Standing up for beneficiaries

Tuesday, January 26, 2010

LEBANON, Tenn. - Industry stakeholders have put in motion a plan to get Medicare to pay for standing wheelchairs that involves getting the agency to change its coverage policy for the equipment, either through its application process or its appeals process.

"We're attacking this on two fronts," said Darren Jernigan, director of government affairs for Permobil, a Lebanon, Tenn.-based manufacturer of standing wheelchairs.

Right now, Medicare has HCPCS codes for power and manual standing systems (E2301 and E2320, respectively) but no reimbursement. The reason, according to the agency: The systems, which add anywhere from $5,000 to $10,000 to a wheelchair's price tag, aren't medically necessary.

Stakeholders beg to differ. They argue that standing wheelchairs have numerous medical benefits, including pressure re-distribution and spasticity management. The wheelchairs also help to improve a user's bowel, bladder, GI and respiratory functions.

"That's not to mention the psycho-social benefits of being able to see eye-to-eye," said Amy Meyer, a pediatric and standing specialist for Permobil, and a member of a RESNA committee also working to get Medicare to pay for standing wheelchairs.

Meyer is leading the application process. She expected to meet with Medicare officials in January to discuss the application that the industry submitted, which includes a sample coverage policy.

"To me, it's a real no-brainer," Meyer said. "They can get restrictive in how they actually write the new coverage policy, but at the very least, I think they need to recognize that this is a feasible feature that should be covered."

Jernigan is leading the appeals process. He's working to find a beneficiary who has been denied a standing wheelchair, so he can appeal the denial on the grounds that Medicare's policy toward the wheelchairs is fundamentally flawed.

"We've succeeded getting individual wheelchairs through, but this would help us make a change more universally," Jernigan said.