Special rules related to treatment of certain manual wheelchairs under the Medicare program

Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph: (23) Special rules related to treatment of certain manual wheelchairs (A) Requirement to establish separate HCPCS codes for certain manual wheelchairs With respect to ultralightweight manual wheelchairs payable under this subsection furnished on or after January 1, 2026, the Secretary shall establish two or more HCPCS codes, as determined appropriate by the Secretary, for the base of such a wheelchair depending on the construction material used in such base (with 1 or more such codes for such a base with titanium or carbon fiber construction material and 1 or more such codes for such a base without such materials). (B) Payment and beneficiary protections (i) Payment On or after January 1, 2026, in the case where an individual purchases or rents from a supplier an ultralightweight manual wheelchair that has titanium or carbon fiber construction material used in the base of such wheelchair, payment to the supplier shall be made in the frequency and amount as would otherwise be made under this subsection (as described in paragraph (1)(A)) for such wheelchair. (ii) Beneficiary charges The supplier may charge the individual the difference between the payment amount described in clause (i) for such wheelchair and the supplier's actual charge for such wheelchair. (iii) Beneficiary protections In order to inform an individual of their potential financial liability under clause (ii), the Secretary may require a supplier to issue a notice to the individual (in a form and manner determined by the Secretary) prior to the purchase or rent of such ultralightweight manual wheelchair by such individual..

Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph: (24) Special rules related to treatment of certain manual wheelchairs (A) Requirement to establish separate HCPCS codes for certain manual wheelchairs With respect to ultralightweight manual wheelchairs payable under this subsection furnished on or after January 1, 2028, the Secretary shall establish two or more HCPCS codes, as determined appropriate by the Secretary, for the base of such a wheelchair depending on the construction material used in such base (with 1 or more such codes for such a base with titanium or carbon fiber construction material and 1 or more such codes for such a base without such materials). (B) Payment and beneficiary protections (i) Payment On or after January 1, 2028, in the case where an individual purchases or rents from a supplier an ultralightweight manual wheelchair that has titanium or carbon fiber construction material used in the base of such wheelchair, payment to the supplier shall be made in the frequency and amount as would otherwise be made under this subsection (as described in paragraph (1)(A)) for such wheelchair. (ii) Beneficiary charges The supplier may charge the individual the difference between the supplier's actual charge for such wheelchair and the payment amount described in clause (i) for such wheelchair. (iii) Beneficiary protections In order to inform an individual of the individual’s potential financial liability under clause (ii), the Secretary may require a supplier to issue a notice to the individual (in a form and manner determined by the Secretary) prior to the purchase or rental of such ultralightweight manual wheelchair by such individual..