CMS Extends Rate Protections for Manual CRT Accessories

After the industry pushed to back a Congressional sign-on letter to CMS, the agency will delay applying competitive bidding-derived rates to the accessories for another 90 days.

• By David Kopf
• Jun 23, 2021

CMS will extend its suspension of applying competitive bidding program rates to CRT manual wheelchair accessories for another 90 days.

The agency’s announcement comes after CRT stakeholders pushed last week to add lawmakers’ signatures to a House sign-on letter from Rep. John Larson (D-Conn.) that urged the agency to protect the accessories. Originally slated to expire June 30, CMS’s current policy of exempting the accessories will stay in place through October 1.

CMS’s policy includes wheelchair accessories (including seating systems) and seat and back cushions for manual complex rebab wheelchairs (HCPCS codes E1161, E1231, E1232, E1233, E1234 and K0005) and certain manual wheelchairs currently described by HCPCS codes E1235, E1236, E1237, E1238 and K0008, as specified in section 106 of the Further Consolidated Appropriations Act, 2020. CMS added that suppliers should continue using the KU modifier on claims for accessories with the aforementioned wheelchair base codes.

“CMS is continuing these payment rates based on several factors,” the agency noted. “Beneficiaries with disabilities such as amyotrophic lateral sclerosis, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury, and traumatic brain injury often rely on complex rehabilitative wheelchairs and accessories to maximize their function and independence. It is important to avoid any potential operational difficulties for suppliers, our partners in the Medicaid program, or private payers that have elected to rely on the DMEPOS fee schedule that could result from frequent updates to the Medicare fee schedules.

CMS added it is reviewing public comments submitted to the agency on related rulemakings, including engaging in future rulemaking, and will update interested stakeholders and suppliers when more information is available.

“While this is not a permanent fix, it shows that the concerns of the CRT community are being heard and listened to. Discussions with CMS will continue and we will provide further updates as they become available,” said Don Clayback, executive director of the National Coalition of Assistive & Rehab Technology (NCART). “We want to thank Rep. Larson and his colleagues in Congress for their leadership and thank CMS for their actions that protect access to CRT manual wheelchairs.

“And special thanks to all the consumer, clinician, and industry individuals and national organizations for coming together to urge their members of Congress and other policymakers to take needed action,” he added. “A great sign that collective advocacy works!”

"Today's action gives the new leadership at CMS a chance to properly align reimbursement policy for both power and manual CRT wheelchair accessories," said Tom Ryan, president and CEO of the American Association for Homecare, which helped advocate in the letter campaign. "I'm grateful for the mobility stakeholders who have continued to raise the visibility of this issue and for Congressman Larson and our other steadfast advocates for access to CRT on Capitol Hill. Now it's time for CMS to finish the job and apply a permanent exemption for CRT."