CMS Proposes Denying Coverage for Power Wheelchairs With Seat Elevation

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) released a proposed local coverage determination (LCD) for a not reasonable and necessary determination for Group 2 power wheelchairs (PWCs) with seat elevation systems (K0830 and K0831) based on the best available evidence.

Durable Medical Equipment Medicare Administrative Contractors (DME MACs) are assigned by CMS to develop LCDs for durable medical equipment, prostheses, orthotics and supplies (DMEPOS). 

The DME MACs are proposing two LCDs as described below:

• Power Mobility Devices With Seat Elevation (DL33789): Proposing a not reasonable and necessary determination for Group 2 power wheelchairs with seat elevation systems (K0830 and K0831), based on the best available evidence. Per the national coverage determination (NCD) 280.16 Seat elevation equipment (power operated) on power wheelchairs, coverage of Group 2 PWCs with seat elevators would be determined at the MAC’s discretion.
• Wheelchair Options/Accessories (DL33792): Proposing a not reasonable and necessary determination for the use of seat elevation added onto non-complex power wheelchairs, based on the best available evidence. The proposed LCD proposes to include, in the coverage criteria for power tilt and/or recline seating systems, examples of clinical conditions that limit the beneficiary’s ability to perform a functional weight shift. Per NCD 280.16 Seat elevation equipment (power operated) on PWCs, coverage of power seat elevation equipment for individuals who use Medicare-covered power wheelchairs other than complex rehabilitative power-driven wheelchairs would be determined at the MAC’s discretion.

CMS will accept comments on the proposed LCD for a 45-day period through April 4. A “Submit a Public Comment” button can be found at the top of this page. 

An open meeting will be held on Wednesday, March 25 at 10 a.m. ET. Registration can be found here. Registration to provide oral comments closes at 5 p.m. ET on Wednesday, March 11. General registration will close after 11:59 p.m. ET on Tuesday, March 24. 

Contact for Comments on proposed LCD:
DME MAC Medical Directors
ATTN: Proposed LCD Comments
4510 13th Ave. S, STE1
Fargo, ND 58103-6646
[email protected]