Medicare Covers Seat Elevation for Medicare Beneficiaries Using Power Wheelchairs
May 18, 2023
Today the Centers for Medicare Services (CMS)
announced their decision to cover seat elevation in all power wheelchairs for the purposes of performing all transfers or to improve reach in performing mobility related activities of daily living (MRADLs) in their homes. This decision is effective immediately and will allow Medicare beneficiaries living with MS to have these essential devices covered and will allow more individuals to maintain their independence. This is a welcome and major expansion of coverage from the preliminary coverage decision announced in February and CMS attributed these coverage improvements to the 2,130 public comments received by wheelchair users, advocates, clinicians, and researchers.
In September 2022, the National Multiple Sclerosis Society submitted comments urging CMS to consider evidence in support of the medical necessity of these devices in helping individuals living with MS to continue to maintain their independence and dignity. In these comments, the Society shared recent scientific evidence showing that these devices minimize the risk of developing repetitive stress injuries from wheelchair use and that the devices provide psychological benefits as they allow an individual to participate in eye-to-eye conversation. In March 2023, the Society submitted additional comments thanking CMS for their preliminary decision to cover seat elevation in Group 3 power wheelchairs and urged CMS to consider extending these benefits to Group 2 power wheelchair users.
For the first time, CMS determined that seat elevation in power wheelchairs is considered “primarily medical in nature” and is, therefore, covered durable medical equipment (DME) under both traditional Medicare and Medicare Advantage. Seat elevation will be covered in Groups 2, 3 and 5 Complex Rehabilitative Technology (CRT) power wheelchairs when a patient needs seat elevation to transfer from one surface to another, with or without caregiver assistance, to utilize assistive devices/lift equipment, to improve one’s reach, or to perform other mobility-related tasks. Seat elevation will also be covered in non-CRT power wheelchairs when determined by Medicare contractors to be reasonable and necessary; however, individuals must undergo a specialty evaluation performed by a licensed/certified medical professional who has specific training and experience in rehabilitative wheelchair evaluations. Please reach out to your healthcare provider if you are on Medicare and are perusing coverage for a power chair with seat elevation.