Seat Elevation Systems: Stakeholders Help CMS Shape Next Steps

Published in Complex Rehab on August 09, 2023

HME NewsThis article was originally featured in HME News.

With Medicare coverage secured for seat elevation systems, stakeholders are working their way through steps 2 and 3 of the process: coding and pricing. 

Manufacturers, led by NCART, submitted code applications to CMS by a July 3 deadline, following about two years of work, including gathering detailed and comprehensive information from each manufacturer. 

“The main goal is to clearly differentiate the standard power seat elevation technology from the complex power seat elevation technology,” said Seth Johnson, vice president of government affairs for Pride Mobility Products. “There is broad agreement on that.” 

CMS in May posted a final benefit category determination and national coverage decision approving seat elevation systems for power wheelchairs. Stakeholders expect the DME MACs to publish draft local coverage determinations, which will include more guidance on coding, later this year, Johnson says. 

NCART is also in the process of collecting data from providers on which payers have covered seat elevation systems in the past and what they’ve paid for the technology. The organization will “scrub” that data and provide it to CMS, per a request from Joel Kaiser, the director of the Division of DMEPOS Policy for the Technology, Coding and Pricing Group at the Center for Medicare, says Wayne Grau, executive director of NCART. 

“We need as many data points as we can get – we don’t want to go in there with 10 or 15; we need thousands of these things – to show them where the majority of the pricing is coming in,” he said. 

It’s pivotal that CMS get the pricing right – “we’ve heard ranges of $1,300 up to $7,200,” Grau says. 

“It’s great to get coverage and coding, but if the pricing comes back and it’s too low, no one is going to get (seat elevation systems),” Grau said, “and we all know how valuable this product is.” 

Because coverage went into effect immediately in May but there is no coding or pricing, providers are living in a world of “interim billing” for seating elevation systems, says Dan Fedor, director of coding and reimbursement for U.S. Rehab. Right now, they must use code E2300 for K0835-K0864, K0890-91 complex wheelchairs, he says. 

“The interim fee schedule will be based on gap filling,” he said. “So, a percentage of the average MSRP on the market will probably be where it lands. We did hear from the MACs that it will be based on each individual claim. So, as you submit a claim with MSRP, there will be an average and that will be the allowable and may vary per state. More to come on that.”


TAGS

  1. billing & reimbursement
  2. cms
  3. complex rehab
  4. reimbursement

From Our Experts

Connections, Community, and Innovation: The Heartland Conference's Networking Experience thumbnail Connections, Community, and Innovation: The Heartland Conference's Networking Experience The VGM Heartland Conference stands out as a premier event, celebrated for its exceptional networking opportunities and memorable social events. U.S. Rehab Puts CRT at U.S. Rehab Puts CRT at "Forefront" at Heartland U.S. Rehab has announced that RESNA will have an increased presence at the Heartland Conference this year, giving CRT professionals more opportunities to access education and networking. DME: A Growing Industry Shaped by Changing Healthcare Landscape thumbnail DME: A Growing Industry Shaped by Changing Healthcare Landscape There is a tremendous reason for optimism in the durable medical equipment (DME) provider community today. It's a market that's poised to experience significant growth in the coming decade, driven by a myriad of compounding factors. Exploring Heartland Conference 2024: What's on the Agenda? thumbnail Exploring Heartland Conference 2024: What's on the Agenda? At Heartland Conference 2024, taking place June 10-12 in Waterloo, IA, prepare for unparalleled educational sessions featuring complex rehab technology (CRT)! 2024 Audit and Compliance Forecast thumbnail 2024 Audit and Compliance Forecast President of The van Halem Group, Wayne van Halem, provides his insight on what suppliers should expect to see from an audit and compliance perspective in 2024. Humanizing the Future: Balancing AI Innovation and Personal Touch in HME Marketing thumbnail Humanizing the Future: Balancing AI Innovation and Personal Touch in HME Marketing The growth of the HME industry, fueled by the increasing needs of our aging population and the surge in chronic diseases, is creating new horizons. CMS Final HCPCS Coding Decision for Seat Elevation thumbnail CMS Final HCPCS Coding Decision for Seat Elevation The Centers for Medicare & Medicaid Services (CMS) has recently released the final rule regarding seat elevation. Unfortunately, it was not the outcome we had hoped for, or expected. Registration Opens for Heartland 2024 thumbnail Registration Opens for Heartland 2024 Registration for VGM's annual Heartland Conference is now open. This popular event will be held June 10-12, 2024, in Waterloo, IA.