Medicare Information Resource, Issue 2007-04AB: Implementation of Revised Fee Schedule Amounts for New Healthcare Common Procedure Coding System (HCPCS) Codes for Power Mobility Devices (PMDs) (JSM-07308)

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MIR-2007 04B, April 2007

Implementation of Revised Fee Schedule Amounts for New Healthcare Common Procedure Coding System (HCPCS) Codes for Power Mobility Devices (PMDs) (JSM-07308)

All Fiscal Intermediaries (FIs), Carriers, Durable Medical Equipment Regional Carriers (DMERCs), Durable Medical Equipment Medicare Administrative Contractors (DME MACs), and All Part A and Part B MACs (A/B MACs)

This is to advise that the 2006 fee schedule amounts for codes K0825, K0850, K0851, K0859 and K0864 have been revised and have been transmitted to contractors in addendum 2006 Durable Medical Equipment Prosthetic, Orthotics & Supplies (DMEPOS) fee schedule files.

Only Louisiana and the United States Virgin Islands are affected by the revisions to the fee schedule amounts for code K0864.

Beginning April 2, 2007, contractors must adjust previously processed claims for codes K0825, K0850, K0851, K0859, and K0864 with dates of service November 15, 2006, through December 31, 2006, if they are resubmitted as adjustments.

As a result of the PMD revisions, a revised 2006 DMEPOS Fee Schedule file was released to the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC), DME MACs, DMERCS, local Part B carriers, and A/B MACs via CMS’ mainframe telecommunications system on March 23, 2007. A revised 2006 DMEPOS Fee Schedule file was also released to FIs, regional home health intermediaries, A/B MACs, Railroad Retirement Board (RRB), Indian Health Service, and United Mine Workers on March 23, 2007.

Additionally, as noted in Change Request (CR) 5537, the April Quarterly Update for 2007 DMEPOS Fee Schedule implements fee schedule changes for several PMD HCPCS codes. This transmittal instructs that the 2007 fee schedule amounts for codes K0822, K0825, K0835, K0838, K0848, K0850, K0851, K0859, and K0864 have been further revised.

Only Louisiana and the United States Virgin Islands are affected by the revisions to the fee schedule amounts for code K0864. Beginning April 2, 2007, contractors will adjust previously processed claims for codes K0822, K0825, K0835, K0838, K0848, K0850, K0851, K0859 and K0864 with dates of service on or after January 1, 2007, if they are resubmitted as adjustments.

CMS Joint Signature Memorandum (JSM)-07308

CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply.