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Medicare and Medicare Advantage now covers seat elevation technology

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    Medicare and Medicare Advantage now covers seat elevation technology

    It's about time for this welcome news!

    Medicare Coverage Win for Wheelchair Users

    By Julie Carter
    May 18, 2023

    The Centers for Medicare & Medicaid Services (CMS) announced this week that it will cover seat elevation technology in Medicare-covered power wheelchairs as durable medical equipment (DME). Effective immediately, both Original Medicare and Medicare Advantage will cover seat elevation for those who need it to perform activities of daily living in the home. This landmark decision meaningfully expands Medicare coverage and appropriately prioritizes enrollee independence and quality of life.

    Despite the clear need many power wheelchair users have for technology that helps them safely transfer to and from the wheelchair and to better reach items and surfaces without joint or muscle strain, Medicare generally considered seat elevation in power wheelchairs to be a “mere accessory.” This categorization prevented coverage and downplayed the importance of features that help people maintain well-being, physical health, and community living.

    Last year, CMS announced that it was considering updating this policy. The agency proposed allowing Medicare to cover seat elevation for some power wheelchair users as DME. This began a series of comment opportunities where beneficiaries and advocates, including Medicare Rights, applauded this proposal, explained the need for seat elevation, and urged CMS to cover seat elevation for all power wheelchair users, not just the proposed subset.

    In the final policy, CMS agreed to expand coverage to additional groups, citing the thousands of public comments from wheelchair users, advocates, and other stakeholders. The new coverage will apply when the individual has a specialty evaluation confirming they can use the equipment safely and when they need it for one of three conditions: (1) to perform weight-bearing transfers with or without caregiver assistance and/or the use of assistive equipment; (2) to perform non-weight bearing transfer to or from the power wheelchair in the home; or (3) to complete one or more mobility related activities of daily living such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home.

    ​Other individuals, including those who do not use complex rehabilitative power-driven wheelchairs, may be able to gain coverage on a case-by-case basis. Future reforms could further improve access—CMS has indicated that it is also considering covering power wheelchair standing systems as DME.
    At Medicare Rights, we celebrate this important decision. We encourage CMS to cover standing systems as well, and to address other coverage gaps, including limitations on DME equipment for use outside of the home. Such technologies can help people live safely and independently in their communities.
    Last edited by Seasha; 05-22-2023, 10:07 PM.

    “When you change the way you look at things, the things you look at change.” ― Max Planck

    This is encouraging news, Kimba! Are you thinking of getting one? I wonder how much Mecicare will pay?
    1st sx '89 Dx '99 w/RRMS - SP since 2010
    Administrator Message Boards/Moderator


      That's really good news. It's about time our government takes basic steps to empower handicapped people.

      Thank you for sharing.


        Originally posted by Seasha
        This is encouraging news, Kimba! Are you thinking of getting one? I wonder how much Mecicare will pay?
        Yes, Seasha, I'm due for a new one. (You can get a new chair every 5 years, but I'm overdue this time.) I just had my evaluation at a w/c clinic. There are different categories of powerchairs (Group 1 - 5). Because I need a need more complex powerchair, I'm required to have an assessment from a PT/OT as well as a RESNA certified assistive technology professional, in ADDITION to the written order and justification from a physician. All three people were at my appt (w/c clinic dr is a physiatrist).

        Everything must be documented in order justify it's necessary so insurance will approve and pay for it. The OT will do that part and send it to DME supplier, who will then submit the info to my insurance for prior authorization. After they receive that, will order it.

        Something I didn't know until my second powerchair is that they also take into consideration what you may need within the next five years. I wasn't anticipating that then, and was actually disappointed I wasn't getting the same chair I had. But, was grateful i had the next level powerchair after two bad flares later that year, and three more the following year. This'll be my fourth one.

        I decided to get the elevating system with my last chair, and was really glad I did. Otherwise, I wouldn't have been able to continue doing everything I need to during the day. It's ludicrous it was considered a "convenience" option by insurance, even when it could be totally be justified as medically necessary.

        Because it wasn't covered by my insurance, if any repairs were needed to the seat elevation system, would have foot the entire bill (both parts and labor). I thought all that involved was the seat elevation feature itself, but found out later it's more involved than that.

        I have the tilt and recline feature, and when it started to make some noises when I used it, I thought it needed some oil or something simple to fix it. I had the DME supplier check it out, and was told one of the gears was bad, and the entire tilt and recline feature would have to be replaced. I had no idea the seat elevation system is somehow built-in with that feature, and my insurance wouldn't pay for it! I haven't had it fixed, and it hasn't gotten any worse the past few years, so don't know if really needed to be replaced yet.

        Recently the control panel to operate chair started randomly beeping and then turns off and back on for no reason when it's stopped. It also operates the seat elevation, so another thing I expected would have to pay to get fixed. Hopefully it holds out until I get new my chair.

        I don't how much the elevation feature has increased in price, but expected it to be at least double the price I paid before. I think I paid $2,000 seven years ago. When I was talking to the OT about needing the feature again, the ATP guy from the DME supplier told him Medicare and had just approved it!

        I still have insurance through my husband's employer, so am not using Medicare yet, because his benefits are better. But that being said, most follow Medicare guidelines for approving a lot of things. Supposedly 3rd party health insurances, other Medicare, will consider paying for it on a case by case basis. But was told last time that it usually wasn't approved, and sure enough, mine denied it. The ATP from the DME supplier said it will probably take a few months for other insurances to update their policies, but mine should be by the time I get my new chair (4 or 5 months).

        Medicare covers 80%, and you'd have to check with your Medicare Advantage provider to find out cost they'll cover and which DME suppliers you can use. They are covered if deemed necessary (and can be used) WITHIN the home.

        Are you considering a power chair? I know you purchased a scooter and use it outdoors. But they aren't really practical within the home because of their size and turning radius. Permobil has a good series of blogs explaining each group of powerchairs, a Google search of each one will bring it up.

        I was surprised when my MS Specialist sent me for my first wheelchair years ago. I could get around with my rollator, but my legs would tire out after a short time and would have to sit down and rest for awhile before I could get up and start moving again. I had urge incontinence so that could sometimes pose a problem if I had to get to the bathroom quickly! But I mainly used my first one for longer distances outdoors. I didn't want to rely on it if I didn't have to.

        Marco, The VA sees elevation technology as a significant benefit for veterans, and covers it, so at least that's something they've been doing right!

        I also hope they can get standing wheelchairs approved. At one time they were recommended to me by my PT. They had one at their facility at the time (left briefly by a sales rep for the w/c company), and got to try it out during a few sessions. It was great, but since my health insurance didn't cover them, would've had to find my own funding.

        The ability to access vertical environments is not only reasonable and necessary for performance of ADLs and IADLs, but medically necessary and vital for:

        • Upper extremity function and reach

        • Lower extremity range of motion, edema control, and weight bearing

        • Bone health and reduction of skeletal deformities, joint contractures, and bone deterioration

        • Circulation and mitigation of skin injuries

        • Pulmonary health and reduction of cardiovascular dysfunction and respiratory illnesses

        • Gastrointestinal/urinary health for adequate digestion, bowel, and bladder function

        • Muscle spasticity and contracture management

        • Pain reduction

        • Psychosocial health and empowering end-users in all environments Here you can also read more why both systems are justified.

        This is an older article, but gives an good idea of what's needed to get a scooter or powerchair ~

        Medicare coverage rules (this hasn't been updated yet to include coverage for elevation system) ~;ver=35&am p;

        “When you change the way you look at things, the things you look at change.” ― Max Planck


          I was able to get a standing wheel chair. My insurance after turning it down the first time agreed to pay for it the second time. The problem I had was my insurance was changing the first of the year. This was last Dec 1922. My new insurance would not cover it. I received the chair 12/30/2022. The only problem I have is the base is so big it's hard to get close to some of my cabinets.