The University of Pittsburgh’s Center for Assistive Technology (UPMC-CAT) serves a large population of wheelchair users. The clinical team identified an unmet need for power seat elevators, which are wheelchair accessories that raise and lower a wheelchair seat to facilitate the users’ functional reach and transfers. In 2003, the Centers for Medicare and Medicaid Services (CMS) identified potential overutilization and billing for seat elevators. At the time, there was no assigned billing code or reimbursement amount, so providers were using a miscellaneous billing code. To address concerns about billing waste, fraud, and abuse, CMS assigned a power seat elevator code with $0 allowable reimbursement, citing a lack of evidence for medical benefit. This decision made power seat elevators non-covered and inaccessible to wheelchair users. 

The lack of Medicare coverage was a detriment to many people served by UPMC-CAT. Many users needing a seat elevator were dependent on caregivers for transfers and at risk of unsafe transfers. Risks associated with functional reach were also substantial; for example, attempting to cook at a stovetop from a low seated position could lead to burns and other medical complications. However, at the time, there was limited published evidence demonstrating the clinical impact of power seat elevators.

The seat elevator issue, along with broader coverage limitations for wheelchairs, prompted investigators at UPMC-CAT to create the Functional Mobility Assessment Uniform Data Set (FMA/UDS). Implemented in 2018 through a corporate partnership with the post-acute member service organization Van G. Miller Group, the registry aims to drive evidence-based practice for mobility device prescription, validate best practices, and influence equitable reimbursement policies. Data collection is ongoing and includes demographic and clinical information from people with disabilities seeking a new wheelchair evaluation across 30+ clinics nationwide, creating a scalable infrastructure for system-wide outcomes tracking in seating and mobility services.

Following the creation of the FMA/UDS, our team analyzed the data and found that power seat elevator users reported higher satisfaction with their mobility. A coalition of national organizations was assembled to prepare an application to CMS requesting reconsideration of coverage. After CMS reviewed the proposal, the coalition mobilized public comment, and more than 3,000 stakeholders, including consumers, clinicians, and advocacy groups, shared their personal experiences. Dr. Mark Schmeler also provided testimony at a congressional meeting attended by Senator Tammy Duckworth and Congressman Dan Meuser. Additionally, a 2022 publication featuring a large sample of seat elevator users, combined with biomechanical studies on transfer safety and functional reach, further demonstrated medical necessity. These efforts ultimately led CMS to approve power seat elevators as medically necessary in May 2023.

This case provides a blueprint for advancing wheelchair policy by integrating registry data, consumer experiences, and coordinated advocacy. The resulting policy change has the potential to improve evidence-based practice, reduce billing inefficiencies, and enhance user satisfaction, safety, equity, and participation. This approach offers a scalable roadmap for influencing other areas of health policy.