Being an advocate for Complex Rehab Technology (CRT) can be as simple as sending an email to your Legislators making them aware of the challenges to appropriate access for people with disabilities and asking them for their support. The more voices delivering our CRT message the better!
Without your help, Congress will not fully understand how CRT maximizes independence and protects the health of the individuals who depend on it. Review the current CRT issues below and use the links provided to contact your Members of Congress today to protect access!
Issue #1 : Medicare Coverage of Power Seat Elevation and Standing Systems
Clinical evidence shows that power seat elevation and power standing systems provide significant medical benefits to people with disabilities and enable them to be much more independent in their homes and communities.
In September 2020, the ITEM Coalition (a coalition of patients, providers, researchers, and other subject matter experts including NCART) submitted a formal Request for Reconsideration of the existing National Coverage Determination (NCD) for Mobility Assistive Equipment to advance a coverage policy for these systems under the Medicare DME benefit. In August 2022, nearly two years after the initial request was submitted, CMS opened the public comment period for power seat elevation systems but did not open the related review of power standing systems.
On May 16, 2023 CMS officially posted a final Benefit Category Determination (BCD) and National Coverage Determination (NCD) for power seat elevation systems (read the full decision memo here). This new coverage applies to both traditional Medicare and Medicare Advantage plans.
In November 2023, CMS issued its preliminary recommendations for coding and pricing of power seat elevation systems. The preliminary decision can be read here.
In summary, the recommendation includes discontinuation of existing HCPCS Level II code E2300, “Wheelchair Accessory, Power Seat Elevation System, Any Type” and establishing two new HCPCS Level II codes reimbursed at a set fee schedule amount:
- EXXXX, “Complex Rehabilitative Power Wheelchair Accessory, Power Seat Elevation System, Any Type”
- EXXXX, “Power Wheelchair Accessory, Power Seat Elevation System, Any Type”
The NCART Coding Workgroup has reconvened following the announcement and is preparing testimony for the CMS hearing, which is scheduled for November 30, 2023. Comments will address questions and concerns related to both coding and pricing. NCART is also encouraging manufacturers, providers, clinicians, and other stakeholders to submit written comments. The public meeting provides an opportunity for stakeholders to offer further comments related to modifications to the HCPCS code set. CMS’ final coding, benefit category, and payment decisions are expected to be published on CMS’ HCPCS website in February 2024 and effective April 1, 2024.
Stakeholders have continued to seek clarity from CMS about when the 30-day comment period for power standing systems can be expected. To date, CMS has not offered any additional detail regarding an anticipated timeframe.
Thanks to ALL advocates for communicating your support for Medicare coverage of this important technology!
Additional Resources:
NCART Comments on Proposed Medicare Coverage of Power Seat Elevation Systems
American Medical Association Letter to CMS on Seat Elevation and Standing Systems
October 2021 Letter from Senators Tammy Duckworth, Bob Casey, and Marsha Blackburn
Issue #2: Ask Your House Representative to Co-Sponsor the Choices for Increased Mobility Act of 2023 (H.R. 5371)
On December 15, 2016, Durable Medical Equipment Medicare Administrative Contractors (DME MACs) released a policy that prohibited upgrades for titanium wheelchairs, which prevents suppliers from billing a Medicare beneficiary for an upgrade to their wheelchair. As a result, the only avenue for a Medicare beneficiary to obtain a titanium or carbon fiber wheelchair is to pay for the entire wheelchair out of pocket and for the supplier to file a non-assigned claim to CMS for partial reimbursement. This has had a significantly negative impact on access to titanium and carbon fiber wheelchairs for individuals with complex medical needs.
Individuals with disabilities should have the choice to pay for a titanium or carbon fiber upgrade to their manual wheelchair. On September 8, 2023, Rep. John Joyce introduced the Choices for Increased Mobility Act of 2023 (H.R. 5371), which would enable beneficiaries to privately pay for upgrades to their equipment by removing the current obstacles in place and offering key benefits to end users at no additional cost to CMS.