Pride Mobility Medicare Updates

Medicare has changed the coverage criteria and documentation requirements for Power Mobility Devices (PMD) for dates of service (date of delivery) on or after May 5, 2005. Power Mobility Devices include power wheelchairs and scooters/power operated vehicles (POV). If you are considering prescribing a Power Mobility Device please review the following information as it will assist you in understanding how these changes have affected the prescription and funding process with Medicare.

"NEW" Coverage Criteria for PMDs - National Coverage Determination (NCD)

• Medicare has modernized the policy and replaced the "Bed or Chair Confined" requirement with consideration now given to the beneficiary's ability to safely and in a reasonable time frame participate in one or more Mobility Related Activities of Daily Living (MRADLs).
• MRADLs include -
  Dressing, grooming, toileting, bathing and eating (including Assisted Living Facilities) in customary locations within the home.
• A face-to-face examination of your patient is required prior to prescribing a PMD.
• As a prescribing physician of a PMD you are entitled to a new add-on payment for conducting the face-to-face examination and for preparing and sending the required documentation to the PMD equipment supplier. The new add-on code is G0372 and will be paid at a rate equal to the physician fee schedule relative values established for a level 1 office visit for an established patient (CPT Code 99211).
• Medicare's coverage policy for PMD's.

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