The Centers for Medicare & Medicaid Services (CMS) published a landmark National Coverage Decision (NCD) for Medicare coverage of seat elevation systems in power wheelchairs. CMS’ preliminary decision, announced in mid-February, determined for the first time that seat elevation is not a convenience item and is, in fact, “primarily medical in nature.”
The agency proposed to cover seat elevation under the durable medical equipment benefit and deemed it reasonable and necessary for beneficiaries who, due to a mobility impairment, need seat elevation in a Group 3 complex rehabilitative technology power wheelchair in order to transfer from one surface to another. Coverage is linked to the ability to perform or participate in mobility-related activities of daily living in the home.
The Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition supported the decision but urged CMS to expand this proposed coverage, as did the majority of the 2,130 comments submitted to CMS by members of the public. The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) and the O&P Alliance submitted comments focusing on the benefits of wheelchair seat elevation for people with limb loss and limb difference.
“The ITEM Coalition and disability stakeholders are thrilled that CMS seriously considered the input from wheelchair users, allies, and experts in the field who requested an expansion of the preliminary coverage decision,” said Peter W. Thomas, JD, general counsel for NAAOP and coordinator of the ITEM Coalition. “The final NCD is a significant victory for the disability community that we expect will have ripple effects with other healthcare payers.”
