NCART has reported that the Centers for Medicare & Medicaid Services (CMS) is ready to talk about the crucial next steps for powered seat elevation coverage.
On May 16, CMS announced its decision to cover powered seat elevation on power wheelchairs for Medicare beneficiaries. CMS even went beyond the scope of the original industry request, which had focused on Complex Rehab Technology (CRT) power chairs. In its decision, CMS said, “After careful consideration of comments, we have expanded the scope of the proposed benefit category decision to include power seat elevation as DME on all Medicare-covered PWCs, i.e., Groups 2, 3, and 5.”
Unanswered Funding Questions Remain
The CMS decision was hailed as a breakthrough moment for CRT funding and policy, as Medicare hadn’t covered seat elevation prior to its May announcement. But even as coverage began immediately, details and logistics remained unclear. For example, what would Medicare’s reimbursement rates be? Since seat elevation mechanisms for Group 2 power chairs are very different than the mechanisms for seat elevation on Group 3 power chairs, how would coding be affected?
After all, inadequate reimbursement would still put seat elevation out of reach for a number of wheelchair riders.
In its Oct. 31 news announcement, NCART said, “CMS has been in the process of determining coding for power seat elevation systems used with complex power wheelchairs. They are also working to establish appropriate reimbursement to ensure access.
“A coding decision is expected to be announced by CMS shortly, and a public meeting is scheduled for November 28-30. Reimbursement rates will be announced following the coding determination and are anticipated in December. Final implementation of coverage will be in early 2024. In the interim, the DME MACs will continue to determine reasonable and necessary coverage as they work to develop local coverage determinations that are in line with the national coverage determination.”
Coverage Efforts Continue for Power Standing
In the announcement, NCART said it’s also working with the ITEM Coalition to continue to push for Medicare coverage for power standing on power wheelchairs.
Industry stakeholders originally asked CMS to consider coverage for both seat elevation and power standing technologies. But when CMS released its proposed decision in February, it added, “Because the evidence base for power seat elevation wheelchair equipment is distinct from that of power wheelchair standing equipment, it is outside the scope of this analysis. CMS will consider these items in a separate future National Coverage Analysis.”
In its Oct. 31 announcement, NCART said, “CRT advocates also continue to pursue establishing Medicare coverage for power standing systems used with complex power wheelchairs. During a September meeting with CMS leadership, ITEM Coalition and others continued the dialogue and provided additional clinical and consumer feedback regarding these systems. NCART was pleased to participate in that discussion and offer CRT perspectives that support coverage. CMS did not indicate a timeline for next steps, but additional data is being provided, and additional meetings will be scheduled.”
