Centers for Medicare & Medicaid Services (CMS) to Reimburse Power Seat Elevation in Wheelchairs
Advocates called the decision a "major milestone and win for wheelchair users and their caregivers."
Calling it a "landmark decision," the Centers for Medicare & Medicaid Services (CMS) announced May 16, 2023 that it had, for the first time, made power seat elevation for power wheelchairs eligible for reimbursement as durable medical equipment (DME). CMS said effective immediately, seat elevation for Medicare-covered power wheelchairs is now considered a clinically meaningful benefit to people with Medicare who perform transfers from power wheelchairs or use their chairs for mobility-related activities of daily living such as dressing, grooming, toileting, feeding and bathing. DME advocates, mobility manufacturers and members of the disability community had urged CMS to issue the Benefit Category Determination (BCD) and National Coverage Decision. “For too long, many people who use a power wheelchair could not access everyday items in their homes and may have struggled to get in and out of their device,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “This landmark Medicare decision to cover seat elevation is a major milestone that will improve the quality of life for so many who rely on this technology.” Advocates called the decision a "win for wheelchair users and their caregivers." American Association for Homecare (AAHomecare), NCART, the ITEM Coalition and a wide variety of mobility user groups pushed hard for the move, spurring more than 5,000 public comments in two response periods. Seat elevation equipment on power wheelchairs raises and lowers users while they remain in a seated position. CMS accepted a formal request from the Independence Through Enhancement of Medicare and Medicaid Coalition to consider a benefit category and coverage of seat equipment earlier this year. Previously, CMS did not consider seat elevation equipment to be a statutorily covered option. Based on comments and evidence reviewed as part of an initial proposal to include power seat elevation equipment of Medicare-covered power wheelchairs, it was determined the equipment serves a medical purpose in assisting with transfers in and out of a power wheelchair and with performing reaching activities. “CMS’ decision will allow more individuals with serious mobility challenges to utilize seat elevation systems,” said AAHomecare President and CEO Tom Ryan. “Our nation's health care infrastructure needs to continue to take full advantage of technologies that prevent additional medical complications and allow seniors and people with disabilities to stay in their homes.” After considering the public comments on the proposed decision memorandum, CMS is also expanding coverage beyond the original review of Group 3 power wheelchairs to include Group 2 and Group 5 power wheelchairs. “We're especially pleased to see that CMS decided to expand the scope of coverage to include additional PWC categories and that reaching activities are included in the coverage criteria," added Ryan. "Thanks to our partners at the ITEM Coalition and NCART for their significant roles in raising awareness and generating support for covering these essential systems.” CMS finds in this national coverage analysis that the evidence is sufficient to determine that power seat elevation equipment is reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs when the following conditions are met:
The individual has undergone a specialty evaluation that confirms the individual’s ability to safely operate the seat elevation equipment in the home. This evaluation must be performed by a licensed/certified medical professional such as a physical therapist (PT), occupational therapist (OT) or other practitioner, who has specific training and experience in rehabilitation wheelchair evaluations; and,
At least one of the following apply:
a. The individual performs weight-bearing transfers to/from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer and/or their lower extremities during a sit-to-stand transfer. Transfers may be accomplished with or without caregiver assistance and/or the use of assistive equipment (e.g. sliding board, cane, crutch, walker, etc.); or b. The individual requires a non-weight bearing transfer (e.g. a dependent transfer) to/from the power wheelchair while in the home. Transfers may be accomplished with or without a floor or mounted lift; or, c. The individual performs reaching from the power wheelchair to complete one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming and bathing in customary locations within the home. MRADLs may be accomplished with or without caregiver assistance and/or the use of assistive equipment.
In addition, the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has the discretion to determine reasonable and necessary coverage of power seat elevation equipment for individuals who use Medicare-covered power chairs other than complex rehabilitative power-driven wheelchairs.