CMS Final HCPCS Coding Decision for Seat Elevation

Published in Services on March 04, 2024

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.

However, our commitment remains unchanged. We will continue working with industry advocates to communicate our concerns and address issues with CMS. Our collective efforts will play a crucial role in advocating for positive change in the future.

The key points of the ruling are as follows:

Discontinue existing HCPCS Level II code E2300, “Wheelchair accessory, power seat elevation system, any type” Effective March 31, 2024
Establish E2298, “Complex rehabilitative power wheelchair accessory, power seat elevation system, any type” Effective April 1, 2024
The NEW Code E2298 is in the capped rental category and can only be used on K0835- K0864 covered bases
Purchase option for code E2298 used on K0835-K0864 with billing modifiers as NUBPKX
National Allowable for E2298 Purchase = $2,000.34
National Allowable for E2298 Rental = $200 for months 1-3 and $150 for months 4-13 for a total of $2,100 for 13 months of continuous use
K0830 and K0831 will continue to be used for noncomplex rehabilitative power wheelchairs with seat elevation equipment and MUST be officially coded by the PDAC as these codes to be billed to Medicare https://www4.palmettogba.com/pdac_dmecs/initProductClassificationResults.do
Currently our vendor partner Merits has several chairs officially coded as K0830 and K0831
Allowable for K0830 and K0831 will continue to be based on local fee schedule amounts calculated by the MACs which based on submitted claims is approx. $4200 AFTER 13 months of rental
K0108 (“Wheelchair component or accessory, not otherwise specified”) can be used for claims for power seat elevation equipment added onto a non-complex rehabilitative power wheelchair owned by the beneficiary (AKA retrofitting)
Include misc code requirements in extra narrative field – MSRP, part number, description of item
Billing K0108 for retro fitting is NUKX and allowable based on a percentage of MSRP (approx. 65%)
K0108 CAN also be used on group 2 NON complex Heavy Duty bases (K0824-K0829)
Example - K0825 with accessory seat elevation bill code K0108 for seat elevation

Read the full summary

PDAC Product Classification List

Full Final Determination from CMS

There are some concerns that will be voiced to CMS moving forward.

Adequate allowable for E2298 as the $2000.34 allowable was NOT calculated accurately based on current marketing information as CMS noted
Heavy Duty code for seat elevation used on complex rehab bases as the inadequate national allowable will restrict access to seat elevation for beneficiaries requiring Heavy Duty complex rehab bases

Be sure to check out our webinar, "A DEEP Dive into Seat Elevation," on April 3 at 1 p.m. CT for more information on the latest in seat elevation. If you have any questions, please contact Dan Fedor at dan.fedor@vgm.com or 570-499-8459.

Updated March 18, 2024