CRT Advocates and Friends,

GREAT news for the CRT community! CMS has 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.

The agency has expanded coverage to include Group 2, Group 3, and Group 5 power wheelchairs and has determined that power seat elevation systems are reasonable and necessary for individuals when the following conditions are met:

1. The individual has undergone a specialty evaluation that confirms the individual’s ability to safely operate the seat elevation equipment in the home. This evaluation must be performed by a licensed/certified medical professional such as a physical therapist (PT), occupational therapist (OT), or other practitioner, who has specific training and experience in rehabilitation wheelchair evaluations; and,

2. At least one of the following apply:

  • The individual performs weight-bearing transfers to/from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer and/or their lower extremities during a sit-to-stand transfer. Transfers may be accomplished with or without caregiver assistance and/or the use of assistive equipment (e.g. sliding board, cane, crutch, walker, etc.); or,
  • The individual requires a non-weight-bearing transfer (e.g. a dependent transfer) to/from the power wheelchair while in the home. Transfers may be accomplished with or without a floor or mounted lift; or,
  • The individual performs reaching from the power wheelchair to complete one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home. MRADLs may be accomplished with or without caregiver assistance and/or the use of assistive equipment.

In addition, the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has the discretion to determine reasonable and necessary coverage of power seat elevation equipment for individuals who use Medicare-covered PWCs other than complex rehabilitative power-driven wheelchairs.

NCART is very proud to have contributed significant resources and funding to this initiative. However, such success required years of consistent and collaborative efforts from the entire CRT community, and we are thankful to each and every advocate who took action along the way. Special thanks go to the ITEM Coalition, the Clinician Task Force, and countless other advocacy organizations. The monumental time invested to ensure a positive outcome will have lasting effects for years to come.

Today is a day to celebrate this huge accomplishment! We will continue to prepare additional data over the next few months as discussions regarding coding and reimbursement for this critical technology take place.

We will share additional updates as they become available. Thank you again to all advocates for coming together and taking action to secure coverage!