Stakeholders ask CMS to fix problems with power seat elevation plan 

WASHINGTON – When CMS is expected to release final coding and pricing for power seat elevation systems in February, complex rehab stakeholders will take a close look to see if the agency incorporated their feedback. 

During a recent hearing hosted by CMS, stakeholders provided testimony outlining problems with the agency’s preliminary recommendations, including its decision to categorize power seat elevation systems as accessories. 

“We don’t believe it should be treated as an accessory,” said Wayne Grau, executive director of NCART. “It is a system; it is similar to tilt systems. If you look at the schematics, the R&D and the material bills we submitted, it’s not an accessory. It’s not a cup holder or an oxygen tank holder. It should be treated like tilt and the fee schedule should reflect that.” 

CMS’s preliminary recommendations also include discontinuing E2300 and establishing two new codes for power seat elevation systems – one for each complex rehab power wheelchairs and power wheelchairs. The agency also recommends discontinuing K0830-K0831. 

Stakeholders told CMS that the coding should also reflect standard and heavy-duty versions of power seat elevation systems. 

“The heavy-duty systems require different parts and testing and have different requirements, and they have to be priced properly,” Grau said. “Because they want to go with one code (for each), a person who is over 350 pounds would be potentially denied this valuable equipment. We also don’t believe K0830-31 should be changed yet. We need more data to avoid any unintended consequences. So, we ask them to keep those for now and address them in the future.” 

Finally, stakeholders voiced their disagreement with CMS’s plans to use a gap-filling methodology to determine pricing for power seat elevation systems – a process that involves taking the retail price for a product and deflating it to 1986, then reinflating it. 

“The problem is we haven’t gotten a CPI-U increase in a number of those years, so naturally, the price comes in lower than if it were inflated properly,” Grau said. “On top of that, the retail pricing they used to start with was $299 below our provided data. We feel they should use a comparable mechanism, where they look at a comparable product like tilt (to determine pricing).” 

Following the expected release of final coding and pricing for power seat elevation systems in February, CMS plans to implement the changes on April 1. 

“Once coding is finalized, the DME MACs will also release local coverage determinations for comment and we’ll have the opportunity to weigh in and influence (those) to make sure the additional coverage guidance that many of us feel is needed is finalized reflects the areas where clarification is needed,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products.