SB247 (Choices for Increased Mobility Act of 2025) amends section 1834(a) of the Social Security Act to add a new special rule for ultralightweight manual wheelchairs. The bill requires the Secretary of Health and Human Services to establish two or more HCPCS codes for the wheelchair base keyed to construction material (including separate codes for bases using titanium or carbon fiber), effective for items furnished on or after January 1, 2026.
The bill preserves Medicare Part B payment ‘‘in the frequency and amount’’ that would otherwise apply for ultralightweight wheelchairs that have titanium or carbon fiber in the base, while explicitly allowing suppliers to charge beneficiaries the difference between Medicare’s payment and the supplier’s actual charge. The Secretary may require a pre‑sale notice to inform individuals of potential out‑of‑pocket liability.
The change clarifies coding and billing mechanics for premium manual wheelchairs but also creates new balance‑billing exposure and implementation work for CMS and suppliers.
At a Glance
What It Does
Requires CMS to establish two or more HCPCS codes for ultralightweight manual wheelchair bases based on construction material (explicitly separating bases with titanium or carbon fiber) and preserves Medicare Part B payment parity for those premium bases. It also permits suppliers to collect the difference between Medicare payment and their charge and allows CMS to mandate a pre‑purchase notice.
Who It Affects
Durable medical equipment (DME) suppliers, wheelchair manufacturers that use titanium or carbon fiber, Medicare claims processors and contractors, and Medicare beneficiaries who purchase or rent ultralight manual wheelchairs.
Why It Matters
This is a targeted change to coding and billing for a high‑cost niche of wheelchairs that can clarify claims processing and market segmentation for premium devices — but it simultaneously formalizes a route for beneficiary balance billing, shifting implementation and consumer‑protection questions to CMS and suppliers.
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What This Bill Actually Does
The bill adds a new paragraph to section 1834(a) governing payment for manual wheelchairs under Medicare Part B. It instructs the Secretary to create ‘‘two or more’’ HCPCS codes for the base of ultralightweight manual wheelchairs furnished on or after January 1, 2026.
Those codes must reflect the construction material used in the base, with at least one code (or code cluster) for bases that include titanium or carbon fiber and at least one for bases that do not.
For ultralightweight manual wheelchairs that include titanium or carbon fiber in the base, the bill says Medicare’s payment to the supplier on or after January 1, 2026, shall be made at the frequency and amount that would otherwise apply under the existing statute (the payment rules described in section 1834(a)(1)(A)). In other words, the bill preserves the underlying Medicare payment structure for these premium bases rather than creating a distinct higher Medicare payment rate.The bill also authorizes suppliers to charge the beneficiary the difference between Medicare’s payment and the supplier’s actual charge for the wheelchair.
To reduce surprise charges, the Secretary can require suppliers to give an individual a notice—formatted and delivered as CMS prescribes—before the purchase or rental. The statute covers both purchases and rentals ‘‘from a supplier,’’ so the balance‑billing and notice provisions apply regardless of acquisition model.Operationally, CMS will need to choose how granular the new HCPCS codes are, draft claim‑processing guidance so Medicare Administrative Contractors (MACs) and suppliers recognize the new codes correctly, and determine the content and timing requirements for any pre‑purchase notice.
Suppliers will need to map product SKUs to new HCPCS codes, update pricing and sales scripts, and decide whether to absorb or pass through any premium charged for titanium/carbon fiber bases.
The Five Things You Need to Know
The bill directs CMS to establish two or more HCPCS codes for the base of ultralightweight manual wheelchairs, distinguishing bases that use titanium or carbon fiber from those that do not.
Effective January 1, 2026, Medicare Part B must pay for ultralightweight wheelchairs with titanium or carbon fiber bases at the same frequency and amount that the statute already provides for manual wheelchairs (no new higher Medicare rate is created).
Suppliers may collect from beneficiaries the difference between Medicare’s payment and the supplier’s actual charge for an ultralightweight wheelchair with a titanium or carbon fiber base (i.e.
balance billing is permitted under the bill).
The Secretary may require suppliers to provide a pre‑purchase or pre‑rental notice to individuals in a CMS‑specified form and manner to inform them of potential financial liability.
The new HCPCS coding and payment rule applies only to ultralightweight manual wheelchairs furnished on or after January 1, 2026.
Section-by-Section Breakdown
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Short title
Declares the Act’s short title: "Choices for Increased Mobility Act of 2025." This is purely nominal but signals the bill’s policy focus on increasing consumer choice for manual wheelchairs.
HCPCS codes by base material for ultralightweight manual wheelchairs
Adds a statutory instruction that CMS must establish two or more HCPCS codes for the base of ultralightweight manual wheelchairs furnished on or after January 1, 2026, separating codes by construction material (specifically calling out titanium and carbon fiber). Practically, this forces CMS to codify a material‑based product taxonomy for a subset of manual wheelchairs, which will be used for claims submission, data collection, and supplier billing.
Medicare payment parity for premium bases
Directs that Medicare pay suppliers for ultralightweight wheelchairs with titanium or carbon fiber bases "in the frequency and amount as would otherwise be made" under the existing manual wheelchair payment rule (section 1834(a)(1)(A)). The provision preserves the existing statutory payment structure rather than creating a distinct Medicare reimbursement that reflects higher manufacturer or supplier prices for premium materials.
Balance billing allowed and notice authority
Authorizes suppliers to charge beneficiaries the difference between Medicare’s payment and the supplier’s actual charge for the wheelchair, and grants the Secretary authority to require a CMS‑prescribed notice to inform beneficiaries of this potential liability before purchase or rental. This creates a statutory pathway for suppliers to recover premium charges directly from beneficiaries while giving CMS the authority to mandate consumer disclosures to reduce surprise billing.
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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
- Manufacturers of titanium or carbon‑fiber wheelchair bases — the new HCPCS codes let them differentiate products explicitly in Medicare claims, supporting premium pricing strategies and product recognition.
- DME suppliers selling premium ultralight wheelchairs — statutory clarity on coding and an explicit route to collect the price difference reduces billing uncertainty and supports revenue recovery for higher‑priced units.
- CMS and claims processors — a material‑based HCPCS taxonomy improves coding consistency and data visibility for utilization and spending on ultralight wheelchair segments.
- Clinicians and rehabilitation professionals — clearer coding can streamline documentation and help ensure claims are routed correctly when prescribing premium manual wheelchairs.
Who Bears the Cost
- Medicare beneficiaries who choose ultralightwheelchairs with titanium or carbon fiber bases — they may face additional out‑of‑pocket charges equal to the supplier’s premium above Medicare payment.
- Small DME suppliers — implementing new HCPCS mappings, updating billing systems, training staff, and preparing compliant notices will impose administrative and IT costs.
- CMS (and MACs) — the agency must develop and publish new HCPCS codes, issue claim processing instructions, and design and enforce the content and delivery requirements for beneficiary notices, adding regulatory workload without explicit appropriations.
- State Medicaid programs and private payers — they commonly adopt or reference HCPCS codes; new codes could prompt parallel policy decisions and administrative changes outside Medicare.
Key Issues
The Core Tension
The bill tries to balance consumer choice and market clarity for high‑end ultralight manual wheelchairs against financial protection for Medicare beneficiaries: it creates clear product codes and preserves Medicare payment mechanics to support supplier and manufacturer markets, but it simultaneously authorizes balance billing that shifts the cost burden to individuals and places the onus on CMS to craft effective notice and enforcement rules.
The bill is straightforward about coding and allows balance billing, but it leaves several operational and definitional gaps for CMS to resolve. It does not define "ultralightweight" or precisely what element of the "base" CMS must code; that creates a risk of inconsistent coding choices across MACs and suppliers unless CMS issues detailed guidance.
The statute also references payment "in the frequency and amount as would otherwise be made" under an existing provision; applying that language to a materially differentiated HCPCS code could raise corner cases—for example, whether a higher supplier charge triggers any reassessment of Medicare’s pricing or rental vs. purchase rules.
Permitting suppliers to collect the difference between Medicare payment and supplier charge shifts the financial burden to beneficiaries who want premium materials. The Secretary’s authority to require a notice helps mitigate surprise billing but is dependent on CMS rulemaking and enforcement—ambiguous notice content or lax delivery requirements could leave beneficiaries exposed.
Finally, the creation of material‑based HCPCS codes risks entrenching market segmentation: devices with titanium or carbon fiber could become a documented premium class, encouraging suppliers to market upgrades that Medicare will not fully cover while leaving enforcement and consumer protection to post‑hoc CMS actions.
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