Power seat elevation: NCART zeroes in on access issues in Medicaid

WASHINGTON – Now that there is a Medicare code and payment for power seat elevation systems, NCART is doing the painstaking work of making sure state Medicaid programs have a pathway to also cover the technology. 

In November, for example, the organization announced that it had secured coverage for E2298 for adults 21 and over in Alabama starting Jan. 1, 2025, with help from Cathy Carver, PT, DPT, ATP/SMS, at University of Alabama Birmingham/Spain Rehabilitation Center, as well the Alabama Durable Medical Equipment Association. 

“We looked to see what states explicitly exclude power seat elevation from coverage, which ones only cover it for beneficiaries under 21, and where there may be access issues, meaning there is a disparity between Medicare and Medicaid coverage or a problem with cross-over claims due to coding,” said Julie Piriano, senior director of payer relations & regulatory affairs for NCART. “We’ve been working closely with the state associations and our complex rehab members because when we work collaboratively to approach state Medicare programs, it becomes local and that’s key.” 

CMS established E2298 in March 2024 and set reimbursement to about $2,000 effective April 1 of that year. 

Even though Medicaid programs are expected to follow Medicare, how they do that can vary. In Utah, for example, the state Medicaid program “isn’t necessarily opposed” to covering seat elevation, Piriano says, but it first must earmark funds to cover the technology. 

“They can’t implement the code until the legislature approves funding for it,” she said. “We’re ready to go when the legislature is back in session in 2025, with a person identified to bring it to the Social Services Appropriations Subcommittee. But until then, it’s going to prolong access to this technology there.” 

NCART has irons in the fire in other states, as well, including Idaho, Indiana, Nevada and North Dakota. In North Carolina, the organization has a similar situation as, until recently, Alabama, where the state Medicaid program covers seat elevation for under 21 but not 21 and over, and in West Virginia, the program excludes coverage completely. 

“Once we got a dedicated code, it became important to watch what the states are doing,” Piriano said. “It was time to flush it out and make sure coding, coverage criteria and reimbursement followed the directive from the CMS.” 

Securing coverage in each state is only the first step – NCART must also raise awareness when, like in Alabama, access to seat elevation is opened up, says Wayne Grau, the organization’s executive director.  

“We have to get the word out to every provider in Alabama,” he said. “Just because we get it doesn’t mean they’ve seen the news or understand it.”