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We are thrilled to announce that CMS decided to cover seat elevation in all power wheelchairs for the purposes of performing all transfers or to improve reach in performing mobility related activities of daily living (MRADLs) in their homes. This is a major expansion of coverage from the preliminary coverage decision announced in mid-February and CMS attributed these coverage improvements to the 2,130 public comments received by wheelchair users, advocates, clinicians, and researchers. The final seat elevation Decision Memo can be viewed HERE.
For the first time, CMS determined that seat elevation in power wheelchairs is considered “primarily medical in nature” and is, therefore, covered durable medical equipment (DME) under both traditional Medicare and Medicare Advantage. Seat elevation will be covered in Groups 2, 3 and 5 Complex Rehabilitative Technology (CRT) power wheelchairs when a patient needs seat elevation to transfer from one surface to another, with or without caregiver assistance, assistive devices, or lift equipment or to improve one’s reach in order to perform MRADLs. Seat elevation will also be covered in non-CRT power wheelchairs when determined by Medicare contractors to be reasonable and necessary. Individuals must undergo a specialty evaluation performed by a licensed/certified medical professional who has specific training and experience in rehabilitative wheelchair evaluations.
This decision is effective immediately but CMS will consider new coding and payment determinations in the future. Beneficiaries who are most likely to benefit from this decision include people with Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, spinal cord injury, paralysis, ALS, limb amputation, Lupus, rheumatoid arthritis, myositis, and other mobility-related conditions.