AMARILLO, TX – CMS has tasked the DME MACs to develop LCDs. In response, the DME MACs have proposed two LCDs that are available for comment.
The first proposed LCD, Power Mobility Devices DL33789, recommends a “not reasonable and necessary” determination for Group 2 power wheelchairs (“PWCs”) with seat elevation systems, specifically HCPCS K0830 and K0831. This proposed non-coverage position is based on what the DME MACs describe as the “best available evidence,” which they interpret as insufficient to support Medicare coverage for seat elevation technology on Group 2 wheelchairs.
Although NCD 280.16 grants DME MACs discretionary authority to determine coverage for seat elevation equipment, the proposed LCD would formalize a national non-coverage stance for these configurations within the Group 2 category.
The second proposed LCD, Wheelchair Options/Accessories DL33792, similarly proposes a “not reasonable and necessary” determination for seat elevation systems added to non-complex power wheelchairs, again citing limits in clinical evidence supporting functional necessity.
This LCD proposes updates to existing coverage criteria for power tilt and/or recline systems, including adding specific examples of clinical conditions that impair a beneficiary’s ability to perform functional weight shifts independently. Like DL33789, this proposal relies on NCD 280.16 to justify DME MAC discretion in determining the medical necessity of power seating systems for beneficiaries using non-complex wheelchairs.
Both proposed LCDs have been published to the Medicare Coverage Database and are open for public comment until April 4, 2026. The proposed LCDs can be pulled by searching the Database by the LCD identification number. CMS encourages stakeholders, including clinicians, suppliers, manufacturers, industry advocates, and other parties involved in the care of Medicare beneficiaries, to submit specific, evidence-based comments.
Stakeholders are advised to provide detailed clinical rationales and full‑text references to peer-reviewed scientific literature when addressing concerns or proposing changes. Commentors need to disclose all conflicts of interest. All comments must be submitted electronically to the designated email addresses for each LCD: [email protected] for DL33789 and [email protected] for DL33792. Only the comments submitted to the correct LCD-specific address will be considered in the final policy development process.
A virtual open meeting will be held on March 25, 2026, to further solicit public input. This meeting offers stakeholders an opportunity to provide oral comments and engage with DME MAC Medical Directors on policy questions and evidentiary concerns.
Attendees may review the open‑meeting announcement for participation details. Stakeholders are warned not to make operational or billing changes based on the proposed LCDs, as revisions may occur following review of comments. The DME MACs emphasize that proposed LCDs are not final and should not be interpreted as current Medicare policy.
Ultimately, these two proposed LCDs represent a significant step in CMS’s ongoing efforts to clarify and standardize coverage criteria for wheelchair technology, particularly seating systems and elevation mechanisms. If finalized as drafted, the policies may limit Medicare coverage for seat elevation functions on non‑complex power wheelchairs and impact clinical practice, equipment ordering, and beneficiary access. Suppliers, clinicians, and manufacturers are strongly encouraged to participate actively in the comment process to ensure that final determinations reflect the best available clinical evidence and the functional needs of Medicare beneficiaries.
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato, PC, a law firm based in Texas with a national healthcare practice. He represents pharmacies, infusion companies, HME companies, manufacturers, and other healthcare providers throughout the United States. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization and can be reached at (806) 345-6320 or [email protected].
Jacque K. Steelman, JD, is a member of the Health Care Group at Brown & Fortunato, PC, a law firm with a national healthcare practice based in Texas. She represents pharmacies, infusion companies, HME companies, manufacturers, and other healthcare providers throughout the United States. Ms. Steelman can be reached at (972) 684-5789 or [email protected].
