms.hhs.gov, Karen Jacobs, Karen.Jacobs@cms.hhs.gov Post-Implementation ontact(s): ontact your ontracting Officer's Representative (OR) or ontractor anager, as applicable. VI. UNING ection A: or edicare Administrative ontractors (As): The edicare Administrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. do not construe this as a change to the A tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. Attachment

7 Attachment A Inexpensive & Routinely Purchased (IN) Items Reclassified to apped Rental (R) Group ategory P escriptor ffective 4/1/14 Automatic xternal K0607 Repl battery for A efibrillator anes/rutches 0117 Underarm spring assist crutch Glucose onitor 0620 apillary blood skin piercing device laser igh requency hest Wall A7025 Replace chest compress vest Oscillation evice (WO) ospital Beds/Accessories 0300 nclosed ped crib hosp grade Infrared ht sys replacement isc. PO A4639 pad 0762 Trans elec jt stim dev sys 1700 Jaw motion rehab system Nebulizers & Related rugs K0730 trl dose inh drug deliv system Other Neuromuscular 0740 Incontinence treatment system timulators ffective 7/1/16 at end of PO ompetitive Bidding Program Round 2 ffective 1/1/17* at end of PO ompetitive Bidding Program Round 1 Recompete Pneumatic ompression evice Power Operated Vehicles (POV) 0764 unctional neuromuscular stimulation 0656 egmental pneumatic trunk 0657 egmental pneumatic chest 0984 Add pwr tiller peech Generating evices 2500 G digitized pre-rec <=8min 2502 G prerec msg >8min <=20min 2504 G prerec msg>20min <=40min 2506 G prerec msg > 40 min 2508 G spelling phys contact 2510 G w multi methods messg/access upport urfaces 0197 * Air pressure pad for mattress 0198 Water pressure pad for mattress Traction quipment 0849 ervical pneum traction equip 0855 ervical traction equipment 0856 ervical collar w air bladder Walkers 0140 * Walker w trunk support 0144 nclosed walker w rear seat 0149 * eavy duty wheeled walker Wheelchairs anual 1161 anual adult wc w tiltinspac 1232 olding ped wc tilt-in-space 1233 Rig ped wc tltnspc w/o seat 1234 ld ped wc tltnspc w/o seat 1235 Rigid ped wc adjustable 1236 olding ped wc adjustable

8 Group ategory P escriptor ffective 4/1/ Rgd ped wc adjstabl w/o seat 1238 ld ped wc adjstabl w/o seat ffective 7/1/16 at end of PO ompetitive Bidding Program Round 2 ffective 1/1/17* at end of PO ompetitive Bidding Program Round 1 Recompete Wheelchair Options/Accessories 0985 * W/c seat lift mechanism 0986 an w/c push-rim pow assist 1002 ^ Pwr seat tilt 1003 ^ Pwr seat recline 1004 ^ Pwr seat recline mech 1005 ^ Pwr seat recline pwr 1006 ^ Pwr seat combo w/o shear 1007 ^ Pwr seat combo w/shear 1008 ^ Pwr seat combo pwr shear 1010 ^ Add pwr leg elevation 1014 Reclining back add ped w/c 1020 * Residual limb support system 1028 * W/c manual swingaway 1029 W/c vent tray fixed 1030 ^ W/c vent tray gimbaled 2227 Gear reduction drive wheel 2228 * wc acc, wheelchair brake 2310 ^ lectro connect btw control 2311 ^ lectro connect btw 2 sys 2312 ^ ini-prop remote joystick 2313 ^ PW harness, expand control 2321 ^ and interface joystick 2322 ^ ult mech switches 2325 ^ ip and puff interface 2326 ^ Breath tube kit 2327 ^ ead control interface mech 2328 ^ ead/extremity control interface 2329 ^ ead control interface nonproportional 2330 ^ ead control proximity switch 2351 ^ lectronic G interface 2368 * Pwr wc drivewheel motor replace 2369 * Pwr wc drivewheel gear box replace 2370 * Pwr wc dr wh motor/gear comb 2373 ^ and/chin ctrl spec joystick 2374 ^ and/chin ctrl std joystick 2375 * Non-expandable controller 2376 ^ xpandable controller, replace 2377 ^ xpandable controller, initial 2378 ^ Pw actuator replacement K0015 * etach non-adjus hght armrest K0070 * Rear whl complete pneum tire Wheelchairs eating 0955 * ushioned headrest * ffective January 1, 2017 if the item is furnished in BAs in accordance with contracts entered into as part of the Round 1 Recompete of PO BP ^ Item billable with omplex Rehabilitative Power Wheelchair codes K0835 K0864