CMS Will Expand PMD Prior Authorization

Program will go nationwide and add 31 more HCPCS codes starting Sept. 1.

Starting Sept. 1, CMS will permanently expand the Prior Authorization Demonstration for Power Mobility Devices nationwide and broaden the program to include additional HCPCS codes.

The expansion, outlined in rule CMS-6080-N, is welcome news for the PMD providers in the demonstration’s 19 states, who were worried about the program’s uncertain future, given that it was slated to end Aug. 31.

Instead, the rule will take the program national and add 31 Power Mobility HCPCS codes to the Prior Authorization program, which originally started with codes K0856 and K0861 in 2016. The rule and the codes can be downloaded as a PDF.

The expansion comes after concentrated work by industry stakeholders such as The American Association for Homecare’s Complex Rehab & Mobility Council and Regulatory Council, who have worked with CMS to refine the program for years.

“The expansion of the PMD prior authorization program is something we have wanted for a long time!” said Jackie Semrad, corporate compliance officer with Reliable Medical Supply. “AAHomecare and other HME stakeholders have been working on this for years, and it’s satisfying to see those efforts pay off in a policy that will benefit everyone involved.”

“Prior authorization makes good sense for the patient, the supplier and the government's budget,” says Georgie Blackburn, vice president of government relations for BLACKBURNS. “Our industry worked hard to illustrate the benefits and CMS listened, and, more importantly, responded with workable timelines. That's progress we can build upon!”

PMD Prior authorization benefits CMS because it ensures medical necessity and should reduce the volume of post-pay audits, Semrad added.

“It will help DME providers by ensuring that equipment delivered to the patient will likely get paid,” she said. “But most importantly, it will benefit Medicare beneficiaries and their caregivers by clearly informing them whether or not their wheelchair is covered.”

To learn more about AAHomecare’s Complex Rehab & Mobility Council, the Home Medical Equipment/Respiratory Therapy Council, or the Medical Supplies Council, contact Ashley Plauche at ashleyp@aahomecare.org.

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.

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