Sponsors (2)
The bill expands Medicare coverage eligibility and billing specificity for ultralight advanced-material wheelchairs—improving access and transparency—but may leave beneficiaries responsible for higher out-of-pocket costs and create administrative burdens for providers and CMS.
Medicare beneficiaries and people with disabilities will be eligible for Medicare payment for ultralight wheelchairs with titanium or carbon-fiber bases purchased or rented on/after Jan 1, 2026, improving access to advanced mobility devices under existing 1834(a)(1)(A) rules.
Hospitals, suppliers, and CMS will have differentiated HCPCS codes by base material (e.g., titanium/carbon fiber vs. others), improving billing clarity and enabling more accurate payment policy, oversight, and data collection by material type.
Medicare beneficiaries and other buyers will receive required notice from suppliers about potential out-of-pocket charges, increasing consumer information and helping people understand likely financial liability before acquiring an advanced-material wheelchair.
Medicare beneficiaries and people with disabilities may face increased out-of-pocket costs because they could be required to pay the difference between Medicare's standard payment and suppliers' charges for titanium or carbon-fiber wheelchairs.
Suppliers may price advanced-material wheelchair bases higher knowing Medicare payment is limited to standard rates, which could raise overall equipment costs for buyers beyond the Medicare-covered amount.
Suppliers, hospitals, and CMS will incur administrative burden to implement new HCPCS codes and provide required notices, which could complicate billing and slow claims processing.
Based on analysis of 2 sections of legislative text.
Creates HCPCS codes separating ultralight wheelchair bases by material and applies Medicare payment rules to titanium/carbon fiber bases while allowing suppliers to bill beneficiaries the difference.
Introduced January 24, 2025 by Marsha Blackburn · Last progress January 24, 2025
Creates separate Medicare HCPCS codes for ultralightweight manual wheelchair bases based on construction material (at least one code for titanium or carbon fiber bases and at least one for non-titanium/carbon bases) and makes those rules effective for items furnished on or after January 1, 2026. Medicare payment for ultralightweight wheelchairs with titanium or carbon fiber bases will follow existing payment frequency and amounts under current law; suppliers may bill beneficiaries the difference between Medicare’s payment and the supplier’s charge, and the Secretary of HHS may require pre-purchase or pre-rental notices to inform individuals of potential out-of-pocket liability.