New and sudden Medicare funding cuts for custom seating have sent the complex rehab industry scrambling to defend previous payment policies.
In an April 24 letter to stakeholders, NCART Executive Director Don Clayback referenced funding cuts to HCPCS codes E2609 (Custom Seat) and E2617 (Custom Back) in Medicare MAC Jurisdictions B and C.
Clayback described the cuts as “significant.” Medicare’s new policy provides “a flat allowable charge set with no notice,” he added.
In response, Clayback said an industry work group has been created and has “been working to resolve this issue, including communications with the respective medical directors.
“Our core message is that these two codes are for custom items and accordingly should continue to be paid based on individual review. There should be no set allowable. Accordingly, our request is the payment methodology return to the previous one as soon as possible. We have also emphasized the reductions in access to these products not only compromises Medicare beneficiaries with significant disabilities ability to get needed custom seating, but without this custom seating, the vast majority will be unable to even use their wheelchairs.”
Clayback said medical directors have agreed to immediately review the funding cuts and are “holding the processing of any claims that include E2609 and E2617 until they have determined any needed changes. Our hope is this review and the need to hold these claims will be concluded in the next seven to 10 days.”
