From NCART: CMS Publishes Initial Implementation Instructions

Published in Complex Rehab on January 30, 2020

In a recent announcement from NCART, it was announced that CMS released initial instructions on implementation of the Complex Rehab Manual Wheelchair accessories legislation (H.R. 1865) that passed in December. This provides an 18-month suspension in Medicare's application of Competitive Bidding Program payment rates to these items. A summary of the highlights are below, and the full announcement can be read here.

CMS specifically identifies "CRT manual wheelchairs" as codes E1161 and K0005, and also includes the other manual wheelchair codes (defined as as HCPCS codes E1235, E1236, E1237, E1238, and K0008) in the legislation.
The new rates are effective January 1, 2020, but "it is unlikely that changes to the Medicare claims processing system can be implemented sooner than July 1, 2020 and possibly later".
For now, providers should continue to bill accessories as they have been doing, and claims will be paid at the Competitive Bid adjusted rates.
Once the claims processing systems are updated, "payment at the full fee schedule amounts for claims submitted for these items with dates of service on or after January 1, 2020 will be available retroactively".
CMS indicated additional information, including a list of HCPCS codes for accessories affected, as well as further instructions regarding the submission and processing of claims will be provided in coming months.

NCART has been in contact with CMS, and a joint work group of CRT stakeholders will be developing questions and suggestions. These comments will include finalizing the system change as soon as possible, adding pediatric size tilt-in-space wheelchair codes, and streamlining the process of securing retroactive payments. More updates will be shared as additional details are received.

Interested in becoming more involved with CRT advocacy? Consider an NCART membership!

Increasing CRT coverage and payment challenges are making it more difficult to provide quality products and service to people with disabilities. NCART’s work brings together dedicated providers, manufacturers, and other advocates in the fight to protect access to CRT at the federal and state levels. As an independent complex rehab provider, we strongly encourage you to consider joining this membership to further the important advocacy work being done today. Your membership will ensure people with disabilities in your community and across the country can access the critical CRT equipment and services you provide. For more information, please visit the membership area of NCART’s website at www.ncart.us.