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  1. #1
    Senior Member elarson's Avatar
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    The future of titanium wheelchairs?

    It was just pointed out to me by chasmengr in this post that TiLite has changed their order forms and removed HCPCS code K0009 for titanium frames (TR, ZRA, etc.) and made titanium frame upgrades to K0005 aluminium chairs (Aero series) classified as HCPCS code K0108. I believe that this was required, but I just had not realized that it already happened.

    I started this post as a discussion point about the Centers for Medicare & Medicaid Services (CMS) decision to remove HCPCS code K0009 "Other manual wheelchair/base", which was previously used for most if not all titanium wheelchairs, and any chair that fell into the following product categories:

    1. Positioning Tilt In Space (<45?) Manual Wheelchairs
    2. Made To Measure Manual Wheelchairs
    3. Bariatric Manual Wheelchairs with Special Features
    4. Standing Manual Wheelchairs

    I'm assuming that this means that even if someone had medical justification for what was previously a K0009 titanium wheelchair, there is no way that they could order one now through Medicare/Medicaid, and most likely private insurance also, because they follow the CMS.

    I also find it strange that an upgrade to a titanium frame has HCPCS code K0108 "Wheelchair component or accessory, not otherwise specified". I did not realize that a frame for a wheelchair was a component or an accessory. My guess is that TiLite was able to reclassify into this code to still offer titanium as a possibility -- thankfully. I'd be curious if for example an Aero Z was ordered with this option, if in fact it would not be a ZRA with an Aero Z name on it. That's what I would do if I was TiLite.

    In my view, this might have a future effect on almost everyone who needs titanium ultralight chairs in the US, regardless of whether they are funded through Medicare/Medicaid, private insurance or out-of-pocket, and also the many of us internationally who purchase titanium chairs from the US, regardless of the funding source. My specific concern is about how long TiLite and other manufacturers will be able to continue to provide non-K0005 titanium wheelchairs, due to the loss of market share for those that were previously covered by private insurers in the US because of changes at CMS for Medicare/Medicaid.

    I have no idea about the numbers, but basically it means that the previously coded K0009 titanium chairs will only be possible in the US for people who pay out-of-pocket, and for internationals who pay out-of-pocket or get funding in other countries. Is that enough to support a business model for titanium wheelchairs? I don't know? Perhaps TiLite or others can pipe in on this. I'd also be curious if the VA is following suit also -- Chas do you know?

    I also recently heard that the Pricing, Data Analysis and Coding (PDAC) has reclassified some other components that many use on ultralight chairs. For example, some hub locks that previously had a more logical HCPCS Code E2228 "Manual wheelchair accessory, wheel braking system and lock" are being lumped into the same HCPCS code K0108 "Wheelchair component or accessory, not otherwise specified".

    I think the end result is that most manufacturers of higher end components have or will decide not to do HCPCS coding classification at all anymore, which really stinks for the many people who require it for private insurance. If manufacturers do reclassify, I suspect it will be almost impossible to get dealers to do it, because all K0108 components require prior authorization, and I think the margins will be too low for them to bother for components.

    It looks to me like many of the points brought up in this article in Mobility Management last year are happening: Ultralight Update: The Demise of K0009

    I think what David Lippes, CEO/chairman of TiLite said is especially worrisome:

    Ninety-five percent of the people you're going to hurt through this decision are not Medicare beneficiaries, yet you're still going to make this decision? CMS simply must consider beneficiaries of private insurers when making decisions like this.
    He also noted some interesting figures, which are my basis of concern for the future of titanium wheelchairs:

    In 2011, Lippes notes, 6,500 K0009 chairs were supplied in the United States. Medicare paid for only 307 of them -- though the agency's elimination of the K0009 code will also carry over to other payors.
    I applaud the efforts of the Clinician Task Force (CTF) and the National Coalition for Assistive and Rehab Technology (NCART) to fight this with the CMS, but it looks like the CMS took the easy way out, rather than doing the more logical thing of recoding to clinical indications. Here is the report that was submitted to the CMS last year if you are curious: CTF & NCART Prepare Medicare K0009 Manual Wheelchair Manual for CMS.
    Last edited by elarson; 08-12-2014 at 01:07 PM. Reason: quote conversion
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  2. #2
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    elarson...I bought titanium TR3 about 18 months ago. Was told no matter who MFG is, Medicare DOES NOT PAY for titanium 0009. Now I tried this even longer ago and no deal. Was told Medicare not pay. At that time I just tossed entire idea in trash. Now when I bought the TR3, this was still the case - Medicare will not pay. I did not even bring up insurance. I simply told vendor I WILL PAY OUT OF POCKET. And that is what I did. I did tell vendor if they not give me Internet price, I will simply buy it there. They DID GIVE internet price. We at my house in less than 1 week. I think I had the new wheelchair in less than 1 month. Now, like I said, I did pay out-of-pocket. I thought that was a decent deal. They assembled and delivered. Was also told there is no justification for titanium over aluminum.

  3. #3
    Quote Originally Posted by rlmtrhmiles View Post
    . . . Was also told there is no justification for titanium over aluminum.
    see my post above. I believe a medical justification does exist for ergo, and by default titanium - are any aluminum-frame chairs avaiialble with ergo?
    Chas
    TiLite TR3
    Dual-Axle TR3 with RioMobility DragonFly
    I am a person with mild/moderate hexaparesis (impaired movement in 4 limbs, head, & torso) caused by RRMS w/TM C7&T7 incomplete.

    "I know you think you understand what you thought I said, but what I don't think you realize is that what you heard is not what I meant."
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    UNKNOWN AUTHOR>

  4. #4
    Senior Member NW-Will's Avatar
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    Picked up my TR 1/1/2013, paid for by medicare / medicaid.

    Quote Originally Posted by rlmtrhmiles View Post
    elarson...I bought titanium TR3 about 18 months ago. Was told no matter who MFG is, Medicare DOES NOT PAY for titanium 0009. Now I tried this even longer ago and no deal. Was told Medicare not pay. At that time I just tossed entire idea in trash. Now when I bought the TR3, this was still the case - Medicare will not pay. I did not even bring up insurance. I simply told vendor I WILL PAY OUT OF POCKET. And that is what I did. I did tell vendor if they not give me Internet price, I will simply buy it there. They DID GIVE internet price. We at my house in less than 1 week. I think I had the new wheelchair in less than 1 month. Now, like I said, I did pay out-of-pocket. I thought that was a decent deal. They assembled and delivered. Was also told there is no justification for titanium over aluminum.

  5. #5
    Senior Member elarson's Avatar
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    These changes took effect in the summer of 2013, after a few delays.

    Quote Originally Posted by NW-Will View Post
    Picked up my TR 1/1/2013, paid for by medicare / medicaid.
    Last edited by elarson; 08-12-2014 at 07:51 PM.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  6. #6
    Quote Originally Posted by elarson View Post
    . . . I'd also be curious if the VA is following suit also -- Chas do you know? . . .
    No, not yet.

    Only The TR and ZR Tilite chairs (both native titanium - no longer HCPCS coded) are available with ergo seating, for which I have demonstrated a medical need to the VA by retrofitting my AeroZ with ergo. And VA staff have told me they will provide ergo seating on my next chair (in about a year) presuming nonmortality But they said this before the new HCPCS coding. From previous experience, VA is all about true patient need rather than formal coding adherence, so I'd be surprised (and deeply saddened) if VA succumbs to the new coding.
    Chas
    TiLite TR3
    Dual-Axle TR3 with RioMobility DragonFly
    I am a person with mild/moderate hexaparesis (impaired movement in 4 limbs, head, & torso) caused by RRMS w/TM C7&T7 incomplete.

    "I know you think you understand what you thought I said, but what I don't think you realize is that what you heard is not what I meant."
    <
    UNKNOWN AUTHOR>

  7. #7
    Senior Member elarson's Avatar
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    Good to hear that about the VA Chas. Unfortunately, I have an idea that most private insurance companies will, just because they can.

    @rlmtrhmiles, My concern is whether manufacturers can maintain a business case for providing titanium and other previously coded K0009 chairs if they lose out on privately insured customers. To me, only the very big and very small manufacturers can probably maintain that business model, which is why I suspect becoming part of Permobil may have been very interesting for TiLite considering these changes.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  8. #8
    Senior Member elarson's Avatar
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    I thought it might help to give an example of what I was meaning when I wrote:

    I have no idea about the numbers, but basically it means that the previously coded K0009 titanium chairs will only be possible in the US for people who pay out-of-pocket, and for internationals who pay out-of-pocket or get funding in other countries. Is that enough to support a business model for titanium wheelchairs? I don't know? Perhaps TiLite or others can pipe in on this. I'd also be curious if the VA is following suit also -- Chas do you know?
    Let's suppose that the numbers given by TiLite for K0009 chairs sold in 2011 were divided up equally between those that are funded by private insurance, the VA (assuming they keep doing this), and out-of-pocket or other funded, for example internationally as ours was. Can a company continue to offer something that requires an extensive production environment like titanium, when they lose 31% of their core product share?

    Name:  2011 K0009 TiLite chairs.jpg
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    P.S. sorry for all the edits. It's not easy to show a simple table.
    Last edited by elarson; 08-12-2014 at 03:54 PM. Reason: fixed table
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  9. #9
    Suspended Andy's Avatar
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    Quote Originally Posted by elarson View Post
    Let's suppose that the numbers given by TiLite for K0009 chairs sold in 2011 were divided up equally between those that are funded by private insurance, the VA (assuming they keep doing this), and out-of-pocket or other funded,.
    I'd be rather curious how many Ti chairs are actually funded private insuance vs. just purchased by the end user. I kind of think that the #'s would be biased towards the 'just purchased' side. Reason for this is watching how my insurance carrier has been handling things since my injury in 2002 vs. today. Also, how rehab 'professionals' are handling things now vs. then (although mine is in a limited, second-person view). I saw the incredible 'letter writing' needed to get my first chair (mis-sized of course). But it was paid for by insurance. Witnessing an attempt to get someone else's chair through the same process resulted in a brick wall, too much effort on the part of the providers apparently, rather big change in roughly 6 years from my experience to that example. Then seeing how my insurance is becoming significantly less 'user-friendly' as well.

    I dunno, I know that I just forgo the hoop-jumping and time wasting and just buy stuff like this. I'd sort of think that maybe the bulk of others wanting a Ti chair just bypass these headaches for Ti chairs and just buy the stupid thing?

    I guess it is just a luxury to have a current technology assistive device in the view of insurers, heck we should be happy with a sheet of plywood and some casters, eh? Lousy state of affairs IMO, but I'm sure I'm preaching to the choir here.

  10. #10
    Senior Member elarson's Avatar
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    I'm curious about the numbers too, and just took a stab at, because I worry if there are not enough to fund otherwise, these options may not be there in future.

    Yep, Lousy state of affairs and you are definitely preaching to the choir, but I still think it's good to talk about how these changes are affecting everyone. Especially those who do not have the option to purchase out-of-pocket.

    Quote Originally Posted by Andy View Post
    I'd be rather curious how many Ti chairs are actually funded private insuance vs. just purchased by the end user.
    ....
    I guess it is just a luxury to have a current technology assistive device in the view of insurers, heck we should be happy with a sheet of plywood and some casters, eh? Lousy state of affairs IMO, but I'm sure I'm preaching to the choir here.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

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