CMC Funding & Insurance for Mobility Equipment 3

Question 1

Which HCPCS code grouping is used specifically for Complex Rehab Technology (CRT) power wheelchairs to distinguish them from standard power chairs?

Accepted Answer

K0835–K0864 (Group 3 and Group 4 power wheelchairs)

Answer

HCPCS K0835–K0864 cover Group 3 and Group 4 power wheelchairs that qualify as CRT, distinguishing them from Group 1 and 2 standard chairs.

Question 2

A client is denied Medicare coverage for a power wheelchair because the clinical documentation does not demonstrate the inability to self-propel a manual chair. This reflects which Medicare coverage criterion?

Accepted Answer

The patient must be unable to use a less costly alternative device

Answer

Medicare applies a least-costly alternative principle, requiring documentation that less complex equipment cannot meet the patient's mobility needs before approving a power chair.

Question 3

What is 'assignment' in Medicare DME billing, and why does it matter for patients?

Accepted Answer

The supplier agrees to accept Medicare's approved amount as full payment, limiting patient out-of-pocket costs

Answer

When a supplier accepts assignment, they cannot bill the patient more than the Medicare copay (20%) and deductible, protecting patients from balance billing.

Question 4

A Medicaid waiver program such as HCBS (Home and Community-Based Services) is used primarily to fund which type of mobility equipment scenario?

Accepted Answer

Equipment that enables individuals to remain in the community rather than institutional settings

Answer

HCBS waivers allow states to fund services and equipment that help individuals with disabilities live in community rather than nursing facility settings.

Question 5

Which federal act prohibits insurers from imposing lifetime or annual dollar limits on essential health benefits, directly impacting funding for mobility equipment?

Accepted Answer

Affordable Care Act (ACA)

Answer

The ACA prohibits lifetime and annual dollar limits on essential health benefits, ensuring ongoing coverage for medically necessary mobility equipment is not capped.

(CMC) Certified Mobility Consultant Practice Test

(CMC) Certified Mobility Consultant Practice Test

CMC Funding & Insurance for Mobility Equipment 3