The Centers for Medicare & Medicaid Services (CMS) has announced its final coding, benefit category, and payment determinations for seat elevation on Complex Rehab Technology (CRT) power wheelchairs. But the agency is putting off its final coding and funding decisions for seat elevation on consumer power chairs.

The CRT determinations were included in CMS’s Second Biannual 2023 HCPCS Coding Cycle. CMS said new coding actions would be effective starting April 1, 2024, unless otherwise noted.

CRT industry asked for standard and bariatric codes

CMS initially provided only one code for seat elevation on Complex Rehab Technology (CRT) power wheelchairs and asked for comments. The CRT industry requested a second code for heavy-duty weight capacities from 301 through 450 lbs. The first code would function as a standard weight code, for weight capacities through 300 lbs.

Despite industry lobbying, CMS’s final coding decision added just one CRT seat elevation code. Effective April 1, CMS will establish E2298, defined as “Complex rehabilitative power wheelchair accessory, power seat elevation system, any type.”

On March 31, CMS will officially discontinue the previous E2300 code that was “Wheelchair accessory, power seat elevation system any type.”

In explaining why it did not create a heavy-duty seat elevation code, CMS said, “The public comments confirmed that regardless of any differences in fabrication cost, there is no significant difference in the commercial pricing for seat elevation equipment for heavy-duty power wheelchairs and seat elevation equipment for standard power wheelchairs.”

Group 2 coding decisions postponed

CMS did agree with industry experts who recommended the agency pause its original proposal to delete HCPCS codes K0830 (Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 lbs.) and K0831 (Power wheelchair, group 2 standard, seat elevator, captain’s chair, patient weight capacity up to and including 300 lbs.).

CMS referenced the comments of Julie Piriano, PT, ATP/SMS, VP, Clinical Education, Rehab Industry Affairs and Compliance Officer, Quantum Rehab, who was the CRT industry’s primary presenter at the November coding meeting.

The CMS decision said, “The speaker also asked CMS to defer the creation of a new HCPCS Level II code for standard seat elevation and the deletion of codes K0830 and K0831 to a subsequent cycle until such time as NCART [National Coalition of Assistive and Rehabilitation Technology] has been able to thoroughly consider such changes. The suggested code language ‘Complex rehabilitative power wheelchair accessory, power seat elevation system, any type,’ would make it so that the wheelchair user would have to install power tilt or recline, both described as ‘power seating systems’ in the current code set, to obtain additional components such as E1010 and E1012. Currently, the code language for those components, power leg elevation system and platform respectively, read as, ‘Wheelchair accessory, addition to power seating system.’

“CMS received many comments from manufacturers of CRT products, groups representing suppliers, consumers, providers, advocates and stakeholders, all in support of the primary speaker’s comments and recommendations.”

“In the interim, HCPCS Level II codes K0830 and K0831 will continue to be used for non-complex rehabilitative power wheelchairs with seat elevation equipment,” the decision added. “HCPCS Level II code K0108 (Wheelchair component or accessory, not otherwise specified) can be used for claims for power seat elevation equipment added onto a non-complex rehabilitative power wheelchair owned by the beneficiary.”

Regarding reimbursement rates, the CMS decision added, “With respect to code K0830 and K0831, and claims for power seat elevation equipment added onto a non-complex rehabilitative power wheelchair owned by the beneficiary that are billed using code K0108, local fee schedule amounts would be calculated by the DME MACs for use in paying claims for any covered items.”

Fee schedule changes will start in April

In a Feb. 29 bulletin to the industry, NCART said the fee schedule amount for the new E2298 code is $2,000.34, and that the fee schedule would be effective April 1.

The American Association for Homecare (AAHomecare) said in a March 1 bulletin, “Under the capped rental rules for complex rehabilitative power wheelchairs, the rental price would be approximately $200 for months 1 through 3, and $150 for months 4 through 13 for a total of $2,100 for 13 months of continuous use.”

“AAHomecare’s Complex Rehab & Mobility Council will share additional analysis as applicable,” the association said in response to the final coding decision.”

And NCART said it “is conducting further analysis of the decision and will have a more detailed report to share [the week of March 4].”