Seating advocates celebrated following the May 16 decision by the Centers for Medicare & Medicaid Services’ (CMS) to fund seat elevation. That jubilation was well deserved: The fight for seat elevation reimbursement had been ongoing literally for decades.
Mobility Management published our seat elevation story well before dawn on Thurs., May 18. When I got to my desk a little after 7 a.m., my office phone was already ringing. On the other end was a power wheelchair rider who’d been needing a replacement chair from Medicare for a while, but had postponed in hopes of getting seat elevation funded this time around. Could she now go to clinic and order her new power chair?
Right after speaking to that consumer, my phone rang again. This time, an ATP was on the line: With the May 16 decision now official, when could he start sending in seat elevation claims?
In the last month, I’ve talked to funding and policy experts and have sat in multiple meetings of ATPs and industry advocates. Those conversations have invariably started with moments of shared congratulations, then progressed to the inevitable question: Now what?
CMS has indeed agreed that power seat elevation fits the definition of durable medical equipment and can be medically necessary for power chair riders under certain circumstances, such as to perform transfers or to reach while performing other mobility-related activities of daily living.
But as of this writing, CMS had not announced allowables for seat elevation. And there are no HCPCS codes, either.
A further potential complication: CMS agreed to cover seat elevation not just on Complex Rehab Technology (CRT) power chairs, but also on Group 2 consumer power wheelchairs.
While making seat elevation accessible to a larger number of wheelchair riders is great, adding Group 2 to the equation does make funding possibilities more complex. Powered seating for Group 3 chairs often includes multiple functions, such as tilt, recline, and/or standing. Powered seating mechanisms and engineering for Group 3 chairs are typically more robust, complicated, and can offer greater seat elevation heights — than seat elevation on Group 2 chairs.
Which also can make seat elevation from Group 3 chairs more expensive than the less robust, more basic mechanisms used on Group 2 chairs.
So the industry will need to advocate for appropriate funding for seat elevation on both Group 3 and Group 2 chairs, to ensure the technology is accessible to all Medicare beneficiaries. Funding seat elevation only at Group 2 reimbursement levels could hinder access for Group 3 wheelchair riders.
When will we hear about allowables? CMS hasn’t said. Guesstimates have ranged from later in 2023 to a year from now.
And what will CRT providers do till then? In the meetings I’ve attended, some have said they intend to wait for the fee schedules. Others floated the idea of hand selecting one or two highly qualified wheelchair riders with excellent documentation and justification, and submitting those claims to see how Medicare will respond.
I can certainly understand wanting to wait for official fee schedules. Right now, it’s as if someone has pledged to pay for our meal without first telling us how much we can spend. Without knowing how much the reimbursement will be, can we afford to order the chicken or the pasta? Or should we just order soup to be on the safe side?
