It was just pointed out to me by chasmengr in this post that TiLite has changed their order forms and removed HCPCS code K0009 for titanium frames (TR, ZRA, etc.) and made titanium frame upgrades to K0005 aluminium chairs (Aero series) classified as HCPCS code K0108. I believe that this was required, but I just had not realized that it already happened.
I started this post as a discussion point about the Centers for Medicare & Medicaid Services (CMS) decision to remove HCPCS code K0009 "Other manual wheelchair/base", which was previously used for most if not all titanium wheelchairs, and any chair that fell into the following product categories:
1. Positioning Tilt In Space (<45?) Manual Wheelchairs
2. Made To Measure Manual Wheelchairs
3. Bariatric Manual Wheelchairs with Special Features
4. Standing Manual Wheelchairs
I'm assuming that this means that even if someone had medical justification for what was previously a K0009 titanium wheelchair, there is no way that they could order one now through Medicare/Medicaid, and most likely private insurance also, because they follow the CMS.
I also find it strange that an upgrade to a titanium frame has HCPCS code K0108 "Wheelchair component or accessory, not otherwise specified". I did not realize that a frame for a wheelchair was a component or an accessory. My guess is that TiLite was able to reclassify into this code to still offer titanium as a possibility -- thankfully. I'd be curious if for example an Aero Z was ordered with this option, if in fact it would not be a ZRA with an Aero Z name on it. That's what I would do if I was TiLite.
In my view, this might have a future effect on almost everyone who needs titanium ultralight chairs in the US, regardless of whether they are funded through Medicare/Medicaid, private insurance or out-of-pocket, and also the many of us internationally who purchase titanium chairs from the US, regardless of the funding source. My specific concern is about how long TiLite and other manufacturers will be able to continue to provide non-K0005 titanium wheelchairs, due to the loss of market share for those that were previously covered by private insurers in the US because of changes at CMS for Medicare/Medicaid.
I have no idea about the numbers, but basically it means that the previously coded K0009 titanium chairs will only be possible in the US for people who pay out-of-pocket, and for internationals who pay out-of-pocket or get funding in other countries. Is that enough to support a business model for titanium wheelchairs? I don't know? Perhaps TiLite or others can pipe in on this. I'd also be curious if the VA is following suit also -- Chas do you know?
I also recently heard that the Pricing, Data Analysis and Coding (PDAC) has reclassified some other components that many use on ultralight chairs. For example, some hub locks that previously had a more logical HCPCS Code E2228 "Manual wheelchair accessory, wheel braking system and lock" are being lumped into the same HCPCS code K0108 "Wheelchair component or accessory, not otherwise specified".
I think the end result is that most manufacturers of higher end components have or will decide not to do HCPCS coding classification at all anymore, which really stinks for the many people who require it for private insurance. If manufacturers do reclassify, I suspect it will be almost impossible to get dealers to do it, because all K0108 components require prior authorization, and I think the margins will be too low for them to bother for components.
It looks to me like many of the points brought up in this article in Mobility Management last year are happening: Ultralight Update: The Demise of K0009
I think what David Lippes, CEO/chairman of TiLite said is especially worrisome:
He also noted some interesting figures, which are my basis of concern for the future of titanium wheelchairs:
I applaud the efforts of the Clinician Task Force (CTF) and the National Coalition for Assistive and Rehab Technology (NCART) to fight this with the CMS, but it looks like the CMS took the easy way out, rather than doing the more logical thing of recoding to clinical indications. Here is the report that was submitted to the CMS last year if you are curious: CTF & NCART Prepare Medicare K0009 Manual Wheelchair Manual for CMS.
I started this post as a discussion point about the Centers for Medicare & Medicaid Services (CMS) decision to remove HCPCS code K0009 "Other manual wheelchair/base", which was previously used for most if not all titanium wheelchairs, and any chair that fell into the following product categories:
1. Positioning Tilt In Space (<45?) Manual Wheelchairs
2. Made To Measure Manual Wheelchairs
3. Bariatric Manual Wheelchairs with Special Features
4. Standing Manual Wheelchairs
I'm assuming that this means that even if someone had medical justification for what was previously a K0009 titanium wheelchair, there is no way that they could order one now through Medicare/Medicaid, and most likely private insurance also, because they follow the CMS.
I also find it strange that an upgrade to a titanium frame has HCPCS code K0108 "Wheelchair component or accessory, not otherwise specified". I did not realize that a frame for a wheelchair was a component or an accessory. My guess is that TiLite was able to reclassify into this code to still offer titanium as a possibility -- thankfully. I'd be curious if for example an Aero Z was ordered with this option, if in fact it would not be a ZRA with an Aero Z name on it. That's what I would do if I was TiLite.
In my view, this might have a future effect on almost everyone who needs titanium ultralight chairs in the US, regardless of whether they are funded through Medicare/Medicaid, private insurance or out-of-pocket, and also the many of us internationally who purchase titanium chairs from the US, regardless of the funding source. My specific concern is about how long TiLite and other manufacturers will be able to continue to provide non-K0005 titanium wheelchairs, due to the loss of market share for those that were previously covered by private insurers in the US because of changes at CMS for Medicare/Medicaid.
I have no idea about the numbers, but basically it means that the previously coded K0009 titanium chairs will only be possible in the US for people who pay out-of-pocket, and for internationals who pay out-of-pocket or get funding in other countries. Is that enough to support a business model for titanium wheelchairs? I don't know? Perhaps TiLite or others can pipe in on this. I'd also be curious if the VA is following suit also -- Chas do you know?
I also recently heard that the Pricing, Data Analysis and Coding (PDAC) has reclassified some other components that many use on ultralight chairs. For example, some hub locks that previously had a more logical HCPCS Code E2228 "Manual wheelchair accessory, wheel braking system and lock" are being lumped into the same HCPCS code K0108 "Wheelchair component or accessory, not otherwise specified".
I think the end result is that most manufacturers of higher end components have or will decide not to do HCPCS coding classification at all anymore, which really stinks for the many people who require it for private insurance. If manufacturers do reclassify, I suspect it will be almost impossible to get dealers to do it, because all K0108 components require prior authorization, and I think the margins will be too low for them to bother for components.
It looks to me like many of the points brought up in this article in Mobility Management last year are happening: Ultralight Update: The Demise of K0009
I think what David Lippes, CEO/chairman of TiLite said is especially worrisome:
Ninety-five percent of the people you're going to hurt through this decision are not Medicare beneficiaries, yet you're still going to make this decision? CMS simply must consider beneficiaries of private insurers when making decisions like this.
In 2011, Lippes notes, 6,500 K0009 chairs were supplied in the United States. Medicare paid for only 307 of them -- though the agency's elimination of the K0009 code will also carry over to other payors.
But they said this before the new HCPCS coding. From previous experience, VA is all about true patient need rather than formal coding adherence, so I'd be surprised (and deeply saddened) if VA succumbs to the new coding.
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