National Coverage Analysis (NCA) Tracking Sheet

Seat Elevation Systems as an Accessory to Power Wheelchairs (Group 3)

CAG-00461N

Issue

The Centers for Medicare and Medicaid Services (CMS) has accepted a formal request to consider both the benefit category and coverage for seat elevation systems and standing systems associated with Group 3 power wheelchairs. Currently neither system is covered on a power wheelchair because it has not been determined that their use is primarily medical in nature.

Because the consideration of the above requests requires the evaluation of two distinct groupings of evidence, CMS will consider the provision of both benefit category and coverage of seat elevation systems in association with Group 3 power wheelchairs through the National Coverage Determination process, at this time. The benefit category and coverage of standing systems will be considered at a later date.

A power seat elevation system is a component of a wheelchair that raises and lowers users while they remain in the seated position, providing varying amounts of vertical height. Section 1861(n) of the Social Security Act specifically identifies wheelchairs as durable medical equipment (DME). Medicare requires (among other criteria) that DME primarily and customarily be used to serve a medical purpose and to make a meaningful contribution to the treatment of the individual’s illness or injury or to the improvement of his or her malformed body member, when used in the home.

The purpose of this National Coverage Analysis is to determine if the use of power seat elevation systems in association with Group 3 power wheelchairs for the purpose of performing non-level transfers, is a medical function that would, in conjunction with other factors and considerations, allow a benefit category and coverage determination for these systems.
*Benefit Category is to be determined*

CMS is soliciting public comment relevant to the request. We are specifically interested in scientific literature that provides evidence of the medical necessity of seat elevation systems by studying the measurable characteristics related to the performance of transfers.

Benefit Category

No Benefit Category

Requestor Information

Requestor NameRequestor Letter
ITEM (Independence Through Enhancement of Medicare and Medicaid) Coalition View Letter

Important Dates

Formal Request Accepted and Review Initiated
08/15/2022
Expected NCA Completion Date
05/16/2023
Public Comment Period
08/15/2022 - 09/14/2022
Proposed Decision Memo Due Date
02/15/2023
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
Heather Hostetler, J.D.
heather.hostetler@cms.hhs.gov
410-786-4515
Lead Medical Officers
Susan Miller, M.D.

Actions Taken

August 15, 2022

CMS initiates this national coverage analysis for Seat Elevation Systems as an accessory to Power Wheelchairs (Group 3). The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the topic under review.

Instructions on submitting comments can be found at: https://www.cms.gov/Medicare/Coverage/InfoExchange/publiccomments.html.

To submit a comment, please use the blue "Comment" button at the top of the page. Enter comments directly into the “Submit A Public Comment” webpage.