CMS & Future Funding for Dynamic Backrests
While dynamic seating can be indicated for a range of people
who use wheelchairs, appropriate funding is an issue in flux.
Michelle L. Lange, OTR/L, ABDA, ATP/SMS, Access to
Independence Inc., said, “There is a coding issue going on right
now” regarding Medicare funding for dynamic backs.
“There is a code for dynamic backs that was introduced almost
two years ago,” Lange explained. “CMS [Centers for Medicare & Medicaid Services] is trying to give it a fee schedule. The first fee
schedule they proposed was very low because they’re comparing
[a dynamic back] to basically a suspension component, just this
“We have a small work group that has been trying to explain
that suspension’s not the same as dynamic seating. Suspension’s
important, but it has different goals, different design.”
A complicating factor, Lange added, is CMS’s coding process:
“They want to compare [dynamic seating] to something else
[that’s already being funded]. The problem is there isn’t anything
else to compare it to.
“Dynamic seating’s been around for a while, but the only code
that’s at all similar is a code for the old Kids Rock [seating]. But
CMS never assigned a fee schedule to it because they said it was
a pediatric product.”
If CMS elected not to provide a fee schedule for dynamic
backs, Lange said, “You could use a miscellaneous code, and
that generally works better. But unfortunately, this whole process
could put dynamic backs in jeopardy. It’s concerning at the level
of [funding for] dynamic backs, that it could literally lead to a lot
of people who need it perhaps not getting it. It’s concerning at a
bigger level that CMS is saying, ‘Anything you want to code for,
you have to show us what it’s comparable to.’ If it was comparable
to something, we wouldn’t need a [separate] code.
“If something is very innovative, it’s not going to work,” Lange
added. “There’s one code for headrests, and there’s quite a
range of head supports from very basic to very complex. And
they’ll often say, ‘We think this is kind of the midpoint. So that’s
what we’re going to pay you.’ Which means some people are
really overcharging for a very simple headrest, and some people
aren’t getting paid enough for a very complex headrest that a
particular client needs.
“It’s a work in progress. Our goal right now with our little work
group is to try to get them to not assign [dynamic backs] the same
fee schedule as a little hydraulic spring.”
This article originally appeared in the issue of .