Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 848 Date: January 28, 2011

Transcription

1 anual ystem Pub One-Time Notification Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 848 Date: January 28, 2011 hange equest 7231 UBJET: ystem hanges for Elimination of Lump um Purchase Payment for tandard Power Wheelchairs urnished on or fter January 1, 2011 Due to the ffordable are ct. UY O HNGE: This one-time notification provides instructions for changes in payment for standard power wheelchairs due to ection 3136 of the ffordable are ct of EETVE DTE: January 1, 2011 PLEENTTON DTE: July 5, 2011 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. HNGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED /N/D HPTE / ETON / UBETON / TTLE N/. UNDNG: or iscal ntermediaries (s), egional Home Health ntermediaries (HHs) and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the 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 contracting officer. f 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 contracting officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTHENT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment One Time Notification Pub Transmittal: 848 Date: January 28, 2011 hange equest: 7231 UBJET: ystem hanges for the Elimination of Lump um Purchase Payment for tandard Power Wheelchairs urnished on or fter January 1, 2011, Due to the ffordable are ct Effective Date: January 1, 2011 mplementation Date: July 5, GENEL NOTON. Background: This one-time notification provides instructions for the shared system maintainer regarding changes in payment for standard power wheelchairs. This change request is a companion to hange equest () 7116, Transmittal 786, Elimination of Lump um Purchase Payment for tandard Power Wheelchairs urnished on or fter January 1, 2011, due to the ffordable are ct (). Power wheelchairs are included in the capped rental durable medical equipment (DE) payment category and suppliers have been required to offer beneficiaries the option of receiving power wheelchairs on either a lump sum purchase basis or monthly rental basis. Beginning with items initially rented on or after January 1, 2006, suppliers have been required to transfer the equipment title for rented power wheelchairs to the beneficiary after the 13th month of continuous use. Previous instructions on payment for power wheelchairs were released in Transmittal 918, 5010, dated pril 28, 2006, Transmittal 929, 4386, dated pril 28, 2006, and Transmittal 1037, 5255 dated ugust 25, B. Policy: Effective for items furnished on or after January 1, 2011, section 3136 of ffordable are ct of 2010 eliminates the lump sum purchase payment for standard power wheelchairs. uppliers must furnish these items on a monthly rental basis like other capped rental DE not subject to a lump sum purchase option. This elimination of lump sum purchase payment applies to standard power wheelchairs classified under the HP codes listed in ttachment. HHs shall deny claims with dates of service on or after January 1, 2011, for these HP codes claims for purchase of standard power wheelchairs which are submitted with revenue codes 0292 (purchased new) or 0293 (purchased used) for types of bill (TOB) 32X, 33X, and 34X. NOTE: n B of the companion 7116, Transmittal 786, the HHs and the J14 /B were instructed to manually process and reject claims for the purchase of standard power wheelchairs until the implementation of this 7231 for system changes. Therefore, the implementation of this ends the B requirement. Payment can continue to be made on a lump sum purchase basis or monthly rental basis for complex rehabilitative power wheelchairs. The HP codes identifying complex rehabilitative power wheelchairs are listed in ttachment B. n addition, this change will not apply to standard power wheelchairs furnished to beneficiaries in the nine competitive bidding areas (Bs) of ound 1 ebid of the durable medical equipment, prosthetics, orthotics, and supplies (DEPO) competitive bidding program with dates of service January 1, 2011 thru December 31, The lump sum purchase payment method remains available for claims with dates of service January 1, 2011 thru December 31, 2013, for standard power wheelchairs furnished to beneficiaries residing in these nine Bs. Per Transmittal 741, 7014, dated July 30, 2010, all suppliers of competitively bid DE items must bill the DE for these items and will no longer be allowed to bill competitively bid items to edicare contractors processing home health claims.

3 lso, ection 3136 of the ffordable are ct changes the monthly fee schedule amounts for rental of standard and complex rehabilitative power wheelchairs furnished on or after January 1, nstructions for the revised fee schedule amounts are included in Transmittal 2108, dated November 24, 2010, 7248, Y 2011 Update for Durable edical Equipment, Prosthetics, Orthotics and upplies (DEPO) ee chedule.. BUNE EQUEENT TBLE Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) / B D E hared- ystem aintainers ontractors shall recognize standard power wheelchair items identified with the HP codes in ttachment or claims with dates of service on or after January 1, 2011, HHs shall deny claims for purchase of standard power wheelchairs identified in B which are submitted with revenue codes 0292 (purchased new) or 0293 (purchased used) for TOB s 32X, 33X, and 34X ontractors shall recognize complex rehabilitative power wheelchair items identified with the HP codes in ttachment B ontractors shall continue to process and pay claims for complex rehabilitative power wheelchairs identified in B with dates of service on or after January 1, 2011, on a lump sum purchase or monthly rental basis. E H H X X X X X X X X V W OTHE HH & H (J14) J14 J14 J14. POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / D hared- ystem B E aintainers None. E H H V W OTHE

4 V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: N/ X-ef equirement Number ecommendations or other supporting information: None. ection B: or all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): nita Greenberg, nita.greenberg@cms.gov or Wil Gehne for claims processing, Wilfried.Gehne@cms.gov Post-mplementation ontact(s): nita Greenberg, nita.greenberg@cms.gov or Wil Gehne for claims processing, Wilfried.Gehne@cms.gov V. UNDNG ection : or iscal ntermediaries (s), egional Home Health ntermediaries (HHs), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the 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 contracting officer. f 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 contracting officer, in writing or by , and request formal directions regarding continued performance requirements. 2 ttachments

5 ttachment tandard Power Wheelchair HP odes K0813 POWE WHEELH, GOUP 1 TNDD, POTBLE, LNG/OLD ET ND BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0814 POWE WHEELH, GOUP 1 TNDD, POTBLE, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0815 POWE WHEELH, GOUP 1 TNDD, LNG/OLD ET ND BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0816 POWE WHEELH, GOUP 1 TNDD, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0820 POWE WHEELH, GOUP 2 TNDD, POTBLE, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0821 POWE WHEELH, GOUP 2 TNDD, POTBLE, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0822 POWE WHEELH, GOUP 2 TNDD, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0823 POWE WHEELH, GOUP 2 TNDD, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0824 POWE WHEELH, GOUP 2 HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND K0825 POWE WHEELH, GOUP 2 HEVY DUTY, PTN H, PTENT WEGHT PTY 301 TO 450 POUND K0826 POWE WHEELH, GOUP 2 VEY HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND K0827 POWE WHEELH, GOUP 2 VEY HEVY DUTY, PTN H, PTENT WEGHT PTY 451 TO 600 POUND K0828 POWE WHEELH, GOUP 2 EXT HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE K0829 POWE WHEELH, GOUP 2 EXT HEVY DUTY, PTN H, PTENT WEGHT PTY 601 POUND O OE K0830 POWE WHEELH, GOUP 2 TNDD, ET ELEVTO, LNG/OLD ET/BK, PTENT WEGHT PTY 126 TO 300 POUND K0831 POWE WHEELH, GOUP 2 TNDD, ET ELEVTO, PTN H,

6 PTENT WEGHT PTY 126 TO 300 POUND K0898 POWE WHEELH, NOT OTHEWE LED

7 K0835 ttachment B omplex ehabilitative Power Wheelchair HP odes POWE WHEELH, GOUP 2 TNDD, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0836 POWE WHEELH, GOUP 2 TNDD, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0837 POWE WHEELH, GOUP 2 HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND K0838 K0839 K0840 POWE WHEELH, GOUP 2 HEVY DUTY, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 2 VEY HEVY DUTY, NGLE POWE OPTON LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND POWE WHEELH, GOUP 2 EXT HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE K0841 POWE WHEELH, GOUP 2 TNDD, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0842 POWE WHEELH, GOUP 2 TNDD, ULTPLE POWE OPTON, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0843 POWE WHEELH, GOUP 2 HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND K0848 POWE WHEELH, GOUP 3 TNDD, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0849 POWE WHEELH, GOUP 3 TNDD, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0850 POWE WHEELH, GOUP 3 HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND K0851 POWE WHEELH, GOUP 3 HEVY DUTY, PTN H, PTENT WEGHT PTY 301 TO 450 POUND K0852 POWE WHEELH, GOUP 3 VEY HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND

8 K0853 POWE WHEELH, GOUP 3 VEY HEVY DUTY, PTN H, PTENT WEGHT PTY 451 TO 600 POUND K0854 POWE WHEELH, GOUP 3 EXT HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE K0855 POWE WHEELH, GOUP 3 EXT HEVY DUTY, PTN H, PTENT WEGHT PTY 601 POUND O OE K0856 POWE WHEELH, GOUP 3 TNDD, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0857 POWE WHEELH, GOUP 3 TNDD, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0858 POWE WHEELH, GOUP 3 HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT 301 TO 450 POUND K0859 POWE WHEELH, GOUP 3 HEVY DUTY, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY 301 TO 450 POUND K0860 POWE WHEELH, GOUP 3 VEY HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND K0861 POWE WHEELH, GOUP 3 TNDD, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND K0862 POWE WHEELH, GOUP 3 HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND K0863 POWE WHEELH, GOUP 3 VEY HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND K0864 POWE WHEELH, GOUP 3 EXT HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE