Almost three years after the Centers for Medicare & Medicaid Services (CMS) announced Medicare coverage for power seat elevation on power wheelchairs, the Medicare DME MACs — Noridian Healthcare Solutions (Jurisdictions A and D) and CGS Administrators (Jurisdictions B and C) — said they’ll hold a March 25 meeting to discuss proposed local coverage determinations (LCDs) that would deny Medicare coverage of power seat elevation for Group 2 power chairs.
Several industry policy and clinical experts contacted by HME Business’s sister publication Mobility Management were surprised by the DME MACs’ announcement, but emphasized the importance of a measured and thoughtful response from stakeholders.
Julie Piriano, senior director, payer relations and regulatory affairs for the National Coalition for Assistive and Rehab Technology (NCART), told Mobility Management that the organization was creating a stakeholder committee to respond to the DME MACs’ plans and to coordinate comments from the industry.
What the proposed LCDs say
According to the DME MACs, the first proposed LCD covers power mobility devices and recommends “a not reasonable and necessary determination for Group 2 power wheelchairs (PWCs) with seat elevation systems (K0830 and K0831), based on the best available evidence.”
The second proposed LCD, for wheelchair options and accessories, recommends “a not reasonable and necessary determination for the use of seat elevation added onto non-complex power wheelchairs, based on the best available evidence.” It also proposes to include, in the coverage criteria for power tilt and/or recline seating systems, examples of clinical conditions that limit the beneficiary’s ability to perform a functional weight shift.
The DME MACs noted that the May 2023 national coverage determination gave them the authority to determine coverage for power seat elevation on non-Complex Rehab power wheelchairs.
Public meeting in late March
Registration for the March 25 virtual meeting opened Feb. 19. A 45-day public comment period will remain open through April 4, Piriano told potential workgroup members in a Feb. 19 email.
Piriano also invited stakeholders who wish to participate in the response to reach out directly: [email protected].
Mobility Management and HME Business will host a March 19 webinar to provide NCART and other industry stakeholders a platform to discuss their comments. Registration is free and now open.
