CMS is ‘engaged’ on power seat elevation reimbursement 

• Reimbursement review: CMS is considering a review of the lower-than-expected reimbursement rate for power seat elevation systems. Stakeholders expressed surprise at the rate being lower than initially posted.
• Rate discrepancy: Stakeholders highlighted a discrepancy between the actual number of complex rehab wheelchairs with seat elevation options and the larger number included in the rate-setting process. CMS accepted this information and expressed openness to reviewing it.
• Power standing systems: While stakeholders didn’t specifically ask about power standing systems, efforts continue to seek an update on their coverage.

WASHINGTON – CMS appears to be open to reviewing the lower-than-expected reimbursement rate for power seat elevation systems, according to NCART, which was among the stakeholders in a recent meeting with the agency. 

A rate of about $2,000 for the new code E2298 went into effect April 1, 2024. 

“CMS was very engaged,” said Julie Piriano, senior director of payer relations & regulatory affairs for NCART. “Sometimes you go into a meeting like this, and the other side is silent, but there was a good dialogue. One of the things we found most surprising was that they also wondered why the final reimbursement rate was lower than what was posted in the preliminary decision.” 

On an interim basis prior to April 1, providers were being paid about $2,800, on average, for seat elevation systems. Stakeholders had recommended a rate of $3,450, on average. 

During the meeting, stakeholders provided an analysis showing the difference between the actual number of complex rehab wheelchairs in the U.S. market that have options for seat elevations systems and the lager number of wheelchairs that were included in the rate-setting process, Piriano says. 

“There’s a discrepancy there (that had an impact on the rate) that we wanted to make sure they understood,” she said. 

CMS “accepted the information provided,” Piriano says, “and they said they were open to reviewing it.” 

“Unfortunately, we haven’t heard back from them yet,” she said. “But they haven’t said no.” 

Stakeholders did not ask CMS about when the agency expects to move forward with the reconsideration process to include coverage for power standing systems. 

“We did not ask at this particular meeting, but NCART and the ITEM Coalition continue to reach out and ask,” said Wayne Grau, executive director of NCART. “We’ve also contacted our legislative champions to see if they can request an update. It is taking longer than we expected.”