CMS Pub. 100-04, ch. 12, § 30.6.15.4

Section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization

Act of 2003 (MMA) sets forth revised conditions for Medicare payment of Power Mobility

Devices (PMDs). This section of the MMA states that payment for motorized or power

wheelchairs may not be made unless a physician (as defined in §1861(r)(1) of the Act), a

physician assistant, nurse practitioner, or a clinical nurse specialist (as those terms are defined

in §1861(aa)(5)) has conducted a face-to-face examination of the beneficiary and written a

prescription for the PMD.

Payment for the history and physical examination will be made through the appropriate

evaluation and management (E&M) code corresponding to the history and physical

examination of the patient. Due to the MMA requirement that the physician or treating

practitioner create a written prescription and a regulatory requirement that the physician or

treating practitioner prepare pertinent parts of the medical record for submission to the durable

medical equipment supplier, code G0372 (physician service required to establish and document the

need for a power mobility device) has been established to recognize additional physician services

and resources required to establish and document the need for the PMD.

The G code indicates that all of the information necessary to document the PMD prescription is

included in the medical record, and the prescription and supporting documentation is delivered

to the PMD supplier within 30 days after the face-to-face examination.

Effective October 25, 2005, G0372 will be used to recognize additional physician services and

resources required to establish and document the need for the PMD and will be added to the

Medicare physician fee schedule.