Seat elevation systems are a go 

WASHINGTON – Complex rehab stakeholders saw their “perseverance” pay off on May 16, when CMS published a final benefit category determination and national coverage decision approving seat elevation systems for power wheelchairs. 

The ITEM Coalition first made the request to reconsider coverage for seat elevation in September 2020, kicking off a process that saw stakeholders conducting countless meetings with CMS and participating in two comment periods in February 2022 and March 2023. 

“They say, ‘It takes a village,’ and this took a whole industry,” said Wayne Grau, executive director of NCART. “I want to compliment the ITEM Coalition, in particular, which has been leading this effort and which brought in consumers. If it had been just providers and manufacturers, this wouldn’t have gotten done. It shows if we all work together, our perseverance pays off.” 

While the ITEM Coalition made the request to reconsider coverage for Group 3 wheelchairs, CMS included Group 2 and Group 5 wheelchairs, as well. The agency also gave the DME MACs the discretion to determine reasonable and necessary coverage for power wheelchairs other than complex rehab wheelchairs. 

Moreover, CMS extended coverage not only for wheelchair users who perform weight-bearing transfers, but also for users who perform reaching to complete one or more mobility related activities of daily living (MRDALs), something stakeholders had advocated for. 

“That’s the coolest part of it, I think,” said Cara Masselink, executive director of the Clinician Task Force. “They made the decision not only for transfers, but also for reaching, recognizing that users are limited in their wheelchair in a vertical environment.” 

Stakeholders lauded CMS for listening to feedback during the comment periods and adjusting coverage along the way. During the second comment period, for example, the agency asked for feedback on opening coverage for Group 2 wheelchairs. 

“I love that CMS expanded it beyond their initial decision,” Masselink said. “They did a nice job responding to people’s comments and also acknowledging that, for example, the ALS Association, submitted 500 comments. That they took the time to do that is really important.” 

While coverage goes into effect immediately, it's still "the first step,” stakeholders say, and now work begins on coding and reimbursement. 

“They’re going to see if there’s an existing code out there that they can use or if it needs to be its own code, and we’re going to give them a lot of information to help them make that decision,” Grau said. “From there, they’ll determine pricing. Based on what we’ve seen from CMS, we think they understand how good this product is and they want to price it accordingly. They want to make sure that people can access it.”