WOCN Asks CMS to Clarify New Caregiver Codes

WOCN has been building community support to urge CMS, and their contractors, to update their payment policy for covering wheelchair cushions so that payment reflects the current published evidence.  Current Medicare policy will only approve a beneficiary for a skin protecting cushion if they met one of the following:

• current pressure ulcer, or history of a pressure ulcer, in area of contact with the seating surface,
• absent or impaired sensation; or,
• inability to carry out a functional weight shift.

These criteria only capture a portion of the at-risk population. All people with impaired mobility, regardless of diagnoses, are at risk, per the “Prevention and Treatment of Pressure Ulcers / Injuries: Clinical Practice Guideline” (2019 Guidelines). Specifically, the 2019 guideline would indicate that anyone who is a permanent wheelchair user should have a pressure redistribution (skin protection) cushion because of impaired mobility.  WOCN will be working with other to request that Medicare update its Wheelchair Seating Policy so that any individual who is a permanent wheelchair user qualifies for a skin protecting cushion without any other criteria (such as pressure ulcers/injury history, impaired sensation, or inability to carry out a functional weight shift.)