Being an advocate for Complex Rehab Technology (CRT) can be as simple as sending an email to your Legislators making them aware of the challenges to appropriate access for people with disabilities and asking them for their support. The more voices delivering our CRT message the better!
Without your help, Congress will not fully understand how CRT maximizes independence and protects the health of the individuals who depend on it. Review the current CRT issues below and use the links provided to contact your Members of Congress today to protect access!
Medicare Coverage of Power Seat Elevation and Standing Systems
Clinical evidence shows that power seat elevation and power standing systems provide significant medical benefits to people with disabilities and enable them to be much more independent in their homes and communities.
In September 2020, the ITEM Coalition (a coalition of patients, providers, researchers, and other subject matter experts including NCART) submitted a formal Request for Reconsideration of the existing National Coverage Determination (NCD) for Mobility Assistive Equipment to advance a coverage policy for these systems under the Medicare DME benefit. In August 2022, nearly two years after the initial request was submitted, CMS opened the public comment period for power seat elevation systems but did not open the related review of power standing systems.
On May 16, 2023 CMS officially posted a final Benefit Category Determination (BCD) and National Coverage Determination (NCD) for power seat elevation systems (read the full decision memo here). This new coverage applies to both traditional Medicare and Medicare Advantage plans.
Now, both CMS and CRT stakeholders are moving forward in the process to determine what coding will be used to bill these systems and how they will be reimbursed. To prepare for this, NCART established a workgroup that has been working diligently for over a year to prepare coding applications that were submitted to CMS in July 2023. NCART has also met with CMS and, at the agency’s request, will be providing CMS with pricing information to support appropriate reimbursement for these systems.
Both the coding and national fee schedule amounts will be addressed as part of an upcoming HCPCS public meeting in fall 2023 and final implementation is anticipated in 2024. In the interim, the DME MACs have the discretion to determine reasonable and necessary coverage as they work to develop local coverage determinations that are in line with the national coverage determination. NCART will provide additional guidance and updates as information becomes available.
Stakeholders have continued to seek clarity from CMS about when the 30-day comment period for power standing systems can be expected. To date, CMS has not offered any additional detail regarding an anticipated timeframe.
Thanks to ALL advocates for communicating your support for Medicare coverage of this important technology!
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