Michelle L. Lange, OTR/L, ATP/SMS
A primary challenge in Complex Rehab Technology (CRT) is funding. A client may benefit from CRT equipment but not receive this equipment due to funding barriers. A new code was created, E2398, in response to the code request application from Sunrise Medical in 2019. Over the last 3 years, an industry workgroup, including Seating Dynamics, has been working with CMS to ensure that Backs were coded and reimbursed appropriately so that clients requiring this technology could continue to receive this component.
A New Code
The Centers for Medicare and Medicaid Services (CMS) approved Healthcare Common Procedure Coding System (HCPCS) Level II code E2398 “Wheelchair accessory, dynamic positioning hardware for back” effective January 1, 2020. Prior to this date, Dynamic Backs were typically coded as K0108, “Wheelchair component or accessory, not otherwise specified”. This new code did not yet include a payment determination. This new code does not include any other dynamic products.
Preliminary Payment Determination
A Preliminary Medicare Payment Determination was made in May of 2022, comparing E2398 to E1015 “Shock Absorber for Manual Wheelchair”. When CMS is trying to determine a fee schedule for a code, one of their methods is to do a cross walk which compares that item to another coded item which already has a fee schedule. The payment determination for the code is then based upon the cost of the item which already has a fee schedule. The proposed reimbursement rate was between $152.55 to $183.02, far below the cost to manufacture any Dynamic Back.
Our industry workgroup had numerous discussions with CMS and provided abundant information demonstrating that a Dynamic Back is not comparable to a shock absorber. CMS has considered our request and has decided to move ahead with the proposed payment determination.
Public Hearing 11/30/2023
CMS held a public hearing on 11/30/2023 and invited our workgroup to speak and submit comments. Many clinicians, complex rehab suppliers, clients using dynamic backs and their caregivers submitted comments. Unfortunately, we received the following message from CMS the week before the hearing: “We would like to apologize for any confusion, but the published payment decision is final. We will not be taking any verbal comments during the public meeting related to this topic.” This was quite disappointing.
The new payment schedule will go into effect April 1, 2024.
Our workgroup is concerned that Dynamic Backs will no longer be available to clients needing this technology as complex rehab suppliers will be unable to provide this product at the proposed reimbursement rate which, as mentioned above, is far below the cost to manufacture any Dynamic Back. The manufacturers may stop making this product as a result. And, even if the product was available, a request for a Dynamic Back would most likely be approved by CMS (or other funding agencies following these guidelines), but at this new low rate. The client would not have the option to appeal, as the Dynamic Back was actually approved, but cannot be provided at a loss by the complex rehab supplier.
- We will keep all comments that we have received and use these to help in future efforts. If you submitted a comment to CMS, please also send these comments to MichelleLange1@outlook.com, if you have not already done so. We are committed to fighting this issue. Not only for the sake of Dynamic Backs and those who require this intervention, but for the sake of future items that will be subjected to this new policy where fee schedules are based on “comparable” items.
- In the meantime, this new fee schedule will not go into effect until 4/1/2024. The fee schedule will most likely not impact non-Medicare funding sources right away (or in some cases, not at all), so we encourage anyone recommending or providing a Dynamic Back to continue to do so and to use the K0108 code until further notice.
- Before the 4/1/24 fee schedule goes into effect, Seating Dynamics will change the coding for the Dynamic Rocker Back interface (DRBi) from a single item code to multiple line items of E2398 and E1015 codes in order to accommodate the new fee schedule and continue to provide this necessary component. We will also have items which fall into each of the codes PDAC Code Verified.
We will be updating everyone via emails and at www.seatingdynamics.com as we move toward the April 1st effective date. We are here to help with any questions.
Thank you so much for your support!