Stakeholders on seat elevation: ‘We need more details’ 

WASHINGTON – Complex rehab stakeholders are disappointed in CMS’s payment rate for seat elevation systems and have requested a meeting with the agency to learn more about how it landed on about $2,000. 

That rate is lower than the $2,800, on average, that providers are being paid for the systems on an interim basis, and significantly lower than the rate stakeholders had recommended. 

“The payment piece was disappointing,” said Wayne Grau, executive director of NCART. “We looked at pricing and provided an average of $3,450. How do you go from that to $2,000. That’s a huge change. That’s more than a 40% difference.” 

CMS announced the payment rate and code, E2298, for seat elevation systems in early March with an implementation date of April 1. 

Stakeholders are trying to get to the bottom of the discrepancy but need more information from CMS. 

“Between the preliminary decision and final decision, it appears, from comparing the two, that they added 12 more products to the mix and that’s their rationale for lowering the payment rate,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “We have a lot of questions about that, and we’re looking for transparency. We just need more details.” 

It's not unprecedented for CMS to make modifications following final decisions, stakeholders say. 

“We’re hopeful that if there are errors identified in the products included or in their calculations that they’re willing to work with us,” Johnson said. “They’ve been willing to work with us throughout this process.” 

Stakeholders are also disappointed in CMS’s decision not to create a separate code for seat elevation systems for heavy duty use. 

“We provided them with data that showed if you have an actuator raising a seat for 400 pounds vs. 280 pounds, there’s a difference in cost,” said Dan Fedor, director of reimbursement and education for U.S. Rehab. “That’s disappointing. We had all our ducks in a row, with the data to prove it, and it was discarded.” 

Stakeholders are hoping to meet with CMS prior to April 1. If there are no modifications, access to seat elevation systems may be impacted for some, they say. 

“I think it will mean more difficult decisions on April 1,” Fedor said. “Providers might look to manufacturers for some help, but in this overall environment of increased costs, absorbing (that difference) is significant. Being able to accept assignment on heavy duty chairs may be off the table due to the new allowable of only $2,000.” 

• Grau and Johnson, along with Julie Piriano, are teaming up on a webinar hosted by Quantum Rehab, “Get Ready to Provide Power Seat Elevation to your Medicare Clients Effective 4/1/2024,” on March 20 at 3 p.m. EST. Go here to register. 

• Fedor will join Grau, along with Jim Stephenson of Permobil and Noel Neil of ACU-Serve, for a webinar, “A Deep Dive into Seat Elevation,” on April 3 at 1 p.m. CDT. Go here to register.