AMARILLO, TX – As of May 16, 2023, Medicare began covering seat elevation devices for power wheelchairs. CMS issued a Benefit Category Determination and National Coverage Determination for power seat elevation equipment on certain power wheelchairs. This decision by CMS followed a formal request by the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition and other supporting organizations.
CMS determined that seat elevation devices in power wheelchairs are medically necessary and should be covered as durable medical equipment (DME) under traditional Medicare and Medicare Advantage. CMS believes that expanding the benefit category will assist some users of power wheelchairs to preserve the function of their shoulders and decrease pain and injuries.
Power seat elevation equipment used in conjunction with a power wheelchair allows an individual to raise and lower himself/herself to different heights while remaining in a seated position. Users of power wheelchairs can face significant tasks and impediments in their daily lives when there is a vertical height differential between their wheeled mobility device and the surface they are transitioning to.
Typically, when users transfer to surfaces with different heights, they must use various techniques such as the side pivot transfer that requires them to (i) push off with their arms, (ii) pivot their body around their feet, and (iii) swing their trunk to a targeted surface. This maneuver requires significant use of upper extremities. Repeated movements can cause injury or pain.
Seat elevation for power wheelchairs offers health benefits to beneficiaries with mobility impairments because it allows level transfers, making the process easier by minimizing the strain on upper extremity joints. Seat elevation allows a person in a wheelchair to quickly move from his/her wheelchair to a bed or a toilet…or to cook safely using a stove. Seat elevation is an important technology that allows individuals to perform and participate in daily activities and avoid falls or injuries related to frequent transfers. Seat elevation devices allow wheelchair users to perform activities of daily living more easily with less risk of injury or falls.
Individuals must meet the following conditions for power seat elevation equipment to be considered reasonable and necessary:
- The individual (i) can safely operate the seat elevation equipment and (ii) undergoes a special evaluation that confirms it. A physical therapist, occupational therapist, or someone specializing in training and experience in wheelchair evaluations, must perform the evaluation.
- At least one of the following applies:
- With or without assistance, the individual does weight-bearing transfers to or from the power wheelchair while home using (i) his/her upper extremities during an uneven sitting transfer or (ii) his/her lower extremities during a sit-to-stand transfer; or
- The individual requires a non-weight-bearing transfer; or
- The individual reaches from the power wheelchair to complete one or more mobility-related daily living activities.
CMS determined that it was necessary to require all individuals who may receive power seat elevation equipment on power wheelchairs to undergo a specialty evaluation that confirms the individual’s ability to operate the seat elevation at home because CMS wants the individuals receiving the seat elevation equipment to be able to operate the equipment in the home without causing harm to themselves or others.
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) can determine reasonable and necessary coverage of power seat elevation equipment for individuals who use Medicare-covered power wheelchairs other than complex rehabilitative power-driven wheelchairs.
The HCPCS coding and national fee schedule amounts for power wheelchairs with power seat elevation will be addressed in an upcoming HCPCS public meeting, that should likely occur later this fall. Until then, interim local fee schedule amounts have been established by the DME MACs for use in paying any allowed claims for power wheelchairs with power seat elevation.
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato, PC, a law firm based in Texas with a national health care practice. He represents pharmacies, infusion companies, HME companies, manufacturers, and other health care 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@example.com.
Jacque K. Steelman, JD is a member of the Health Care Group at Brown & Fortunato, PC, a law firm with a national health care practice based in Texas. She represents pharmacies, infusion companies, HME companies, manufacturers, and other health care providers throughout the United States. Steelman can be reached at (806) 345-6316 or firstname.lastname@example.org.
AAHOMECARE’S EDUCATIONAL WEBINAR
Six-Year Lookback Audits: What the Law Requires
Presented by: Jeffrey S. Baird, Esq., Brown & Fortunato and Denise M. Leard, Esq., Brown & Fortunato
Wednesday, September 27, 2023
1:30-2:30 p.m. CENTRAL TIME
The Affordable Care Act includes the 60-day overpayment rule that requires DME suppliers to refund overpayments within 60 days of identification. What many suppliers are not aware of is that if an overpayment is identified, either internally or externally, suppliers are mandated by law to perform a six-year lookback audit. If suppliers do not comply with this rule, they are at risk for false claim penalties. This webinar will (i) discuss the 60-day overpayment rule and the six-year lookback obligation; (ii) discuss steps that suppliers can take to reduce the risk of being subjected to the 60-day overpayment rule; and (iii) set out the steps the supplier should take to successfully fulfill its obligations under the rule.