American College of Physicians: Internal Medicine — Doctors for Adults ®

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Getting paid for mobility

From the October ACP Observer, copyright © 2007 by the American College of Physicians.

PMC TipsMedicare pays for documenting the medical necessity of power-operated wheelchairs and scooters. Yes, Medicare pays physicians, PAs or NPs when they prescribe a power mobility device (PMD). The payment is for completing the form, not for assessing the patient.

In order to collect the Medicare payment, the physician must communicate to a durable medical equipment (DME) supplier that they certify a patient needs a power-operated scooter or power wheelchair. This add-on payment reimburses physicians for the time and resources used to complete and submit the required medical record documentation to the supplier.

The Centers for Medicare and Medicaid Services rules pertaining to Medicare coverage and payment for power mobility devices include several changes from previous rules.

  • Physicians, PAs or NPs are required to examine the patient face-to-face to evaluate the medical necessity of a power mobility device. Medicare pays physicians for that face-to-face examination through the appropriate E&M code for the level of service rendered.
  • Physicians must submit supporting medical record documentation of the face-to-face examination that justifies the written prescription. Using copies of the medical record, which the physician already needs to maintain, as confirmation of medical necessity avoids additional paperwork. Physicians no longer have to submit the certificate of medical necessity form.
  • Practices should bill using Healthcare Procedural Coding System code G0372 in addition to the E&M code.

Replacing the certificate of medical necessity submission requirement with both the face-to-face examination and documentation submission requirements is meant to reduce fraudulent billing by DME suppliers. These regulations prohibit suppliers from delivering power mobility devices to beneficiaries without receipt of a written prescription and supporting medical record documentation.

For more information on receiving payment for documentation of power mobility devices as well as other Medicare payment regulations, check out the Practice Management Center’s Web site.

PMC Tips is a regular feature on small-practice management from ACP's Practice Management Center.

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