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Medicare Revisits Power-Wheelchair Codes; ECRI Wants More iBOT Studies

This article was originally published in The Gray Sheet

Executive Summary

ECRI recommends larger, longer-term studies of Johnson & Johnson/Independence Technology's iBOT 3000 stair-climbing power wheelchair to better determine the device's cost-to-benefit ratio

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Senate budget

Appropriations Committee approves $1.1 bil. increase to NIH budget at Sept. 15 mark-up, bringing agency to $28.91 bil. for FY 2005. The Senate version represents an increase over a Sept. 9 House budget earmarking $28.51 bil. for NIH. The Senate bill echoes House recommendations that CMS develop a wheelchair coverage policy "firmly based on a functional standard" of what it means for a patient to be "non-ambulatory," including "beneficiaries who cannot perform their basic acts of daily living, toileting, food preparation and emergency egress." The Senate and House both note the cost-effectiveness of avoiding institutional care or hospitalization. At a Sept. 1 town meeting, CMS had proposed new payment codes to help combat power wheelchair fraud (1"The Gray Sheet" Sept. 6, 2004, p. 15)...

Senate budget

Appropriations Committee approves $1.1 bil. increase to NIH budget at Sept. 15 mark-up, bringing agency to $28.91 bil. for FY 2005. The Senate version represents an increase over a Sept. 9 House budget earmarking $28.51 bil. for NIH. The Senate bill echoes House recommendations that CMS develop a wheelchair coverage policy "firmly based on a functional standard" of what it means for a patient to be "non-ambulatory," including "beneficiaries who cannot perform their basic acts of daily living, toileting, food preparation and emergency egress." The Senate and House both note the cost-effectiveness of avoiding institutional care or hospitalization. At a Sept. 1 town meeting, CMS had proposed new payment codes to help combat power wheelchair fraud (1"The Gray Sheet" Sept. 6, 2004, p. 15)...

Competitive Bidding Could Benefit From Subdivision Of HCPCS Codes – GAO

CMS monitoring of items provided to Medicare beneficiaries under competitive bidding could be improved by subdividing certain HCPCS codes or collecting identifying product information, according to GAO

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