Page 13 - Mobility Management, September/October 2022

CMS & Future Funding for Dynamic Backrests
While dynamic seating can be indicated for a range of people who use wheelchairs, appropriate funding is an issue in flux.
Michelle L. Lange, OTR/L, ABDA, ATP/SMS, Access to Independence Inc., said, “There is a coding issue going on right now” regarding Medicare funding for dynamic backs.
“There is a code for dynamic backs that was introduced almost two years ago,” Lange explained. “CMS 􏰀Centers for Medicare 􏰁 Medicaid Services􏰂 is trying to give it a fee schedule. 􏰃he first fee schedule they proposed was very low because they’re comparing 􏰀a dynamic back􏰂 to basically a suspension component, 􏰄ust this plain hydraulic.
“We have a small work group that has been trying to explain that suspension’s not the same as dynamic seating. Suspension’s important, but it has different goals, different design.”
A complicating factor, Lange added, is CMS’s coding process􏰅 “􏰃hey want to compare 􏰀dynamic seating􏰂 to something else 􏰀that’s already being funded􏰂. 􏰃he problem is there isn’t anything else to compare it to.
“Dynamic seating’s been around for a while, but the only code that’s at all similar is a code for the old 􏰆ids Rock 􏰀seating􏰂. But CMS never assigned a fee schedule to it because they said it was
a pediatric product.”
If CMS elected not to provide a fee schedule for dynamic
backs, Lange said, “You could use a miscellaneous code, and
that generally works better. But unfortunately, this whole process could put dynamic backs in 􏰄eopardy. It’s concerning at the level of 􏰀funding for􏰂 dynamic backs, that it could literally lead to a lot of people who need it perhaps not getting it. It’s concerning at a bigger level that CMS is saying, 􏰇Anything you want to code for, you have to show us what it’s comparable to.’ If it was comparable to something, we wouldn’t need a 􏰀separate􏰂 code.
“If something is very innovative, it’s not going to work,” Lange added. “There’s one code for headrests, and there’s quite a range of head supports from very basic to very complex. And they’ll often say, 􏰇We think this is kind of the midpoint. So that’s what we’re going to pay you.’ Which means some people are really overcharging for a very simple headrest, and some people aren’t getting paid enough for a very complex headrest that a particular client needs.
“It’s a work in progress. Our goal right now with our little work group is to try to get them to not assign 􏰀dynamic backs􏰂 the same fee schedule as a little hydraulic spring.” m
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