This bill would amend title XVIII of the Social Security Act to add special rules for ultralightweight manual wheelchairs under Medicare Part B. It requires the Secretary to establish two or more HCPCS codes for the wheelchair base, differentiated by construction material, including codes for bases made with titanium or carbon fiber and for bases without those materials.
The changes would take effect for wheelchairs furnished on or after January 1, 2026, with payment to suppliers determined under the new code regime. The bill also allows suppliers to charge beneficiaries the difference between the payment amount and their actual charge and requires notices to inform individuals of potential liability before purchase or rental.
At a Glance
What It Does
The Secretary must create two or more HCPCS codes for ultralightweight wheelchair bases, differentiated by construction material (e.g., titanium or carbon fiber vs. non-titanium/carbon fiber). It then sets payment rules effective January 1, 2026, under which the supplier is paid per the new codes, and allows cost-sharing by beneficiaries.
Who It Affects
Directly affects Medicare Part B beneficiaries purchasing or renting ultralightweight wheelchairs and the DME suppliers who bill under the new codes. CMS and its contractors will implement the coding and payment adjustments.
Why It Matters
Clarifies reimbursement for advanced wheelchairs and improves transparency around potential out-of-pocket costs, addressing cost-shifting risks for patients while standardizing payment for newer base materials.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The bill adds a dedicated rule set to the Medicare Parts program for ultralightweight manual wheelchairs. It directs the Secretary to create multiple HCPCS codes for the chair base, distinguishing codes by whether the base uses titanium or carbon fiber or other materials.
This creates a structured pricing framework so payors know which code applies to a given chair variant and how it should be reimbursed. The changes are tied to wheelchairs furnished on or after January 1, 2026, aligning payment with the new code regime that accounts for material-based differences.
In terms of cost sharing, the bill permits suppliers to charge beneficiaries the difference between the structured payment amount and the supplier’s actual charge for the wheelchair. This creates a potential out-of-pocket exposure for patients depending on the chair chosen and the negotiated supplier price.
To mitigate surprise costs, the Secretary may require suppliers to provide a liability notice to individuals before purchase or rental, in a form and manner determined by the Secretary. The combination of new codes, payment rules, and disclosure requirements is designed to reduce ambiguity around reimbursement for ultralightweight wheelchairs and to improve patient awareness of financial liability.
The Five Things You Need to Know
HCPCS codes for ultralightweight wheelchair bases will be created in two or more variants based on material.
There will be separate codes for bases with titanium or carbon fiber and bases without those materials.
Starting January 1, 2026, payments to suppliers follow the new code regime as described by the bill.
Suppliers may charge beneficiaries the difference between the payment amount and their actual charge.
Suppliers must provide beneficiaries with a notice regarding potential financial liability before purchase or rental.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Establishment of material-based HCPCS codes for ultralightweight chair bases
The Secretary shall establish two or more HCPCS codes for the base of ultralightweight manual wheelchairs, differentiated by construction material. At minimum, there will be codes for bases with titanium or carbon fiber construction and for bases without those materials. This enables reimbursement categories that reflect material choices and their respective costs, improving alignment between product attributes and payment.
Payment, cost-sharing, and beneficiary notices
For wheelchairs furnished on or after January 1, 2026, the payment to the supplier shall be made in the frequency and amount described by the new code regime for such wheelchairs. The supplier may charge the beneficiary the difference between the payment amount described and the supplier’s actual charge. To protect patients, the Secretary may require a supplier to issue a notice to the individual before purchase or rental, informing them of potential financial liability in the form and manner determined by the Secretary.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Beneficiaries purchasing or renting ultralightweight wheelchairs, particularly those with titanium or carbon fiber bases, who gain clearer coverage and better pricing transparency.
- Durable medical equipment (DME) suppliers who bill under Medicare Part B, who receive clearer, material-based coding and payment pathways.
- Medicare Part B program and CMS staff, who gain clearer administrative processes for reimbursement and coding consistency.
Who Bears the Cost
- Medicare Part B program may face changes in cost patterns due to new codes and potential liability structures.
- DME suppliers incur administrative costs to implement new HCPCS codes, process liability notices, and adjust billing systems.
- Beneficiaries could incur higher out-of-pocket costs if the difference between payment and supplier charges is substantial for certain wheelsheets.
Key Issues
The Core Tension
The central tension is between achieving price transparency and protecting beneficiaries from unexpected costs, versus the administrative and cost burdens that come with introducing new, material-based codes and liability notices in a federal program.
The bill introduces a new, material-based coding regime for ultralightweight manual wheelchairs, but it also creates potential implementation and cost challenges. The reliance on multiple HCPCS codes could introduce administrative complexity for CMS, payers, and suppliers as they map products to codes and ensure correct payment amounts.
Additionally, the possibility of beneficiary charges means out-of-pocket costs could vary based on price negotiations between suppliers and patients, potentially affecting affordability for some users. The notice requirement adds a new compliance task for suppliers, which could impose administrative burdens and require robust processes to ensure timely and accurate disclosures.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.