NEW 2009 CMS Fee Schedule

As previously announced by CMS, reimbursement for products included in the first round of competitive bidding will be reduced 9.5% in 2009.  VARILITE cushions and back systems were included in the competitive bidding “Wheelchair Accessory” category.   On November 7, CMS released a Medicare Claims Processing Fee Schedule Update, which clarifies the 2009 reimbursement for wheelchair accessories that are purchased for use on wheelchairs that were not part of competitive bidding.   The news is good – reimbursement will increase 5% for cushions and back systems that are used on non-competitive bidding wheelchairs.

 

To indicate how wheelchair accessories will be used, CMS has created a new HCPCS modifier: KE.  Claims for wheelchair accessories for use on non-competitively bid wheelchairs should be submitted with the KE modifier.  The 2009 reimbursement rate will be the 2008 HCPCS rate, adjusted up 5%.

 

When wheelchair accessories are purchased for use on wheelchairs that were included in competitive bidding the KE modifier is not to be used.  In these cases, the 2009 reimbursement rate will be the 2008 HCPCS rate, reduced by 9.5%.

 

VARILITE products affected are the seating cushions, back systems, PAL™ Swing Away hinge mechanism and lateral thoracic supports.  Generally, power wheelchairs were included in competitive bidding (KE modifier does not apply) and manual chairs were not (KE modifier applies).

 

Learn More about the Updated Fee Schedule   

 

Reimbursement 101

While it’s nothing new for therapists to have to work with and understand reimbursement coding systems, the implementation of the Medicare policy for wheelchair seating has placed additional responsibility on you to negotiate these new rules and requirements.

VARILITE’s Therapists have composed the CMS Guide to help you better understand Medicare policy, its rules and requirements, in order to ensure that you can get the products that are best for your clients.