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Today, CMS is issuing a new policy on how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories and back and seat cushions used with group 3 complex rehabilitative power wheelchairs.  Section 16005 of the 21st Century Cures Act currently allows higher payments for these items but is set to expire after June 30, 2017. By continuing these higher payments, this new action will help to protect access to complex rehabilitative power wheelchair accessories on which people with significant disabilities depend.

The law provides the categories of items that are subject to the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) Competitive Bidding Program. This provision excludes certain complex rehabilitative power wheelchairs recognized by the Secretary as classified within group 3 or higher (and related accessories when furnished in connection with such wheelchairs). CMS has reconsidered its policy on adjusting fee schedule amounts using information from the competitive bidding program for these items under 1834(a)(1)(F) of the Social Security Act to take into consideration the exclusion at section 1847(a)(2)(A). As a result, effective July 1, 2017, payment for these items will be based on the standard unadjusted fee schedule amounts.       

Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs with dates of service beginning July 1, 2017. No additional action will be required by suppliers.

For more information, view the revised Frequently Asked Questions on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) 2015 Medicare Payment Final Rules (CMS-1614-F) 

This announcement is posted on the DME Spotlight page at: https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html.