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.
