Billing Reminders - (POV - Power Operated Vehicles) Modifiers, Verification, Delivery time...

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
February 23rd, 2016

According to CMS, delivery of the PMD must be within 120 days following completion of the F2F.

                Exception: within 6 months from the date of an affirmed ADMC.
 
• The PMD will be denied if the underlying condition is reversible and length of need is < 3 months.
 
• The KX modifier must be added to the code if all the coverage criteria noted above have been met.
 
• When there is an expectation of a medical necessity denial, the GA modifier must be added to the code if a valid ABN has been obtained or a GZ modifi er if a valid ABN has not been obtained.
 
• The GY modifier must be added to the code if the requirements related to the face-to-face examination have not been met or if the PMD is needed for outside use only.
 
• Upgrades that are to perform leisure or recreational activities are noncovered.
 
• The only products that may be billed using HCPCs K0800-K0808K0812 are those for which a written
coding verification determination has been made by the PDAC contractor.
 
• Group 2 POVs (K0806-K0808) have added capabilities that are not needed for use in the home and will be denied as not medically necessary
 
References: L23598, A41127 (prior to 10/01/2015); L33789, A52498 (on/after 10/01/2015)
 

References:

Billing Reminders - (POV - Power Operated Vehicles) Modifiers, Verification, Delivery time.... (2016, February 23). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/billing-reminders-pov-power-operated-vehicles-modifiers-verification-delivery-time-31617.html

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