1. (1) Indications and limitations of coverage and medical appropriateness: Adaptive car seats and travel vests provide safety during transportation in a vehicle for individuals of all ages with health care needs that cannot be met using conventional car seats.

2. (2) An adaptive car seat or travel vest that meets Federal Motor Vehicle Safety Standard 213 may be covered by the Division for an individual with a significant health condition for which a conventional car seat harness or its positioning is unsafe or physically incompatible as documented by one or more of the following functional limitations (list not all-inclusive):

   1. (a) Inability to maintain an unsupported sitting position independently;
   2. (b) Significant head and trunk instability;
   3. (c) Significant hypotonicity, hypertonicity, spasticity, muscle spasm, contractures, seizure activity, or other physiological symptoms or events that result in uncontrollable movement and position changes and/or the inability to make positional correction;
   4. (d) Bony or other fragility for which a conventional car seat harness use or positioning is unsafe;
   5. (e) Fracture casting or post-surgical casting for which positioning in a conventional car seat is unsafe or physically incompatible;
   6. (f) Congenital or acquired condition for which conventional car seat harness use and/or car seat positioning is incompatible (e.g. omphalocele, osteogenesis imperfecta, myelomeningocele, airway anomalies including tracheostomy, scoliosis or kyphosis); or
   7. (g) Neurodevelopmental condition that renders conventional car seat safety features unsafe or ineffective.

3. (3) Prior Authorization (PA): The PA request must include the following documentation:

   1. (a) The prescribing practitioner’s clinical documentation supporting the individual’s diagnosed medical condition(s) for an adaptive car seat or travel vest;

   2. (b) A signed and dated evaluation by a licensed physical therapist, a licensed occupational therapist, or a National Highway Traffic Safety Administration (NHTSA) certified Child Passenger Safety Technician (CPST/CPS Technician) that is co-signed by a licensed practitioner with CPST-I certification in adaptive needs transportation, which includes detailed documentation of all of the following:

      1. (A) The individual’s medical condition(s) for which the adaptive car seat or travel vest is needed;
      2. (B) Description of what equipment is currently being used to transport the individual in a vehicle and why it no longer meets their medical needs;
      3. (C) Interventions and less costly alternatives that have been tried and why those interventions were not successful (e.g., conventional car seats, vests, harnesses);
      4. (D) Brand name and model number of the adaptive car seat or travel vest being requested (including each accessory);
      5. (E) Acknowledgement that the requested adaptive car seat or travel vest is appropriate for use in the vehicle used to transport the client; and
      6. (F) Client’s current height and weight, and the weight capacity and growth potential of the adaptive car seat model or travel vest requested.
   3. (c) An order signed by the prescribing practitioner supporting the adaptive car seat (and accessories) or travel vest requested; and
   4. (d) Manufacturer’s suggested retail price (MSRP) for the brand and model number of the adaptive car seat (including each accessory) or travel vest requested.
4. (4) The licensed physical therapist, licensed occupational therapist, CPS Technician (CPST), or licensed practitioner performing the evaluation must have no financial relationship with the DMEPOS provider.

5. (5) Reimbursement:

   1. (a) HCPCS code E1399 shall be used for billing the adaptive car seats or travel vests and reimbursed in accordance with OAR 410-122-0186;
   2. (b) All accessories shall be billed using HCPCS E1399 and reimbursed in accordance with OAR 410-122-0186;
   3. (c) Certified CPS Technician visits for the initial equipment evaluation, installation and instructional training, and follow up visits to address a change in individual’s growth or development, a change in individual’s behavior, a change in vehicle/mode of transportation, or a change in medical need may be billed to the Division (Refer to (6) in this rule for coding descriptions and details) only when records of those evaluations and visits are reviewed and co-signed by a licensed practitioner with CPST-I certification in adaptive needs transportation.

6. (6) Documentation:

   1. (a) For PA, submit documentation that supports coverage criteria and guidelines in this rule are met;
   2. (b) Medical records and documentation to support the client meets criteria and conditions of coverage in this rule must be kept on file with the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provider and shall be made available to the Division upon request.

7. (7) Procedure Codes and definitions:

   1. (a) E1399 - Durable medical equipment, miscellaneous (adaptive car seat, accessories, travel vest); - PA Required
   2. (b) 99204 - New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more (Initial assessment and evaluation of client and vehicle performed by certified CPST - provider type specialty 321);
   3. (c) 99213 - Established patient office or other outpatient visit with low level of decision making, if using time, 20 minutes or more (Follow up visit performed by certified CPST - provider type specialty 321);
   4. (d) 99214 - Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more (Follow up visit performed by certified CPST - provider type specialty 321);
   5. (e) 99215 - Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more to address a change in the client’s growth or development, a change in client’s behavior, a change in vehicle/mode of transportation, or a need to change from a conventional seat to an adaptive car seat or travel vest (Reevaluation/reassessment visit performed by a certified CPST - provider type specialty 321).
   6. (f) A CPST, also known as a CPS Technician, is defined as a professional who is currently NHTSA certified by Safe Kids Worldwide and Safe Travel for all Children (STAC) in Transporting Children with Special Healthcare Needs. A CPST must be trained in adaptive needs transportation and perform services in accordance with the National CPS Board’s Child Passenger Safety Technician Code of Conduct.

Statutory/Other Authority

ORS 413.042 & ORS 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 87-2025, amend filed 12/09/2025, effective 12/09/2025
DMAP 101-2023, adopt filed 12/29/2023, effective 01/01/2024