This week, the Centers for Medicare and Medicaid Services (CMS) announced Medicare coverage for Power Seat Elevation Systems as an accessory to Group 3 Power Wheelchairs through a National Coverage Analysis (NCA) with a final National Coverage Determination (NCD). The decision memo and final benefit category determination, found here: https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=309.
Seat elevation devices allow power wheelchair users greater ability to engage in many activities of daily living they could not otherwise perform, such as transferring in and out of the wheelchair, preparing meals, and reaching items placed at varied heights. The coverage decision follows years of advocacy by disability and aging organizations. The Center for Medicare Advocacy (the Center) applauds the leadership of the Independence through Enhancement of Medicare and Medicaid (ITEM) Coalition, of which the Center is a member, for the steadfast work in advocating for, and achieving, this necessary coverage.
Effective for services performed on or after May 16, 2023, including an evaluation for coverage, power seat elevation equipment is considered reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs who meet criteria defined in the NCD. The Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has discretion to 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.
Following this significant coverage accomplishment, the ITEM Coalition is also awaiting an NCD for wheelchair standing system coverage. For additional information about these efforts, and how to join in supporting them, visit https://www.itemcoalition.org/ or www.Rise4Access.org.
May 18, 2023 – K. Holt