In The News! Navigating the Changing Landscape of Medicare Funding for Power Seat Elevation Systems

In May 2023, the Centers for Medicare & Medicaid Services (CMS) made a significant announcement that marked a pivotal moment in the realm of healthcare mobility – the inclusion of Medicare funding for power seat elevation systems. However, this announcement proved to be just the starting point, prompting industry stakeholders to delve into the complexities of reimbursement. As we step into 2024, industry leaders are gearing up to advocate for additional codes, with a particular focus on bariatric power wheelchairs.

The battle for these advancements is already underway. In a November move, CMS released details on seat elevation funding, outlining a strategy that involved the elimination of codes K0830 and K0831. These codes, associated with power wheelchairs in Group 2 standard, were deemed insufficient. Notably missing from CMS’s strategy was a dedicated code or payment structure for bariatric power wheelchairs, specifically designed for individuals with heavier body weights.

In response, industry representatives, including Julie Piriano, Bill Ammer, Brad Peterson, and Peter Thomas, took the stage in a coding meeting on Nov 30. Their collective voice resonated as they called for a bariatric seat elevation code, urged CMS to postpone the elimination of K0830 and K0831, and emphasized the need for CMS to recognize and fund seat elevation as an independent system rather than merely a seating add-on.

The surprise inclusion of seat elevation coverage for Group 2 power chairs prompted industry presenters to request a pause in Group 2 funding decisions. This pause was essential to allow the industry time to collect relevant data, ensuring informed decisions moving forward.

Looking ahead, 2024 will see the industry investing time and effort in educating CMS and other funding sources on the practical challenges associated with designing and manufacturing bariatric power chairs. While CMS currently views bariatric wheelchairs as those with higher weight capacities, the reality is more nuanced, especially for those using Complex Rehab Technology (CRT). Bariatric CRT users often have asymmetric weight distribution, necessitating complex seating solutions. Introducing seat elevation into this equation further complicates matters, impacting center of gravity and stability and requiring sophisticated engineering solutions.

As the industry continues to navigate these challenges, stay tuned for updates on the evolving landscape of Medicare funding for power seat elevation systems. The journey towards equitable and comprehensive mobility solutions for all is underway.