PainTechnology Mcare Rentals 4 1 14 User Manual

User Manual: PainTechnology Mcare Rentals 4-1-14

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CMS Manual System

Department of Health &

Human Services (DHHS)

Pub 100-20 One-Time Notification

Centers for Medicare &

Medicaid Services (CMS)

Transmittal 1332

Date: January 2, 2014

Change Request 8566

SUBJECT: Rescind and Replace of CR 8409: Reclassification of Certain Durable Medical Equipment

from the Inexpensive and Routinely Purchased Payment Category to the Capped Rental Payment

Category

I. SUMMARY OF CHANGES: This one-time notification provides instructions regarding the

reclassification of certain Durable Medical Equipment (DME) from the inexpensive and routinely purchased

(IN) DME payment category to the capped rental (CR) DME payment category for the Healthcare Common

Procedure Coding System (HCPCS) codes listed in Attachment A.

EFFECTIVE DATE: April 1, 2014

IMPLEMENTATION DATE: April 7, 2014

Disclaimer 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. However, if this

revision contains a table of contents, you will receive the new/revised information only, and not the entire

table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)

R=REVISED, N=NEW, D=DELETED-Only One Per Row.

R/N/D

CHAPTER / SECTION / SUBSECTION / TITLE

N/A

III. FUNDING:

For Medicare Administrative Contractors (MACs):

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined

in your contract. CMS does not construe this as a change to the MAC 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 Contracting 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 Contracting Officer, in writing or by e-mail, and request formal directions

regarding continued performance requirements.

IV. ATTACHMENTS:

One-Time Notification

*Unless otherwise specified, the effective date is the date of service.

Attachment - One-Time Notification

Pub. 100-20

Transmittal: 1332

Date: January 2, 2014

Change Request: 8566

SUBJECT: Rescind and Replace of CR 8409: Reclassification of Certain Durable Medical Equipment

from the Inexpensive and Routinely Purchased Payment Category to the Capped Rental Payment

Category

EFFECTIVE DATE: April 1, 2014

IMPLEMENTATION DATE: April 7, 2014

I. GENERAL INFORMATION

A. Background: This one-time notification provides instructions regarding the reclassification of certain

Durable Medical Equipment (DME) from the inexpensive and routinely purchased (IN) DME payment

category to the capped rental (CR) DME payment category for the Healthcare Common Procedure Coding

System (HCPCS) codes listed in Attachment A.

DME and accessories used in conjunction with DME are paid for under the DME benefit and in accordance

with the rules at section 1834(a) of the Act. The Medicare definition of routinely purchased durable medical

equipment (DME) set forth at 42 CFR §414.220(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 1987. A review of expensive items that have been classified as routinely purchased

equipment since 1989, that is, new codes added to the HCPCS 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 DME was published in the Federal Register (CMS-1526-F) along with notice of DME items

(codes) requiring a revised payment category. Also in the rule, CMS established that DME 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 CFR §414.229(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 HCPCS

codes listed in Attachment A shall reclassify from the inexpensive and routinely purchased (IN) DME

payment category to the capped rental (CR) DME payment category. Instructions for billing capped rental

items can be found at Medicare Claims Processing Manual (Pub. 100-04), chapter 20, section 130.9 along

with other sources listed on the CMS and contractor websites.

Note: The effective date is April 1, 2014 for HCPCS codes not included in a Competitive Bidding

Program (CBP) as shown in Attachment A. A forthcoming change request will address the codes that

are reclassifying to the CR payment category effective July 1, 2016 and January 1 2017.

As shown below, HCPCS codes for items included under the Round 2 and/or Round 1 Recompete DMEPOS

competitive bidding programs (CBP) shall transition to the capped rental payment category in stages.

Payment Category Transition Effective Dates

April 1, 2014: HCPCS codes not included in a CBP are reclassified from IN DME to CR DME in all areas.

July 1, 2016: HCPCS codes included in a CBP are reclassified from IN DME to CR DME in all areas except

the 9 Round 1 Recompete CBAs, where items furnished to beneficiaries residing in these areas will remain

in IN DME through December 31, 2016.

January 1, 2017: HCPCS codes included in a CBP are reclassified from IN DME to CR DME in the 9

Round 1 Recompete CBAs

For the HCPCS codes that are not included in either a Round 2 or Round 1 Recompete CBP, the effective

date for the reclassification from routinely purchased DME to capped rental DME in all areas (i.e.

competitive bidding areas (CBAs) and non-CBAs) is April 1, 2014. For the HCPCS codes that are included

under a Round 2 CBP and/or a Round 1 Recompete CBP the effective date for the transition to capped rental

DME shall be July 1, 2016, except for items furnished in the 9 Round 1 Recompete CBAs. When the

HCPCS codes listed below are furnished in CBAs in accordance with contracts entered into as part of the

Round 1 Recompete CBP, the payment category transition from inexpensive and routinely purchased to

capped rental DME is effective January 1, 2017.

HCPCS for Items Reclassified to Capped Rental DME Category Effective July 1, 2016*

Support Surfaces E0197

Walkers E0140 E0149

Wheelchairs Options/Accessories E0985 E1020 E1028 E2228 E2368 E2369 E2370 E2375 K0015 K0070

Wheelchair Seating E0955

* Items furnished in accordance with Round 1 Recompete contracts reclassify effective January 1, 2017

Complex Rehabilitative Power Wheelchair Accessories

Effective April 1, 2014, for wheelchair accessory codes classified under the capped rental DME 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 CFR § 414.229(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. BUSINESS REQUIREMENTS TABLE

"Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.

Number

Requirement

Responsibility

A/B

MAC

D

M

E

M

A

C

Shared-

System

Maintainers

Other

A

B

H

H

H

F

I

S

S

M

C

S

V

M

S

C

W

F

8566.1

Contractors shall recognize Inexpensive/Routinely

Purchased (IN) DME items reclassified to Capped

Rental (CR) DME category identified with the

HCPCS codes in Attachment A. The effective date is

April 1, 2014 for HCPCS codes not included in a

Competitive Bidding Program (CBP) as shown in

Attachment A. A forthcoming change request will

address the codes that are transitioning to the CR

X

X

X

X

Number

Requirement

Responsibility

A/B

MAC

D

M

E

M

A

C

Shared-

System

Maintainers

Other

A

B

H

H

H

F

I

S

S

M

C

S

V

M

S

C

W

F

payment category effective July 1, 2016 and January

1, 2017.

8566.2

Effective 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 (CR) basis.

The CR 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.

X

X

X

8566.2.1

Effective for claims with dates of service on or after

April 1, 2014, the contractors shall cease any IN rental

payments for codes in BR 8566.1 and start payment

under the Capped Rental (CR) 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, 2014.

X

X

X

X

8566.3

The CWF shall revise the DME payment category for

the HCPCS codes identified in Attachment A with

transition effective dates of April 1, 2014 from CWF

category (04) Inexpensive/Routinely Purchased DME

to CWF category (1) Capped Rental DME, effective

April 1, 2014. A forthcoming change request will

address the codes transitioning to the CR payment

category effective July 1, 2016 and January 1, 2017.

X

8566.4

Effective 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

X

8566.5

The applicable contractor(s) shall update the existing

VMS shared system maintainer DMEPOS Fee

Schedule load process to create the new and used

pricing for capped rental wheelchair accessory

HCPCS defined by CMS 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

X

Number

Requirement

Responsibility

A/B

MAC

D

M

E

M

A

C

Shared-

System

Maintainers

Other

A

B

H

H

H

F

I

S

S

M

C

S

V

M

S

C

W

F

the rental price times ten; the fee for used accessories

(UE modifier) shall be 75 per cent of the purchase fee.

III. PROVIDER EDUCATION TABLE

Number

Requirement

Responsibility

A/B

MAC

D

M

E

M

A

C

C

E

D

I

A

B

H

H

H

8566.6

MLN Article : A provider education article related to this instruction will be

available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNMattersArticles/ shortly after the CR is released. You will

receive notification of the article release via the established "MLN Matters"

listserv. Contractors 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. Contractors are free to supplement MLN Matters articles with localized

information that would benefit their provider community in billing and

administering the Medicare program correctly.

X

X

IV. SUPPORTING INFORMATION

Section A: Recommendations and supporting information associated with listed requirements: N/A

"Should" denotes a recommendation.

X-Ref

Requirement

Number

Recommendations or other supporting information:

Section B: All other recommendations and supporting information: N/A

V. CONTACTS

Pre-Implementation Contact(s): Anita Greenberg, Anita.Greenberg@cms.hhs.gov , Karen Jacobs,

Karen.Jacobs@cms.hhs.gov

Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR) or Contractor

Manager, as applicable.

VI. FUNDING

Section A: For Medicare Administrative Contractors (MACs):

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined

in your contract. CMS do not construe this as a change to the MAC Statement 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. 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 Contracting Officer, in writing or by e-mail, and request formal directions

regarding continued performance requirements.

Attachment

Attachment A

Inexpensive & Routinely Purchased (IN) Items Reclassified to Capped Rental (CR)

Group Category

HCPCS

Descriptor

Effective

4/1/14

Effective

7/1/16 at

end of

DMEPOS

Competitive

Bidding

Program

Round 2

Effective

1/1/17* at

end of

DMEPOS

Competitive

Bidding

Program

Round 1

Recompete

Automatic External

Defibrillator

K0607 Repl battery for AED



Canes/Crutches

E0117

Underarm spring assist crutch



Glucose Monitor

E0620

Capillary blood skin piercing

device laser



High Frequency Chest Wall

Oscillation Device (HFCWO)

A7025 Replace chest compress vest



Hospital Beds/Accessories

E0300

Enclosed ped crib hosp grade



Misc. DMEPOS A4639

Infrared ht sys replacement

pad



E0762

Trans elec jt stim dev sys



E1700

Jaw motion rehab system



Nebulizers & Related Drugs

K0730

Ctrl dose inh drug deliv system



Other Neuromuscular

Stimulators

E0740

Incontinence treatment system



E0764

Functional neuromuscular

stimulation



Pneumatic Compression

Device

E0656

Segmental pneumatic trunk



E0657

Segmental pneumatic chest



Power Operated Vehicles

(POV)

E0984

Add pwr tiller



Speech Generating Devices

E2500

SGD digitized pre-rec <=8min



E2502

SGD prerec msg >8min

<=20min



E2504

SGD prerec msg>20min

<=40min



E2506

SGD prerec msg > 40 min



E2508

SGD spelling phys contact



E2510

SGD w multi methods

messg/access



Support Surfaces

E0197 *

Air pressure pad for mattress





E0198

Water pressure pad for

mattress



Traction Equipment

E0849

Cervical pneum traction equip



E0855

Cervical traction equipment



E0856

Cervical collar w air bladder



Walkers

E0140 *

Walker w trunk support





E0144

Enclosed walker w rear seat



E0149 *

Heavy duty wheeled walker





Wheelchairs Manual

E1161

Manual adult wc w tiltinspac



E1232

Folding ped wc tilt-in-space



E1233

Rig ped wc tltnspc w/o seat



E1234

Fld ped wc tltnspc w/o seat



E1235

Rigid ped wc adjustable



E1236

Folding ped wc adjustable



E1237

Rgd ped wc adjstabl w/o seat



Group Category

HCPCS

Descriptor

Effective

4/1/14

Effective

7/1/16 at

end of

DMEPOS

Competitive

Bidding

Program

Round 2

Effective

1/1/17* at

end of

DMEPOS

Competitive

Bidding

Program

Round 1

Recompete

E1238

Fld ped wc adjstabl w/o seat



Wheelchair

Options/Accessories

E0985 *

W/c seat lift mechanism





E0986

Man w/c push-rim pow assist



E1002 ^

Pwr seat tilt



E1003 ^

Pwr seat recline



E1004 ^

Pwr seat recline mech



E1005 ^

Pwr seat recline pwr



E1006 ^

Pwr seat combo w/o shear



E1007 ^

Pwr seat combo w/shear



E1008 ^

Pwr seat combo pwr shear



E1010 ^

Add pwr leg elevation



E1014

Reclining back add ped w/c



E1020 *

Residual limb support system





E1028 *

W/c manual swingaway





E1029

W/c vent tray fixed



E1030 ^

W/c vent tray gimbaled



E2227

Gear reduction drive wheel



E2228 *

Mwc acc, wheelchair brake





E2310 ^

Electro connect btw control



E2311 ^

Electro connect btw 2 sys



E2312 ^

Mini-prop remote joystick



E2313 ^

PWC harness, expand control



E2321 ^

Hand interface joystick



E2322 ^

Mult mech switches



E2325 ^

Sip and puff interface



E2326 ^

Breath tube kit



E2327 ^

Head control interface mech



E2328 ^

Head/extremity control

interface



E2329 ^

Head control interface

nonproportional



E2330 ^

Head control proximity switch



E2351 ^

Electronic SGD interface



E2368 *

Pwr wc drivewheel motor

replace





E2369 *

Pwr wc drivewheel gear box

replace





E2370 *

Pwr wc dr wh motor/gear comb





E2373 ^

Hand/chin ctrl spec joystick



E2374 ^

Hand/chin ctrl std joystick



E2375 *

Non-expandable controller





E2376 ^

Expandable controller, replace



E2377 ^

Expandable controller, initial



E2378

Pw actuator replacement



K0015 *

Detach non-adjus hght armrest





K0070 *

Rear whl complete pneum tire





Wheelchairs Seating

E0955 *

Cushioned headrest





* Effective January 1, 2017 if the item is furnished in CBAs in accordance with contracts entered into as part of the Round 1

Recompete of DMEPOS CBP

^ Item billable with Complex Rehabilitative Power Wheelchair codes K0835 – K0864