CurrentAlaska MedicaidPolicy N/A

Power wheelchair seat elevation accessory — coverage criteria (adopts NCD 280.16)

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Defines Alaska Medicaid coverage and supplier requirements for power seat elevation accessories for Group 3 power wheelchairs, including clinical eligibility and prior authorization expectations for members and suppliers.

Policy Summary

PayerAlaska Medicaid

PolicyPower wheelchair seat elevation accessory — coverage criteria (adopts NCD 280.16)

Policy CodePolicy N/A

Change TypeHCPCS code update

Effective DateApril 1, 2024

Next Review Date

Key ActionObtain service authorization approval and use HCPCS code E2298 when requesting coverage prior to dispensing the accessory.

SourceLink

POLICY UPDATE CHANGES

Effective April 1, 2024, suppliers must request coverage for the seat elevate accessory using HCPCS code E2298, PWR SEAT ELEV SYS FOR CRT.

Group 3power wheelchairs eligible

E2298required HCPCS code effective 4/1/2024

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CurrentAlaska MedicaidPolicy N/A

Power wheelchair seat elevation accessory — coverage criteria (adopts NCD 280.16)

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Know when Alaska Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerAlaska Medicaid

PolicyPower wheelchair seat elevation accessory — coverage criteria (adopts NCD 280.16)

Policy CodePolicy N/A

Change TypeHCPCS code update

Effective DateApril 1, 2024

Next Review Date

Key ActionObtain service authorization approval and use HCPCS code E2298 when requesting coverage prior to dispensing the accessory.

SourceLink

POLICY UPDATE CHANGES

Effective April 1, 2024, suppliers must request coverage for the seat elevate accessory using HCPCS code E2298, PWR SEAT ELEV SYS FOR CRT.

Group 3power wheelchairs eligible

E2298required HCPCS code effective 4/1/2024

Coverage Criteria for Power Seat Elevation

Coverage criteria (adopts NCD 280.16)

Covered when ALL of the following are met:

Group and evaluation: Member uses a Group 3 power wheelchair AND has undergone a specialty evaluation by a practitioner with training and experience in rehabilitation wheelchair evaluations (e.g., PT or OT) assessing ability to safely use seat elevation at home.

Evaluation must document safety in the home setting.

Functional criteria (at least one): One or more of the following: (1) member performs weight-bearing transfers to/from the power wheelchair in the home (using upper or lower extremities), with or without assistance or assistive devices; OR (2) member requires a non-weight-bearing (dependent) transfer to/from the power wheelchair in the home, with or without a lift; OR (3) member performs reaching from the power wheelchair to complete one or more mobility-related activities of daily living (MRADLs) (toileting, feeding, dressing, grooming, bathing) in customary home locations, with or without assistance or assistive equipment.at least 1 item

Transfers and MRADLs may involve caregiver assistance or assistive devices.

Coverage for power seat elevation accessories is limited to individuals using Group 3 power wheelchairs; this policy adopts the CMS coverage approach and addresses only Group 3 equipment and users.

This policy adopts National Coverage Determination 280.16 and does not specify any additional not-medically‑necessary (NMN) statements beyond the adopted NCD language.

Medical Necessity Requirements

DME medical necessity criteria

Evaluator requirement: Specialty evaluation by a practitioner experienced in rehabilitation wheelchair evaluations (e.g., PT or OT) that assesses safety of seat elevation in the home.

Supplier must be able to document practitioner qualifications if requested.

Functional need: Member meets at least one: weight-bearing transfers in home; non-weight-bearing dependent transfers in home; or reaching from wheelchair to perform MRADLs in customary home locations.1 of 3

Transfers/MRADLs may involve assistance or equipment.

HCPCS / Coding

Covered HCPCS Code (effective 4/1/2024)HCPCSCovered

E2298

PWR SEAT ELEV SYS FOR CRT

Previously referenced HCPCS codeHCPCS

E2300

PWR SEAT ELEVATION SYS

Provider Authorization & Documentation Actions

Prior Authorization

Authorization required; new HCPCS code effective 4/1/2024

Service authorization approval must be obtained prior to dispensing the seat elevation accessory. Coverage requests for the accessory must use HCPCS code E2298 beginning April 1, 2024.

Obtain service authorization as identified on the DMEPOS fee schedule before dispensing.
Use HCPCS code E2298 (PWR SEAT ELEV SYS FOR CRT) for coverage requests effective 4/1/2024.

Note

Follow supplier responsibilities and contact policy leads for questions

Suppliers must follow the supplier responsibilities in this policy, including ensuring specialty evaluations and obtaining prior authorization before dispensing the accessory.

Follow all supplier responsibilities in the policy's SUPPLIER RESPONSIBILITIES section.
Direct questions to the listed Alaska Medicaid contacts if clarification is needed.

Rental and Purchase Rules

Item	Rental vs Purchase	Provider requirements / operational details
Power seat elevation accessory
Purchase — Alaska Medicaid treats power seat elevation accessories as purchased DME (not rental).
Service authorization approval must be obtained prior to dispensing the accessory; effective April 1, 2024 coverage requests must use HCPCS code E2298 (PWR SEAT ELEV SYS FOR CRT). Suppliers must ensure a specialty evaluation by a practitioner with training and experience in rehabilitation wheelchair evaluations and produce documentation if requested.

Replacement Rules for Power Seat Elevation Equipment

Power seat elevation equipment — replacement rules

Replacement intervalNo specific replacement interval specified in this policy for power seat elevation equipment; suppliers should follow standard DME replacement practice and document medical necessity for replacements.

Purchase vs rentalTreated as purchase (power seat elevation accessory is provided as DME); suppliers must obtain service authorization prior to dispensing.

HCPCS code for replacement/requestsEffective April 1, 2024 coverage requests and replacements should use HCPCS code E2298 (PWR SEAT ELEV SYS FOR CRT).

Documentation for replacementsSupplier must maintain and produce the specialty evaluation and practitioner qualification documentation upon request to support replacement or continued need.

Scope limitationReplacement coverage applies only for seat elevation accessories on Group 3 power wheelchairs as defined in this policy; other groups not covered here.

Documentation Requirements

Documentation Required

Maintain and produce specialty evaluation and practitioner qualification documentation

Maintain records that demonstrate the specialty evaluator’s training and experience in rehabilitation wheelchair evaluations and the specialty evaluation assessing safe home use, and produce them when requested by the payer.

Document the evaluator’s credentials, training, and experience in rehabilitation wheelchair evaluations.
Retain the specialty evaluation report showing assessment of safe use in the home.

Background

CMS determined that power seat elevation equipment for Group 3 power wheelchairs falls within the Durable Medical Equipment (DME) benefit category; Alaska Medicaid has adopted NCD 280.16, which permits coverage requests for seat elevation when the member has undergone a specialty evaluation and meets the functional criteria described in the NCD.

Definitions

DME definition — Social Security Act and CFR

Legal definition (Act)Durable medical equipment (DME) is defined by Section 1861(n) of the Social Security Act.

Regulatory definition (CFR)Additional details on DME are provided in 42 CFR 414.202.

Alaska Medicaid interpretationAlaska Medicaid follows CMS determination that power seat elevation equipment on Group 3 power wheelchairs falls within the DME benefit category.

Implication for coverageItems meeting the statutory/regulatory DME definitions may be covered when medically necessary and when other policy criteria are met.

Not Covered

Seat elevation accessories for power wheelchairs other than Group 3 are not addressed as covered in this policy.