Q: I heard that NPs are allowed to order motorized scooters and electric wheelchairs. Is this true and, if so, are there any special considerations in prescribing this equipment?
A: NPs and CNSs may order power wheelchairs, power mobility devices (PMDs), and other mobility assistive equipment (MAE) for Medicare patients. For several years, the Centers for Medicare and Medicaid Services (CMS) has permitted NPs and CNSs to order durable medical equipment, but until May 2005, only certain specialty physicians could order certain motorized vehicles such as scooters.
As with all health care and medical services, in order to be reimbursed, the service must be within the practitioner’s scope of practice in the state in which the service was provided. According to the Texas Board of Nurse Examiners it is in the scope of practice for NPs and CNSs to assess a patient’s need for DME and to order the equipment. Therefore, NPs may order PMDs for Medicare patients. However, the answer is different for Medicaid patients. At this time, the Texas Medicaid program still requires durable medical equipment to be ordered by a physician. (CNAP initiated a formal request in May 2006 to change these Medicaid rules.)
Background Information
When scooters and similar power operated vehicles (POVs) were introduced, CMS was concerned about their stability and potential dangers. At that time, CMS staff decided only specialists in physical medicine, orthopedic surgery, neurology, and rheumatology were qualified to perform the evaluation to determine whether a POV was medically necessary and whether the patient had the ability to operate the POV safely. Since that time technological advances resulted in POVs with a much tighter turning radius and more stability.
Therefore, CMS published a final rule in the April 5, 2006, issue of the Federal Register (www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms3017f.pdf). The new rule became effective on June 5th, and makes the change that was implemented in May 2005 permanent. The change allows any physician or other treating practitioner, including a NP, CNS or PA, to write a prescription for a PMD.
Requirements and Documentation
You are very astute to ask if there are any special considerations in ordering these important, but expensive, power mobility devices. Practitioners must perform a face-to-face assessment of the patient’s physical and psychological condition to determine the patient’s need, ability to operate, and potential to benefit from a PMD within the patient’s home.
In order to qualify for the PMD, the patient’s condition must impair his/her ability to participate in mobility-related activities of daily living (MRADLs). These MRADLs include activities within the home such as feeding, dressing, toileting, bathing and grooming. The need for a PMD or other MAE is determined through an algorithm set forth in a MLN Matters article that was issued on October 19, 2005, MM3791 available from the CMS Website, www.cms.hhs.gov/MLNMattersArticles/2005MMA/List.asp#TopOfPage. Any physician or other practitioner ordering MAEs must know and follow the algorithm and flow chart in this article.
If the NP determines that the most appropriate mobility assistive equipment for this patient is a PMD, the NP must determine the type of PMD (power wheelchair versus scooter, etc.) and write the prescription. The written prescription must include the patient’s name, date of the face-to-face examination, diagnoses and conditions that the PMD is expected to modify, description of the item, how long it is needed, the practitioner’s signature who performed the assessment, and the date the prescription is written. MLN Matters article MM3952, issued on 11/03/05, contains additional information and may be accessed at the same web address as above.
Within 45 days of the evaluation, the NP must also provide documentation of the face-to-face assessment with supporting documentation that includes the medical history, physical exam, diagnostic tests, summary of findings, diagnoses, treatment plans and other pertinent information. The exam and documentation may have been completed during a hospital admission as long as the supplier receives
the prescription and documentation within 45 days of discharge.
Reimbursement
NPs should also be aware that, for services billed on or after April 1, 2006, the practitioner should bill the appropriate E/M code and an add-on code, G0372, on the same claim. The G0372 code results in an additional payment to compensate the work and resources required for submitting the pertinent parts of the medical record. For more information on this issue, refer to MNL Matters article MM4372 issued on 3/16/06, available at www.cms.hhs.gov/MLNMattersArticles/2006MMAN/List.asp#TopOfPage. |
