Reflecting provisions adopted by Congress in 2003, new Medicare regulations for providing wheelchairs and power mobility devices restrict the role of physical therapists in conducting face-to-face examinations of Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) issued new interim final rules recently that implement provisions of the Medicare Modernization Act of 2003 limiting payment for motorized or power wheelchairs to those for which a physician, physician assistant, nurse practitioner or clinical nurse conducts a face-to-face examination of the beneficiary and prescribes the device. The rules are published in the Federal Register and will go into effect October 25, 2005.

The regulations eliminate the current certificate of medical necessity required for Medicare coverage of powered mobility devices. Instead, CMS will require documentation from the patient's medical record and a written prescription before suppliers can provide a wheelchair to beneficiaries. The rule also fails to address the "in the home" restriction limiting the availability of mobility devices to a patient's home.

APTA is developing comments on the interim rule and will coordinate with other organizations to address this issue.


Source: APTA