A Major Win for Power Wheelchair Users: Power Seat Elevation Coverage by Medicare
Last week, some exciting news was delivered for power wheelchair users. The Centers for Medicare & Medicaid Services (CMS) announced their decision to expand the mobility device benefit, establishing power seat elevation for power wheelchairs as eligible for coverage by the Medicare program. This is considered a major win in increasing independence for Medicare beneficiaries.
Seat elevation for power wheelchairs will now be covered by Medicare for beneficiaries who need it to perform transfers to/from their wheelchairs or use their wheelchairs for reaching during mobility-related activities of daily living – for example, dressing, grooming, toileting, feeding and bathing.
The coverage amount is unknown currently but should be set later this year as part of CMS’s standard rate-setting process. CMS 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:
- 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,
- 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.
Private insurances often follow Medicare’s lead on decisions regarding coverage, so it’s expected that many plans will add power seat elevation as a covered item relatively soon. Users and clinicians interested in the iBOT® should contact Mobius Mobility for more information: firstname.lastname@example.org and (833) 3GO-IBOT (833-346-4268).