Use G Code to Bill Medicare for Authorization Under Demo Project

The Centers for Medicare & Medicaid Services is conducting a three-year demonstration project in Texas and six other states to make sure Medicare only pays for power mobility devices (PMDs) that are medically necessary under existing guidelines. PMDs include power wheelchairs and power-operated vehicles that beneficiaries use in their home.

The demonstration project began with orders written on or after Sept. 1, 2012. The ordering physician or the durable medical equipment supplier must submit a prior authorization request for review by the DME Medicare administrative contractor, Cigna Government Services. Physicians can bill for their time in submitting the request, using code G9156.

The prior authorization demonstration does not create new documentation requirements for physicians or suppliers; it allows them to provide the information earlier in the claims process.

Published Sept. 13, 2012 

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