Tremendous change has significantly altered the way power mobility devices (PMDs) are to be ordered and documented. In late November, Congress was considering postponing (until April 1, 2006) CMS’ implementation of its “Face-to-Face Exam” and New Documentation Rules. In October, CMS announced it would maintain the current HCPCS codes for power wheelchairs until it could develop a new (and third) set of codes to replace the current ones.

Earlier this year, CMS issued a new National Coverage Determination (NCD) for mobility assistive equipment (MAE), effective May 5, 2005. The NCD for MAE addresses the coverage criteria of all MAE, including canes, crutches, walkers, manual wheelchairs, power wheelchairs, and power operated vehicles (POVs)/scooters—and extends national coverage of MAE to those who have mobility deficits that impair mobility related activities of daily living (MRADLs) in customary areas of the home. (MRADLs are defined as toileting, eating, dressing, grooming, and bathing.) In mid October, DMERCs issued their Local Coverage Determinations based on existing codes and on the NCD.

On August 26, 2005, CMS issued a new regulation making significant changes to the requirements for prescribing and documenting POVs and power wheelchairs, now known as PMDs. These changes were outlined in the CMS Interim Final Rule (IFR), “Conditions for Payment of Power Mobility Devices” and were effective October 25, 2005. The public comment period remained open until November 25, 2005. At press time, Congress was considering the Labor-HHS Appropriations bill, which included a provision that would delay implementation of this rule until April 1, 2006, and would require CMS in the meantime to issue new proposed and final regulations.

Suppliers need to educate their physician referral sources about their new documentation responsibilities and work toward full compliance with the new documentation rules. (We are writing this under the assumption that the “Face-to-Face Exam” rule and new documentation rules are in effect.) That means you should first obtain a prescription from the ordering physician. Second, obtain progress notes that substantiate the medical need for the PMD. Submit a claim with the “partially completed” CMN (only the supplier portions need to be completed due to systems issues).

The physician or treating practitioner (physician assistant, nurse practitioner, or clinical nurse specialist) must conduct a face-to-face examination prior to prescribing a PMD. Upon completion of the examination, the physician or treating practitioner must provide the supplier with a signed and dated written order within 30 days. (Unless the exam is performed during a hospital or nursing home stay, the supplier must receive the report of the exam within 30 days after discharge).

The prescription must include: beneficiary’s name; date of the face-to-face examination; diagnosis and conditions that the PMD is expected to modify; description of the item ordered; length of need; physician signature; and date prescription was written.

If this order does not identify the specific type of PMD that is provided, then the supplier must clarify this by obtaining another written order that lists the specific PMD being ordered and any options and accessories that will be separately billed. The supplier may enter these items. This order must be signed and dated by the treating physician and must be received by the supplier prior to dispensing the power mobility device—this does not have to be received within the 30-day window.

Along with the prescription, the physician must provide supporting documentation, which will include pertinent parts of the medical record that clearly support the need for a PMD in the home. Physicians should provide only the information that relates to the need for a PMD. This documentation should be sufficient to: delineate the history of events leading up to the request for a PMD; identify the mobility deficit to be corrected by the PMD; document that other treatments do not obviate the need for a PMD; document that the patient lives in an environment that supports the use of a PMD; and document that the patient or caregiver is capable of safe operation of the PMD. Can suppliers use a form to obtain information from physicians? Yes, but the information must also be in the medical record.

The face-to-face examination does not necessarily have to occur at a single visit and is not always performed by a single individual. For example, the physician may refer the patient to a licensed/certified medical professional, such as a physical therapist (PT) or occupational therapist (OT), to perform part of this face-to-face examination. In these situations, the documentation requirements and the start of the “30-day window” for getting documentation to the supplier depends on whether the physician saw the patient in person to begin the examination prior to the referral. DP

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a consultant for political and legislative strategy.