07/10/2023

NCART Update on Power Seat Elevation Systems Coding Application

The following article was published by NCART, 6/30/2023:

As we shared last month, CMS announced its positive coverage determination for seat elevation systems on May 16. This new coverage applies to both traditional Medicare and Medicare Advantage Plans for Group 2, 3, and 5 power wheelchairs. To review the announcement and learn more about the details of coverage, visit www.protectmymobility.org.

Now, both CMS and CRT stakeholders are moving forward in the process to determine what coding will be used to bill these systems and how they will be reimbursed. To prepare for this, NCART established a workgroup that has been working diligently for over a year to prepare coding applications that will be submitted to CMS by the July 3 deadline. NCART also met with CMS in June and, at the agency’s request, will be providing CMS with pricing information to support appropriate reimbursement for these systems.

Both the coding and national fee schedule amounts will be addressed as part of an upcoming HCPCS public meeting, likely later this fall and final implementation would be early in 2024. In the interim, the DME MACs have the discretion to determine reasonable and necessary coverage as they work to develop local coverage determinations that are in line with the national coverage determination.

NCART will be providing additional guidance and updates as the information becomes available.