PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
Gait Trainers and Accessories
Gait Trainers and Accessories
Healthcare Common Procedure Coding System (HCPCS) code E1399 should not be used when requesting prior authorization for a gait trainer. The following codes should be used:
- E8000 (Gait Trainer, Pediatric Size, Posterior Support, Includes All Accessories)
- E8001 (Gait Trainer, Pediatric Size, Upright Support, Includes All Accessories)
- E8002 (Gait Trainer, Pediatric Size, Anterior Support, Includes All Accessories)
CPAP Criteria
Prescribers no longer need to contact the DME Helpdesk for a CPAP override if a home sleep study is performed. The home sleep study criteria have been integrated into CyberAccess to be used for DME pre-certification.
DME Walker Criteria
MO HealthNet requires pre-certification for standard walkers, walkers with trunk support, walkers with variable wheel resistance, and heavy duty walkers. However, MO HealthNet does not cover rollator walkers. Therefore, rollator walkers cannot be billed to MO HealthNet under HCPCS E0143 or E0149.
Durable Medical Equipment (DME) Program Policy Clarification for Custom and Power Wheelchairs Provided in a Skilled Nursing Facility
MO HealthNet has updated the Durable Medical Equipment (DME) Provider Manual to clarify policy related to the physician face-to-face evaluation when providing custom and power wheelchairs in a skilled nursing facility. The policy clarification can be found in Section 13.18.C of the manual located here.