The Centers for Medicare & Medicaid Services’ (CMS) DME MAC contractors have removed ICD-10 codes from its wheelchair seating requirements.
The National Coalition for Assistive & Rehab Technology (NCART) reported the change in an Oct. 2 breaking news bulletin to stakeholders while linking to the updated article. The article’s revision date is Oct. 1, 2025.
ICD-10 — the International Classification of Diseases and Related Health Problems, 10th revision — is a World Health Organization-endorsed system used to code and classify medical diagnoses. Johns Hopkins Medicine described the codes as “ a combination of diagnoses and symptoms, so fewer codes need to be reported to completely describe a condition.”
While the updated article still lists definitions for seating HCPCS codes and the need, for example for a specialty evaluation and subsequent written report to be available on request, diagnosis codes are no longer indicated.
The removal of ICD-10 code requirements should give clinicians greater latitude to recommend seating based on a client’s clinical needs, regardless of that client’s diagnosis. When ICD-10 codes were part of the documentation requirement, a client could be deemed ineligible for seating components or systems if that client lacked one of the qualifying diagnoses — even if the seating clinician were willing to document medical necessity.
Tamara Kittelson, MS, OTR/L, ATP/SMS, Intermediate Wheelchair Provider Certification/ISWP, is the executive director of the National Clinician Task Force (CTF).
In an interview with Mobility Management, Kittelson said the previous ICD-10 requirement “used to eliminate some people” from receiving the seating technology that best matched their needs.
“You might have the presentation that you need tilt in space, you need a positioning cushion,” Kittelson said as examples. “But if your diagnosis didn’t fit into that framework, then you’re out of luck.”
The flip side of the elimination of the ICD-10 code requirement is that clinicians less familiar with seating and wheeled mobility — for example, clinicians who don’t perform seating assessments on a regular basis — no longer have that ICD-10 code list that tells them what seating interventions have been typically provided for clients with various diagnoses.
“That’s the rub,” Kittelson said. “It’s a double-edged sword. We know there are therapists out there who only do [seating assessments] once in a while, who don’t feel comfortable in their knowledge, who are overly dependent on the supplier ATP for what they should be [recommending] for that person.
“We know that’s happening all the time, and that’s one of the reasons the CTF continues to push for education and training and mentoring to try to help people become more confident.”
This is a developing story. Check back for more Mobility Management coverage.
