The Nov. 6-8 second biannual HCPCS public meeting includes a request to revise the Medicare reimbursement for HCPCS code E2298, defined as Complex rehabilitative power wheelchair accessory, power seat elevation system, any type.”
The applicant — the National Coalition for Assistive & Rehab Technology (NCART) — is recommending that language be changed to “Complex Rehabilitative power wheelchair accessory, power seating system, Complex Rehab seat elevation, any type.”
CMS details the industry’s seat elevation argument
The public meeting notes said, “NCART, on behalf of its member manufacturers of power seat elevation systems, submitted a request to revise existing HCPCS Level II code E2298 to identify the advanced technology of Complex Rehabilitative Technology (CRT) power seat elevation (PSE) systems and to re-calculate its fee schedule amount. The current code description for HCPCS Level II code E2298, ‘Complex
Rehabilitative power wheelchair accessory, power seat elevation system, any type,’ does not
differentiate CRT PSE systems from a basic PSE accessory and will have long-term unintended consequences if it is not changed.”
The meeting notes added that in NCART’s prior HCPCS Level II code application from the second biannual 2023 coding cycle, “It was requested CMS adopt characteristics to define CRT PSE that included at least 10 inches of elevation, being capable of elevating/descending while the power wheelchair moves, and of moving on a horizontal surface while fully elevated, and compatible with other power seating options (power tilt and/or power recline).
“If CMS’s objective is to preclude billing of a CRT PSE system with non-CRT base codes, such as E2300, NCART recommends revising the code description to differentiate clinically relevant CRT PSE characteristics from a basic PSE accessory used on a non-CRT PWC [power wheelchair].”
Read the full meeting notes on seat elevation, scheduled for Wed., Nov. 6, starting on page 13.
Palmetto requests further differentiation for joystick mounting hardware
The agenda item immediately following seat elevation — and also scheduled for discussion on Nov. 6 — is wheelchair mounting hardware.
CMS listed the request “to establish three new codes and revise an existing HCPCS Level II code E1028,
‘Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for
joystick, other control interface or positioning accessory’ to further describe wheelchair
mounting hardware.”
CMS said the applicant, Palmetto GBA, “submitted a request to revise HCPCS Level II code E1028 and establish three new HCPCS Level II codes to further identify wheelchair mounting hardware accessories.
Palmetto GBA further requested HCPCS Level II code E1028 be revised to account for any type of mounting hardware that does not fall into the three requested new HCPCS Level II codes.”
Palmetto has suggested the following codes and definitions:
— E1028: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other.
— EXXX1: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with remote joysticks or touchpads.
— EXXX2: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type.
— EXXX3: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type.
In its meeting notes, CMS noted that a wheelchair user “will often need multiple accessories to be mounted, and this will require multiple billings of E1028, each needing a narrative description to identify the type of accessory being mounted. … Creation of the new codes will help with multiple billings of E1028, and the need to review the narrative description, manual tracking of the rental months, and correction when MUE [Medically Unlikely Edit] edits are applied.
“We believe there is a claims processing need on behalf of Medicare to address issues related to multiple billings of existing HCPCS Level II code E1028, such as review the narrative description, manual tracking of the rental months, and correction of inappropriate MUE edits.”
To attend the Nov. 6 meeting, use this Zoom link. The pass code is 132470. Attendees can also dial into the meeting by calling (833) 435-1820 and using webinar ID number 160 226 0511.
