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Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

Appendix C

Medicare Data

METHODS

This study was a secondary analysis of Medicare claims data for the calendar years 2013-2014. We used a 5 percent random sample of Medicare beneficiaries’ claims data that is available at the University of Texas Medical Branch, in the Research Identifiable Format, for those years.

Study Sample Population

The study sample population comprised all Medicare beneficiaries, irrespective of the type of plan (e.g., traditional fee-for-service or Medicare Advantage) in which they were enrolled during the study period. However, we selected only those beneficiaries aged 20 to 67 years so the sample would be representative of the beneficiaries of the U.S. Social Security Administration. No other inclusion/exclusion criterion were used for deriving the study sample cohort.

Data Sources and Characteristics

For this study, we used data from two data files that are part of the Medicare claims data resources. Detailed descriptions of these data files are provided in Table C-1.

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

TABLE C-1
Description of Data Files

Data File Years Description
Durable Medical Equipment (DME) 2013–2014 Two DME data files were used: the DME claim line file and the DME claims file. (For additional information related to these files, see ResDAC, n.d.-b.)
  • The DME claim line file comprised Berenson-Eggers type of service (BETOS) codes and Health Care Common Procedure Coding System (HCPCS) codes and all information related to processing the claims.
  • The DME claims file comprised individual-level information such as sociodemographic characteristics and diagnosis codes.
Master Beneficiary Summary File (MBSF) 2013–2014 The MBSF comprised individual-level characteristics such as age, gender, race/ethnicity, disability status, Medicare/Medicaid dual eligibility status, and Medicare Advantage participation. (For additional information related to these files, see ResDAC, n.d.-d.)

Data Extraction and Management Process

The primary criterion for selection of cases for this study was type of durable medical equipment (DME). We targeted three broad categories of DME: wheeled and seated mobility devices (WSMDs), speech-generating devices (SGDs), and upper-extremity prostheses (UEPs). We constructed three separate datasets comprising these DME categories. The data extraction for each type of DME was based on a combination of the Berenson-Eggers type of service (BETOS) codes and the Health Care Common Procedure Coding System (HCPCS) level II alphanumeric codes:

  • BETOS codes were developed as a way to categorize the types of services provided to Medicare beneficiaries. There are seven categories for these codes: evaluation and management, procedures, imaging, tests, DME, other, and exception/unclassified. For example, BETOS codes for WSMDs are in the DME category. Table C-2 provides a detailed list of the BETOS codes (CMS, n.d.).
  • The HCPCS is a combination of codes that indicate services, procedures, or products (e.g., DME) provided to Medicare beneficiaries or to individuals under other health plans (including private insurance). There are three levels of HCPCS codes. For this study, we utilized HCPCS level II alphanumeric codes to identify and define the types of DME that were provided. Tables C-3, C-4, and C-5,
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

respectively, list HCPCS level II alphanumeric codes associated with the WSMD, UEP, and SGD groups (ResDAC, n.d.-c).

After constructing the product database, we linked it with the Master Beneficiary Summary File (MBSF) to obtain sociodemographic and clinical characteristics (including diagnosis codes) and state of residence for individuals in these three categories who received DME. All the individual-level sociodemographic characteristics were extracted from the MBSF:

  • For age we used four categories: 20-45, 46-55, 56-64, and 65-67.
  • Gender was classified as male or female.
  • Race/ethnicity was divided into white, black, Hispanic, and other.
  • For Medicare Advantage enrollment, we determined the number of months a person was covered under Medicare health maintenance organization (HMO) plans, and those with “no” Medicare HMO enrollment for that year were classified as Medicare fee-for-service.

For classification of International Classification of Diseases, Ninth Revision (ICD-9) codes into diagnostic categories, we used a method suggested by the Centers for Medicare & Medicaid Services (CMS) as part of its release of public-use files for DME. Using that method, we could classify ICD-9 codes associated with provision of WSMDs, SGDs, and UEPs into such categories as diseases of the nervous system, diseases of the circulatory system, and diseases of the musculoskeletal system and connective tissue, among others. Table C-6 provides a full list of the ICD-9 codes and their

TABLE C-2
Berenson-Eggers Type of Service Codes: Durable Medical Equipment

Code Service
D1A Medical/surgical supplies
D1B Hospital beds
D1C Oxygen and supplies
D1D Wheelchairs
D1E Other Durable Medical Equipment
D1F Prosthetic/orthotic devices
D1G Drugs administered through Durable Medical Equipment

SOURCE: ResDAC, n.d.-a.

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

TABLE C-3
List of Healthcare Common Procedure Coding System (HCPCS) Codes for Wheeled and Seated Mobility Devices

HCPCS Code Description
E0983 Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control
E0986 Manual wheelchair accessory, push-rim activated power assist system
E1038 Transport chair, adult size, patient weight capacity up to and including 300 pounds
E1039 Transport chair, adult size, heavy-duty, patient weight capacity greater than 300 pounds
E1088 High-strength, lightweight wheelchair, detachable arms desk or full length, swing-away detachable elevating leg rests
E1130 Standard wheelchair, fixed full-length arms, fixed or swing-away detachable footrests
E1140 Wheelchair, detachable arms, desk or full length, swing-away detachable footrests
E1161 Manual adult-size wheelchair, includes tilt in space
K0001 Standard wheelchair
K0002 Standard hemi (low-seat) wheelchair
K0003 Lightweight wheelchair
K0004 High-strength, lightweight wheelchair
K0005 Ultralightweight wheelchair
K0006 Heavy-duty wheelchair
K0007 Extra-heavy-duty wheelchair
K0009 Other manual wheelchair/base
K0011 Standard—weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control, and braking
K0014 Other motorized/power wheelchair base
K0800 Power-operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds
K0801 Power-operated vehicle, group 1 heavy-duty, patient weight capacity 301 to 450 pounds
K0802 Power-operated vehicle, group 1 very-heavy-duty, patient weight capacity 451 to 600 pounds
K0806 Power-operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds
K0807 Power-operated vehicle, group 2 heavy-duty, patient weight capacity 301 to 450 pounds
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
HCPCS Code Description
K0808 Power-operated vehicle, group 2 very-heavy-duty, patient weight capacity 451 to 600 pounds
K0814 Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
K0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds
K0816 Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds
K0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0821 Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds
K0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0823 Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds
K0824 Power wheelchair, group 2 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0825 Power wheelchair, group 2 heavy-duty, captains chair, patient weight capacity 301 to 450 pounds
K0826 Power wheelchair, group 2 very-heavy-duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0827 Power wheelchair, group 2 very-heavy-duty, captains chair, patient weight capacity 451 to 600 pounds
K0829 Power wheelchair, group 2 extra-heavy-duty, captains chair, patient weight 601 pounds or more
K0835 Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0837 Power wheelchair, group 2 heavy-duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0838 Power wheelchair, group 2 very-heavy-duty, single power option sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0839 Power wheelchair, group 2 very-heavy-duty, single power option sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0840 Power wheelchair, group 2 extra-heavy-duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more
K0841 Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0843 Power wheelchair, group 2 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
HCPCS Code Description
K0848 Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0849 Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds
K0850 Power wheelchair, group 3 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0851 Power wheelchair, group 3 heavy-duty, captains chair, patient weight capacity 301 to 450 pounds
K0853 Power wheelchair, group 3 very-heavy-duty, captains chair, patient weight capacity 451 to 600 pounds
K0854 Power wheelchair, group 3 extra-heavy-duty, sling/solid seat/back, patient weight capacity 601 pounds or more
K0855 Power wheelchair, group 3 extra-heavy-duty, captains chair, patient weight capacity 601 pounds or more
K0856 Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0857 Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds
K0858 Power wheelchair, group 3 heavy-duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds
K0860 Power wheelchair, group 3 very-heavy-duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds
K0861 Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0862 Power wheelchair, group 3 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0870 Power wheelchair, group 4 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
K0877 Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0880 Power wheelchair, group 4 very-heavy-duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds
K0884 Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds
K0886 Power wheelchair, group 4 heavy-duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds

SOURCE: CMS, 2016.

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

TABLE C-4
Healthcare Common Procedure Coding System (HCPCS) Codes for Upper-Extremity Prostheses

Prosthetic Devices HCPCS Codes
Body-Powered Devices ‘L6620’ ‘L6621’ ‘L6623’ ‘L6624’ ‘L6625’ ‘L6637’ ‘L6640’ ‘L6641’ ‘L6642’ ‘L6645’ ‘L6646’ ‘L6647’ ‘L6799’ ‘L6700’ ‘L6704’ ‘L6705’ ‘L6706’ ‘L6707’ ‘L6708’ ‘L6709’ ‘L6710’ ‘L6711’ ‘L6712’ ‘L6713’ ‘L6714’ ‘L6720’ ‘L6721’ ‘L6722’ ‘L6723’ ‘L6725’ ‘L6730’ ‘L6804’ ‘L6845’ ‘L6850’ ‘L6855’ ‘L6860’ ‘L6865’ ‘L6867’ ‘L6868’ ‘L6870’ ‘L6872’ ‘L6873’ ‘L6875’ ‘L7610’ ‘L7611’ ‘L7612’ ‘L7613’ ‘L7614’ ‘L7621’ ‘L7622’
Myoelectric Devices ‘L6611’ ‘L6621’ ‘L6628’ ‘L6629’ ‘L6638’ ‘L6648’ ‘L6681’ ‘L6682’ ‘L6881’ ‘L6882’ ‘L6920’ ‘L6925’ ‘L6930’ ‘L6935’ ‘L6940’ ‘L6945’ ‘L6950’ ‘L6955’ ‘L6960’ ‘L6965’ ‘L6970’ ‘L6975’ ‘L7007’ ‘L7008’ ‘L7009’ ‘L7040’ ‘L7045’ ‘L7170’ ‘L7180’ ‘L7181’ ‘L7185’ ‘L7186’ ‘L7190’ ‘L7191’ ‘L7260’ ‘L7261’ ‘L7360’ ‘L7362’ ‘L7364’ ‘L7366’ ‘L7367’ ‘L7368’
Other NA

NOTE: NA = not applicable.

SOURCE: Etter et al., 2015.

TABLE C-5
Healthcare Common Procedure Coding System (HCPCS) Codes for Speech-Generating Devices

Speech-Generating Device HCPCS Code
Speech-generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time E2502
Speech-generating device, synthesized speech, permitting multiple methods of message formulation and device access E2510

SOURCE: ASHA, n.d.

classification in these diagnosis categories, while Table C-7 lists the ICD-9 codes associated with the distribution of diagnosis categories for upper-extremity amputation.

DATA LIMITATIONS

The data used for this study were Medicare claims for the years 2013-2014. These data are “claims processing” data and not typically intended

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

TABLE C-6
International Classification of Diseases, Ninth Revision (ICD-9) Codes and Diagnostic Categories

Diagnostic Category ICD-9 Codes
Infectious and parasitic diseases 001–139
Neoplasms 140–239
Endocrine, nutritional, and metabolic diseases and immunity disorders 240–279
Diseases of the blood and blood-forming organs 280–289
Mental disorders 290–319
Diseases of the nervous system 320–359
Diseases of the sense organs 360–389
Diseases of the circulatory system 390–459
Diseases of the respiratory system 460–519
Diseases of the digestive system 520–579
Diseases of the genitourinary system 580–629
Complications of pregnancy, childbirth, and the puerperium 630–679
Diseases of the skin and subcutaneous tissue 680–709
Diseases of the musculoskeletal system and connective tissue 710–739
Congenital anomalies 740–759
Certain conditions originating in the perinatal period 760–779
Symptoms, signs, and ill-defined conditions 780–799
Injury and poisoning 800–999
External causes of injury and supplemental classification E and V codes
Mental disorders 290–319

SOURCE: CMS, 2010.

for use in research studies. They lack the information necessary for creating a health/disability profile of patients to match with the types of DME that were prescribed. Thus, the information presented in this report cannot be used to determine the appropriateness of the provision of DME. In addition, the data are based on a random 5 percent sample of Medicare beneficiaries. That sample yielded a small study sample for the SGD and UEP groups, which limited the presentation of granular information based on individual-level characteristics. In future analyses, use of a 20 percent random sample and/or more years of data is needed. The age criterion used for selection of the study cohort (ages 20-67 years) also is underrepresented in Medicare claims data. This is another reason for the small study sample

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

TABLE C-7
Distribution of Diagnosis Categories for Upper-Extremity Amputation Using International Classification of Diseases, Ninth Revision (ICD-9) Codes

Amputation Category ICD-9 Codes
Below Elbow ‘8870’ ‘8871’ ‘V4965’ ‘24930’ ‘25900’ ‘25905’ ‘25907’ ‘25909’ ‘25915’ ‘8405’ ‘V4963’ ‘25927’ ‘25931’ ‘8403’ ‘V4964’ ‘25920’ ‘25924’ ‘8404’
Above Elbow ‘8872’ ‘8873’ ‘8406’ ‘V4966’ ‘24900’ ‘24920’ ‘24925’ ‘24931’ ‘24935’ ‘24940’ ‘8407’
Level/Side Unspecified ‘8874’ ‘8875’ ‘8876’ ‘8877’ ‘V4960’ ‘V520’ ‘V528’
Thumb/Finger ‘885’ ‘8850’ ‘8851’ ‘886’ ‘8860’ ‘8861’ ‘V4961’ ‘V4962’

SOURCE: Etter et al., 2015.

for the SGD and UEP groups. It is important as well to acknowledge the coding errors that occurred in the course of the claims processing and are part of these data and could not be detected or eliminated in the data extraction process.

Despite these limitations, however, the Medicare DME files are a valuable resource in the absence of universal data developed specifically to study the prescription and utilization of assistive devices. These data represent a good resource for determining the use of these devices among older adults and individuals with disabilities.

REFERENCES

ASHA (American Speech-Language-Hearing Association). n.d. Medicare coverage policy on speech-generating devices. http://www.asha.org/practice/reimbursement/medicare/sgd_policy (accessed March 3, 2017).

CMS (Centers for Medicare & Medicaid Services). 2010. CMS 2010 basic stand alone (BSA) DME line items public use file (PUF) data dictionary and codebook. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/BSAPUFS/Downloads/2010_DME_DataDictionary.pdf (accessed January 24, 2017).

CMS. 2016. Medicare referring provider DMEPOS data CY2014. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-ProviderCharge-Data/DME2014.html (accessed March 6, 2017).

CMS. n.d. Berenson-Eggers type of service (BETOS) codes. https://www.cms.gov/ResearchStatistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/downloads/betosdesccodes.pdf (accessed January 23, 2017).

Etter, K., M. Borgia, and L. Resnik. 2015. Prescription and repair rates of prosthetic limbs in the VA healthcare system: Implications for national prosthetic parity. Disability and Rehabilitation: Assistive Technology 10(6):493-500.

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×

ResDAC (Research Data Assistance Center). n.d.-a. BETOS table. https://www.resdac.org/sites/resdac.umn.edu/files/BETOS%20Table.txt (accessed March 6, 2017).

ResDAC. n.d.-b. Durable medical equipment RIF. https://www.resdac.org/cms-data/files/dmerif/data-documentation (accessed January 23, 2017).

ResDAC. n.d.-c. Health care common procedure coding system. https://www.resdac.org/cms-data/variables/Line-HCFA-Common-Procedure-Coding-System (accessed January 23, 2017).

ResDAC. n.d.-d. Master beneficiary summary file. https://www.resdac.org/cms-data/files/mbsf/data-documentation (accessed January 23, 2017).

Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 463
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 464
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 465
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 466
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 467
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 468
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 469
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 470
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 471
Suggested Citation:"Appendix C: Medicare Data." National Academies of Sciences, Engineering, and Medicine. 2017. The Promise of Assistive Technology to Enhance Activity and Work Participation. Washington, DC: The National Academies Press. doi: 10.17226/24740.
×
Page 472
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The U.S. Census Bureau has reported that 56.7 million Americans had some type of disability in 2010, which represents 18.7 percent of the civilian noninstitutionalized population included in the 2010 Survey of Income and Program Participation. The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. As of December 2015, approximately 11 million individuals were SSDI beneficiaries, and about 8 million were SSI beneficiaries.

SSA currently considers assistive devices in the nonmedical and medical areas of its program guidelines. During determinations of substantial gainful activity and income eligibility for SSI benefits, the reasonable cost of items, devices, or services applicants need to enable them to work with their impairment is subtracted from eligible earnings, even if those items or services are used for activities of daily living in addition to work. In addition, SSA considers assistive devices in its medical disability determination process and assessment of work capacity.

The Promise of Assistive Technology to Enhance Activity and Work Participation provides an analysis of selected assistive products and technologies, including wheeled and seated mobility devices, upper-extremity prostheses, and products and technologies selected by the committee that pertain to hearing and to communication and speech in adults.

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