New payment eases process

Monday, July 1, 2019

BISMARCK, N.D. – North Dakota Medicaid now pays physical and occupational therapists separately for wheelchair evaluations.

The state’s Department of Human Services added CPT Code 97542 (wheelchair assessment, fitting, training—each 15 minutes) to its fee schedule for coverage effective May 1.

“We were having PTs and OTs at hospitals and clinics refuse to do these assessments because they weren’t getting paid for them,” said Barb Stockert, who is the co-state chairperson for North Dakota for the Midwest Association of Medical Equipment Services.

The state’s Medicaid program, much like the Medicare program, requires evaluations for certain wheelchairs. They also require that a licensed PT, OT or physician with specific training conduct the evaluations.

Medicaid officials were responsive to adding payments for wheelchair evaluations, once industry stakeholders explained the issue, Stockert says.

“They had no idea,” said Stockert, who works in government relations for Sanford HealthCare in Bismarck, N.D. “We went through the whole thing and told them how these people go through training, and they agreed on the payments.”

Stockert acknowledges that getting Medicaid to make a change isn’t usually this easy.

“It’s a definitely a win, which can be rare,” she said. “We were glad to help raise awareness of the issue.”