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Elizabeth M. Whitehorn, Director

Provider Notice Issued 04/25/2018

 

Date:  April 25, 2018

 

To:     Durable Medical Equipment Providers

 

Re:     New Prior Approval Requirements for Wheelchair Providers

 

 

 

 

 

This notice informs providers of prior approval changes for new wheelchairs and/or wheelchair modifications or repairs. To comply with the 21st Century Cures Act of 2016, the Department of Healthcare and Family Services (HFS) is revising information required on Form HFS 1409 Prior Approval Request.

 

Effective with dates of service on or after June 1, 2018, distinct HCPCS codes and descriptions for all components that require prior approval for a custom manual or power wheelchair or Power-Operated Vehicle (POV) must be identified on Form HFS1409 Prior Approval Request. This policy applies to new requests and repairs or modifications to a custom manual or power wheelchair or POV that is patient owned. This new prior approval process may require the submittal of more than one (1) HFS1409 form.

 

In addition, providers are reminded that HCPCS code K0108 (Wheelchair Accessories, Not Otherwise Specified) should only be used for items that do not have an assigned HCPCS code. Durable Medical Equipment (DME) HCPCS codes can be found on the DME fee schedule.

 

When billing for repairs that do not require prior approval because the sum of the repairs is less than $400, providers must bill distinct HCPCS.

 

Questions regarding this provider notice should be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Felicia F. Norwood

Director