Transmittal 65 Date: FEBRUARY 23, 2007

Transcription

1 anual ystem Pub edicare National overage eterminations epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 65 ate: BUY 23, 2007 hange equest 5372 ubject: NPNN ibot 4000 obility ystem. UY O NG: This updates the section , as it relates to the recent national coverage determination (N) memorandum for the NPNN ibot 4000 obility ystem. will provide coverage for the tandard unction of the NPNN ibot 4000 obility ystem, which meets the definition of durable medical equipment under section 1861(n) of the ocial ecurity ct, as a wheelchair used in the patients home that is reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobilityrelated activities of daily living in customary locations in the home. This addition of section is an N. Ns are binding on all carriers, fiscal intermediaries, quality improvement organizations, qualified independent contractors, the edicare ppeals ouncil, and administrative law judges (LJs) New / evised aterial ffective ate: July 27, 2006 mplementation ate: pril 2, 2007 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTUTON: (N/ if manual is not updated) =V, N=NW, =LT /N/ N PT / TON / UBTON / TTL 1/Table of ontents 1/280.15/NPNN ibot 4000 obility ystem. UNNG: No additional funding will be provided by ; contractor activities are to be carried out within their Y 2007 operating budgets. V. TTNT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.

2 ttachment - Business equirements Pub Transmittal: 65 ate: ebruary 23, 2007 hange equest: 5372 UBJT: NPNN ibot 4000 obility ystem ffective ate: July 27, 2006 mplementation ate: pril 2, GNL NOTON. Background: This transmittal adds a new ection to the N manual as a result of the July 27, 2006 national coverage determination decision memo for the NPNN ibot 4000 obility ystem. The change clarifies the coverage policy for this particular power mobility device. B. Policy: The addition to the coverage manual will indicate that will provide coverage for the tandard unction of the NPNN ibot 4000 obility ystem, which meets the definition of urable edical quipment () under section 1861(n) of the ocial ecurity ct (the ct), as a wheelchair used in the patient s home that is reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobility-related activities of daily living (L) in customary locations in the home.. BUN QUNT TBL Use hall" to denote a mandatory requirement Number equirement esponsibility (place an in each applicable column) / B hared- ystem aintainers ontractors shall cover only the tandard unction of the NPNN ibot 4000 obility ystem The 4-wheel, balance, stair, and remote functions of the NPNN ibot 4000 obility ystem are not covered under the edicare program ffective for services performed on and after July 27, 2006, edicare will provide coverage for the tandard unction of the NPNN ibot 4000 obility ystem that functions like a traditional power wheelchair ffective for services performed on and after July 27, 2006, edicare will not provide coverage for the 4-wheel, balance, stair, and remote functions of the NPNN V OT

3 Number equirement esponsibility (place an in each applicable column) / B hared- ystem aintainers ibot 4000 obility ystem ontractors shall use the following messages when denying/rejecting claims: edicare ummary Notice and laim djustment eason ode 96, Non-covered charges ontractors shall not search for and adjust claims that have been paid prior to the implementation dates. owever, contractors shall adjust claims brought to their attention. V OT. POV UTON TBL Number equirement esponsibility (place an in each applicable column) / B hared- ystem aintainers provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. V OT ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within 1 week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. V. UPPOTNG NOTON

4 . or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. -ef equirement Number ecommendations or other supporting information: N B. or all other recommendations and supporting information, use this space: V. ONTT Pre-mplementation ontact(s): Linda mith at or Linda.mith@cms.hhs.gov Post-mplementation ontact(s): ppropriate O V. UNNG. or iscal ntermediaries, arriers, and the urable edical quipment egional arrier (), use only one of the following statements: No additional funding will be provided by ; contractor activities are to be carried out within their Y 2007 operating budgets. B. or edicare dministrative ontractors (), use only one of the following statements: The contractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work (OW). The contractor is not obligated to incur costs in excess of the amounts specified in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

5 edicare National overage eterminations anual hapter 1, Part 4 (ections ) overage eterminations Table of ontents (ev. 65, ) NPNN ibot 4000 obility ystem (ffective July 27, 2006)

6 NPNN ibot 4000 obility ystem (ffective July 27, 2006) (ev. 65; ssued: ; ffective: ; mplementation: ). General The NPNN ibot 4000 obility ystem is a battery-powered mobility device that relies on a computerized system of sensors, gyroscopes, and electric motors to allow indoor and outdoor use on stairs as well as on level and uneven surfaces. The mobility system incorporates a number of different functions, including: a) tandard unction that provides mobility on smooth surfaces and inclines at home, work, and in other environments; b) 4-Wheel unction that provides movement across obstacles, uneven terrain, curbs, grass, gravel, and other soft surfaces; c) Balance unction that provides mobility in a seated position at an elevated height; d) tair unction that allows for ascent and descent of stairs, with or without assistance; and e) emote unction that assists in the transportation of the product while unoccupied. n tandard unction, the NPNN ibot 4000 obility ystem functions like a traditional power wheelchair. The mobility device can be programmed for tandard unction only to meet the assessed needs of the user. B. Nationally overed ndications ffective for services performed on and after July 27, 2006, the enters for edicare & edicaid ervices () finds that the evidence is sufficient to determine that the tandard unction of the NPNN ibot 4000 obility ystem meets the definition of urable edical quipment () under section 1861(n) of the ocial ecurity ct (the ct) as a wheelchair used in the patient s home that is reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobility-related activities of daily living (L), such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home. etermination of the presence of a mobility deficit will use an algorithmic process, as outlined in hapter 1, Part 4, ection of this manual.. Nationally Non-covered ndications ffective for services performed on and after July 27, 2006, has reviewed the evidence and concludes that the 4-Wheel, Balance, tair and emote unctions of the NPNN ibot 4000 obility ystem do not meet the definition of under section 1861(n) of the ct.. Other N/ (This N last reviewed July 2006)