Will Medicare Expand Benefits for Power Wheelchair Users?

For people with disabilities who use power wheelchairs, completing certain daily tasks can pose great difficulty. For these individuals, seat elevation systems available for their wheelchair can give them improved, more independent access to everything from brushing their teeth to preparing meals.

Power seat elevation equipment has not traditionally been covered by Medicare, however. A new proposal from the Centers for Medicare & Medicaid Services (CMS) outlines the possibility of expanding coverage to include this feature.

Benefits of Power Seat Elevation for Motorized Wheelchair Users

Seat elevation systems can assist power wheelchair users in carrying out a range of activities on their own, including:

• Using the kitchen

• Personal grooming

• Moving safely between a wheelchair and a bed, bathtub, or toilet

• Working at a desk

In addition, they minimize the wheelchair user’s risk of pain or injury, reducing the risk of fall or fractures and improving circulation.

While power wheelchairs are among the types of items that Medicare generally covers in its definition of durable medical equipment (DME), seat elevation systems — having not been considered “primarily medical” in nature  – have not been covered.

What Is DME?

Durable medical equipment (DME) is medical equipment typically ordered by a health care provider that can aid an individual in their day-to-day home life as they complete routine functions such as bathing and dressing. DME, which may include wheelchairs, crutches, prosthetic limbs, or portable oxygen tanks, is generally covered by Medicare.

Medicare has historically categorized power wheelchairs as DME. However, “if the wheelchair includes other enhancing features, such as … a seat elevating function, Medicare has limited its coverage only to the wheelchair, since the enhancing features do not serve a medical purpose.”

Meeting the Definition of Durable Medical Equipment

In February 2023, the CMS announced results from a months-long analysis of medical literature and initial public comments on the use of power seat elevation systems.

It is proposing that coverage of seat elevation systems be expanded for Medicare recipients who use eligible types of power wheelchairs. For power wheelchair users with certain mobility impairments, “there is sufficient evidence to conclude that power seat elevation equipment on Group 3 power wheelchairs meets the definition of DME.”

“Millions of people with Medicare rely on medically necessary assistive devices to perform daily tasks that directly impact their quality of life,” Chiquita Brooks-LaSure of the CMS said in a news release announcing the proposal. This proposal, she adds, “promotes a first of its kind benefit expansion providing people with Medicare additional tools to improve their lives.”

Comments from the public about this proposal may be submitted by March 17, 2023.