The Center for Medicare Advocacy (CMA) recently helped Michigan schoolteacher Cara Bunnell successfully challenge her Medicare Advantage (MA) plan’s denial of prior authorization for a rolling shower chair prescribed by her physician.
Ms. Bunnell has relapsing-remitting, secondary progressive multiple sclerosis and associated quadriplegia that prevents voluntary movement from her neck down. In order to take a shower, her caregiver needs to transfer her via Hoyer lift from bed into a rolling chair that can be wheeled into the shower stall of her modified bathroom. The chair must be customized with a reclining back, arm troughs, armrest locks, calf straps, and anti-tippers to ensure her safety, and a special soft seat overlay with cut-outs to protect and allow proper cleansing of the fragile skin at her surgical wound sites. Her first rolling shower chair lacked some of these features and was falling apart after 13+ years of use.
Ms. Bunnell had been warned by the durable medical equipment (DME) supplier that, in their experience, Medicare almost never covers rolling shower chairs, even for persons with significant physical disabilities. Thus, the MA plan’s denial of prior authorization came as no surprise. In its decision, the plan categorized the item as a “bathtub seat,” which is not considered DME by Medicare policy but rather a “comfort or convenience item, hygienic equipment; not primarily medical in nature.” National Coverage Determinations (NCD) Manual, Pub. 100-03, Ch. 1, Section 280.1 – DME Reference List.
In challenging the denial, her CMA attorney argued that the requested item is a rolling chair, which is recognized under the same NCD as a coverable DME “if patient meets Mobility Assistive Equipment clinical criteria (see § 280.3 of this manual). Coverage is limited to those roll-about chairs having casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals.” Id. The rolling shower chair prescribed for Ms. Bunnell has 5-inch casters.
CMA asserted that Ms. Bunnell meets the Mobility Assistive Equipment (MAE) clinical criteria, including that she has “a mobility limitation that significantly impairs her ability to participate in one or more MRADLs in the home.” NCD § 280.3. MRADL is an acronym for mobility-related activities of daily living, which Medicare’s policy expressly defines to include “toileting, feeding, dressing, grooming, and bathing in customary locations within the home.” Id.
Additionally, CMA walked through how the prescribed rolling shower chair meets the 4-prong legal definition of DME: (1) It can withstand repeated use; (2) It is primarily and customarily used to serve a medical purpose; (3) It is generally not useful to an individual in the absence of an illness or injury; and (4) It is appropriate for use in the home. 42 C.F.R. § 414.202; Medicare Claims Processing Manual Ch. 20 § 10.1.1.
CMA staff members, Shumin He and Kyle Martin, obtained a statement from Ms. Bunnell and supporting letters from four of her doctors attesting that it was impossible and unsafe for her to utilize a standard bathtub seat. The doctors’ letters also validated that the requested rolling shower chair is not a personal convenience or comfort item, but rather essential medical equipment to carry out her treatment plan by providing therapeutic benefit and preventing complications like injuries and infections, particularly related to her suprapubic catheter, skin and wound sites.
Despite this and Medicare’s coverage policy on Mobility Assistive Equipment, an Administrative Law Judge (ALJ) upheld the coverage denial, finding the item was not primarily and customarily used to serve a medical purpose, and therefore did not qualify as DME.
While awaiting the ALJ’s decision, however, Kyle Martin researched and determined a more appropriate way to code the rolling shower chair – as a Miscellaneous Item (E1399) — and denote 5-inch casters in the description. This made more sense as there is no specific code for the item, and coding it as bathtub seat or shower chair does not adequately describe it. The DME supplier agreed to submit a new prior authorization request with this coding. Notwithstanding, the plan denied the new request, on the same basis as before – that the item is a bathtub seat, hygiene, convenience or comfort item, etc.
CMA promptly appealed the new denial, presenting all of the earlier arguments and supporting letters. Shortly, the plan overturned its denial and approved coverage for Ms. Bunnell’s rolling shower chair. The telling factor may have been that a “Medical Director” had reviewed the request at this stage of appeal. The plan’s decision noted that “[m]ultiple treating providers have attested to the medical necessity of the requested mobility assistive equipment, and there is a signed written order.” It concluded, “The member has a mobility limitation that significantly impairs her ability to participate in one or more mobility-related activities of daily living (bathing) in the home, and criteria are met per Medicare NCD 280.3.”
While CMA and Ms. Bunnell are pleased by the outcome achieved in her case, they are very concerned that other Medicare beneficiaries with significant mobility impairments have routinely been, and are still being, improperly denied coverage of rolling shower chairs for which they are eligible. The manufacturers’ price for such equipment can exceed $4,000, which is beyond what many people can afford. Ms. Bunnell knows all too well that access to such equipment can be critical to maintaining health, safety, and the ability to remain in one’s home in the community.
April 9, 2026 – W. Kwok