Article Detail - JD DME

CMS issued a national coverage decision that establishes power seat elevation for power wheelchairs as durable medical equipment, eligible for coverage by the Medicare program.

Coverage, Coding, and Payment for Power Seat Elevation Equipment on Power Wheelchairs

CMS published a final Benefit Category Determination and National Coverage Determination (BCD NCD) for Seat Elevation Equipment (Power Operated) on Power Wheelchairs on May 16, 2023. This determination finds that power seat elevation equipment on Medicare-covered power wheelchairs falls within the benefit category for DME. It also provides for national coverage of power seat elevation equipment on Medicare-covered complex rehabilitative power-driven wheelchairs, as defined in 42 CFR 414.202, under criteria specified in the NCD. In addition, the DME MAC has discretion to determine reasonable and necessary coverage of power seat elevation equipment for individuals who use Medicare-covered power wheelchairs other than complex rehabilitative power-driven wheelchairs.

To submit claims to the DME MACs for power seat elevation equipment beginning May 16, 2023, outside of the exceptions noted below, suppliers must use HCPCS code E2300 (wheelchair accessory, power seat elevation system, any type). Additionally, HCPCS codes K0830 (power wheelchair, Group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds and K0831 (power wheelchair,  Group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds) must be used to submit claims for individuals with Medicare using seat elevation on Group 2 power wheelchairs that are not complex rehabilitative power-driven wheelchairs. Claims submitted using HCPCS code E2300 for power seat elevation equipment on wheelchairs other than Group 5 and complex rehabilitative power-driven wheelchairs will be denied.

Effective for claims with dates of service on or after May 16, 2023, interim local fee schedule amounts for power seat elevation equipment will be established by the DME MACs for use in paying any allowed claims for power wheelchairs with power seat elevation. HCPCS coding and national fee schedule amounts for power wheelchairs with power seat elevation will be addressed as part of an upcoming HCPCS public meeting, likely later this fall. Additional details on the timing and agenda of the public meetings that will include power seat elevation coding and payment will be provided in the future on the CMS website.