LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2011-02 HCPCS Code K0823 - Service Specific Pre-Pay Review

February 17, 2011

HCPCS Code K0823 – Service Specific Pre-Pay Review
  • CIGNA Government Services, the Jurisdiction C DME MAC, will be implementing
    a service-specific prepayment edit for Healthcare Common Procedure Coding System (HCPCS) code K0823 (Power wheelchair, Group 2 standard, captains chair, patient weight capacity up to and including 300 pounds). This edit is the result of data demonstrating a high claims payment error rate for this power wheelchair product category.
  • Claims subjected to this edit will be developed for additional documentation.
    Suppliers receiving a development letter should follow the instructions contained in the letter for the specific documentation requested. Suppliers will be asked to submit documentation including, but not limited to:
    1. Physician’s Seven-Element Detailed Written Order
    2. Detailed Product Description
    3. In-home Assessment
    4. Signed delivery documentation with the beneficiary’s name
    5. Face-to-Face Evaluation
  • The face-to-face evaluation must be completed prior to the physician’s order
    and support the medical necessity for the motorized/power wheelchair. This evaluation should provide subjective and objective information regarding the patient’s condition and progression of disease over time. It should clearly indicate ambulatory status, why a power wheelchair is needed as compared to a cane, walker or a manual wheelchair and address the medical justification for each accessory billed. Other medical records (physician office records, hospital records, home health agency records, physical and occupational therapy notes, etc.) may be submitted to supplement the information in the face-to-face evaluation.

The information listed above must be received within 30 days of the date of the letter or the claim will be denied.