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National Coverage Determinations

The Centers for Medicare & Medicaid Services (CMS) makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations (NCDs). The following NCDs have been finalized in the past 12 months.

 

Seat Elevation Equipment

Effective May 16, 2023: CMS issued a Benefit Category Determination and National Coverage Determination (NCD 280.16) for power seat elevation equipment on certain power wheelchairs.

Power seat elevation equipment is reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs when the following conditions are met under NCD 280.16:

  1. 1. The individual has undergone a specialty evaluation that confirms the individual’s ability to safely operate the seat elevation equipment in the home. This evaluation must be performed by a licensed/certified medical professional such as a physical therapist (PT), occupational therapist (OT), or other practitioner, who has specific training and experience in rehabilitation wheelchair evaluations; and

  2. At least one of the following apply:
  • The individual performs weightbearing transfers to/from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer and/or their lower extremities during a sit-to-stand transfer. Transfers may be accomplished with or without caregiver assistance and/or the use of assistive equipment (e.g., sliding board, cane, crutch, walker); or,
  • The individual requires a non-weight bearing transfer (e.g., a dependent transfer) to/from the power wheelchair while in the home. Transfers may be accomplished with or without a floor or mounted lift; or,
  • The individual performs reaching from the power wheelchair to complete one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home. MRADLs may be accomplished with or without caregiver assistance and/or the use of assistive equipment.

 

Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting (CAS)

Effective March 11, 2013: Percutaneous Transluminal Angioplasty of the Carotid Artery Concurrent with Stenting

This procedure involves inserting a balloon catheter into a narrow or occluded blood vessel to recanalize and dilate the vessel by inflating the balloon. The objective of percutaneous transluminal angioplasty (PTA) is to improve the blood flow through the diseased segment of a vessel so that vessel patency is increased, and embolization is decreased. With the development and use of balloon angioplasty for the treatment of atherosclerotic and other vascular stenosis, PTA (with and without the placement of a stent) is a widely used technique for dilating lesions of peripheral, renal, and coronary arteries.

Below is a list of conditions that must be met for coverage, to better understand the conditions required for PTA coverage, please see NCD - Percutaneous Transluminal Angioplasty (PTA) (20.7) (cms.gov)

  1. Treatment of Atherosclerotic Obstructive Lesions
  2. Concurrent with Carotid Stent Placement in Food and Drug Administration (FDA)- Approved Category B Investigational Device Exemption (IDE) Clinical Trials
  3. Concurrent with Carotid Stent Placement in FDA-Approved Post-Approval Studies
  4. Concurrent with Carotid Stent Placement in Patients at High Risk for Carotid Endarterectomy (CEA)