Nearly three years after the Centers for Medicare & Medicaid Services (CMS) affirmed Medicare coverage for power seat elevation on power wheelchairs, the Medicare DME MACs — Noridian Healthcare Solutions (Jurisdictions A and D) and CGS Administrators (Jurisdictions B and C) — have announced a March 25 meeting to discuss proposed local coverage determinations (LCDs) that would deny Medicare coverage of power seat elevation for Group 2 power chairs.
Several industry policy and clinical experts contacted by Mobility Management immediately after the DME MACs’ announcement on the afternoon of Feb. 19 expressed surprise over the DME MACs’ plans, but emphasized the importance of a measured response from stakeholders.
Within minutes of the DME MACs’ announcement, Julie Piriano, senior director, payer relations and regulatory affairs for the National Coalition for Assistive and Rehab Technology (NCART), told Mobility Management that the organization was creating a stakeholder committee to respond and coordinate comments from the industry.
Currently proposed LCDs
According to the DME MACs, the first proposed LCD covers power mobility devices and suggests “a not reasonable and necessary determination for Group 2 power wheelchairs (PWCs) with seat elevation systems (K0830 and K0831), based on the best available evidence.”
The second proposed LCD, for wheelchair options and accessories, suggests “a not reasonable and necessary determination for the use of seat elevation added onto non-complex power wheelchairs, based on the best available evidence.” It also proposes to include, in the coverage criteria for power tilt and/or recline seating systems, examples of clinical conditions that limit the beneficiary’s ability to perform a functional weight shift.
The DME MACs noted that the May 2023 national coverage determination gives them discretion to determine coverage of power seat elevation on non-Complex Rehab power wheelchairs.
Public meeting in late March
Registration for the March 25 virtual meeting opened Feb. 19. A 45-day public comment period will remain open through April 4, Piriano told potential workgroup members in a Feb. 19 email.
Piriano also invited stakeholders who wish to participate in the response to reach out directly: [email protected].
This is a developing story. Check back for updates.
