The Problem:

CMS approved HCPCS Level II code E2398 “Wheelchair accessory, dynamic positioning hardware for back” effective January 1, 2020. A Preliminary Medicare Payment Determination was made in May of 2022, comparing E2398 to E1015 Shock Absorber for Manual Wheelchair. The proposed reimbursement rate is between $152.55 to $183.02. An industry workgroup has been in discussions with CMS and provided abundant information demonstrating that this is not a comparable item. CMS has considered our request and has decided to move ahead with the proposed payment determination.

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.

If this payment determination is finalized after the upcoming CMS Public Hearing on 11/30/23, 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 is far below the cost to manufacture any Dynamic Back. The manufacturers will most likely 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.

What we are asking you to do:

CMS is holding a virtual HCPCS Public Meeting on November 30, 2023. We have 4 people who are speaking on this subject on that day. CMS is open to written comments regarding items on their agenda. We are asking your organization to submit written comments before 11/29/23. It is important that CMS hears from your organization BEFORE they make their final decision.

1. In your email, discuss your concerns for Dynamic Backs for wheelchairs only. Do not mention any other Dynamic product, only Dynamic Backs.
2. Identify yourself as: a user, a parent/caregiver, clinician, supplier or whatever your involvement in the field may be.
3. It is more important that viable comments from experienced persons are received. We do not want a large quantity of cut and past emails from people with no knowledge or experience.
4. Send your written comments to HCPCS@cms.hhs.gov before 5pm ET on 11/30/23. We recommend you do so by 11/29/23 just to be on the safe side. Please include at the beginning of your comments: “Wheelchair accessory, dynamic positioning hardware for back, Agenda item #2, Application #19.120.” Feel free to share this information with others, particularly people who are using Dynamic Backs.
5. If you are a parent/caregiver of someone using a Dynamic Back:
   • Please include your experiences before receiving the Dynamic Back including equipment damage/breakage, injury from pushing against the wheelchair and seating system, injury from contact with broken components, being unable to use the wheelchair while waiting for repairs secondary to damage, and any consequences to not being able to use the wheelchair such as having to remain in bed.
   • Please also include any difference you have noted after the Dynamic Back was received, such as decreased or no further equipment damage/breakage, decreased active extension or pushing against the wheelchair and seating system, decreased agitation, increased alertness, increased sitting tolerance, etc.
   • Finally, include what the implications would be for the client if they could no longer get a Dynamic Back in the future.
   • Please urge CMS to not assign a fee schedule that would prevent the client from obtaining a Dynamic Back in the future.
6. If you are a Complex Rehab Supplier:
   • Please include your need to supply Dynamic Backs, when appropriate, to limit equipment/damage, to reduce needed repairs, to help clients remain in alignment with the seating surfaces, and to increase sitting tolerance.
   • Please include your concern that your company will be unable to provide any product, including Dynamic Backs, at a loss.
   • Please urge CMS to either not assign a fee schedule to E2398 or to determine a more appropriate fee schedule as a Dynamic Back is not comparable to a shock absorber, and the proposed fee schedule would prevent clients who require this technology from acquiring it as complex rehab suppliers will be unable to provide any Dynamic Back under the proposed fee schedule.
7. If you are a Clinician:

• • Please include the problems noted when clients with increased muscle tone, whole body extensor patterns, movement disorders, and rocking movements when placed in static seating systems and wheelchair frames. This may include:
    • The client is moving seating components out of alignment
    • The client has broken seating, hardware, or the wheelchair frame
    • The client actively seeks out movement, such as rocking
    • The client is more alert and/or less agitated with movement
    • The client has sustained injuries from colliding with portions of the seating system or wheelchair frame with sudden force
    • The client has sustained injuries from pushing against the seating system with sustained force
    • The client is ‘standing up’ in the seating system
    • The client is extending within the seating system and moving out of alignment with the support surfaces
  • Please include the clinical benefits you have observed when working with clients who use Dynamic Backs, including decreased or eliminated client injury, equipment damage, loss of position in relation to the seating surfaces, agitation, active extension, energy consumption, and fatigue. Also including increased sitting tolerance, vestibular input, active range of motion, alertness, function, and strength and postural control.
  • Please urge CMS to either not assign a fee schedule to E2398 or to determine a more appropriate fee schedule as a Dynamic Back is not comparable to a shock absorber, and the proposed fee schedule would prevent clients who require this technology from acquiring it as complex rehab suppliers will be unable to provide any Dynamic Back under the proposed fee schedule.

Thank you for advocating for clients who benefit from Dynamic Seating. If you have any questions, please contact Wayne Grau at NCART at wgrau@ncart.us.

Michelle L. Lange, OTR/L, ATP/SMS, Access to Independence
Greg Peek, President, Seating Dynamics
Frederick J. Diamond, Miller’s Adaptive Technologies
Brent Hatch, Sunrise Medical
Wayne Grau, NCART