Group 1
| Code | Description |
| E2601 | GENERAL USE WHEELCHAIR SEAT CUSHION, WID ... |
| E2602 | GENERAL USE WHEELCHAIR SEAT CUSHION, WID ... |
| E2603 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ... |
| E2604 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ... |
...
Information.
| HCPCS Code | Description |
|---|---|
| K0008 | CUSTOM MANUAL WHEELCHAIR/BASE |
| K0009 | OTHER MANUAL WHEELCHAIR/BASE |
| K0013 | CUSTOM MOTORIZED/POWER WHEELCHAIR BASE |
What are the Medicare guidelines for a wheelchair?
covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home. You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair.
What is the diagnosis code for wheelchair?
Some diagnoses that qualify a patient for a standard power or manual wheelchair include:
- Arthritis
- Obesity
- Diabetes
- Fibromyalgia
- Degenerative Disc Disease
- COPD
- Scoliosis
- And many others
How does Medicare coverage apply to wheelchairs?
- Your condition makes it difficult for you to move about your home.
- Even with a cane or walker, you’re unable to manage daily activities of living such as bathing and using the bathroom.
- You can operate the wheelchair and get in and out of it on your own or with the help of someone who lives with you.
What is a Medicare BIC code?
What are Beneficiary Identification Codes (BIC)? BICs indicate the type of benefits a Social Security claimant receives and are used as Medicare claim numbers. These codes are not assigned to a claim number until the claimant applies for Social Security benefits. For example, if the Social Security number of the Primary Claimant is 999-99-9999 ...
What type of codes would be used for coding for a wheelchair?
Code 97542 is used to report management of a patient using a wheelchair including assessment (eg, pos- tural/positioning needs), fitting (eg, pressure relief), and training (eg, getting in and out of the wheelchair safely and managing wheelchair propulsion on various terrains).
What is the CPT code for standard wheelchair?
HCPCS Code Details - K0001HCPCS Level II Code Durable Medical Equipment for Medicare Administrative Contractors (DME MACs) SearchHCPCS CodeK0001DescriptionLong description: Standard wheelchair Short description: Standard wheelchairHCPCS Modifier19 more rows•Jan 1, 1994
What are K codes in relation to wheelchairs?
The K0001 through K0004 codes are defined as follows:Standard wheelchair (K0001) Weight: Greater than 36 lbs. ... Standard hemi (low seat) wheelchair (K0002) Weight: Greater than 36 lbs. ... Lightweight wheelchair (K0003) Weight: 34-36 lbs. ... High-strength, lightweight wheelchair (K0004) Weight: Less than 34 lbs.
What kind of wheelchairs Does Medicare pay for?
Medicare benefits cover manual wheelchairs, power scooters, and power wheelchairs. It's important to verify that your doctor and your medical equipment supplier are both enrolled in Medicare before you get a wheelchair.
What is the CPT code for lightweight wheelchair?
K0003 - HCPCS Code for Lightweight wheelchair.
Is a standard wheelchair?
A typical wheelchair has a length of 42” (106.7 cm), a height of 36” (91.4 cm), seat heights around 19.5” (49.5 cm), and a width of 25” (63.5 cm). Wheelchairs are chairs with wheels designed to serve users that are unable to, or have difficulty with, walking due to injury, illness, or disability.
What is a K0004 wheelchair?
Lightweight K0004 wheelchair with elevating legrests and spacer saver arms. This durable K0004 wheelchair features a weight capacity of 300 lb., includes fixed height, flip back padded arms to save space and elevating legrests for easy transfer. The dual-axle allows for easy conversion to hemi-height.
What is a K0001 wheelchair?
Short Description: Standard wheelchair. Long Description: STANDARD WHEELCHAIR.
What are K codes?
ICD-10 CM & PCS Codes Temporary K codes are developed by the DME MACs to report supplies and other products for which a national code has not yet been developed. Payment jurisdiction lies with the DME MACs unless otherwise specified.
What qualifies for a wheelchair diagnosis?
Which Diagnoses Qualify for Wheelchairs?Multiple Sclerosis (MS)ALS (AKA Lou Gehrig's Disease)Parkinson's Disease.Spinal Cord Injuries.Cerebral Palsy.Muscular Dystrophy.CVA (AKA stroke-related paralysis)Post-Polio Syndrome.More items...
How do you write a prescription for a wheelchair?
The PCP and seating specialist collaboratively write a wheelchair prescription after the face-to-face encounter. This prescription includes wheelchair type, initial date and duration of need, specific components (eg, cushion, backrest, power seat functions), and medical justification.
How often will Medicare pay for a new wheelchair?
If your equipment is worn out, Medicare will only replace it if you have had the item in your possession for its whole lifetime. An item's lifetime depends on the type of equipment but, in the context of getting a replacement, it is never less than five years from the date that you began using the equipment.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Coverage Guidance
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. The purpose of a Local Coverage Determination (LCD) is to provide information regarding “reasonable and necessary” criteria based on Social Security Act § 1862 (a) (1) (A) provisions. In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement:.
What percentage of Medicare payment does a supplier pay for assignment?
If your supplier accepts Assignment you pay 20% of the Medicare-approved amount, and the Part B Deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
What happens if you don't enroll in Medicare?
If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. Make sure your doctors and DME suppliers are enrolled in Medicare. It’s important to ask your suppliers if they participate in Medicare before you get DME.
Does Medicare cover DME equipment?
You may be able to choose whether to rent or buy the equipment. Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare.
Does Medicare cover wheelchairs?
Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home. You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair.
Do you have to get prior authorization for a wheelchair?
Starting September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under this program, 40 types of power wheelchairs require “prior authorization” before Medicare will cover the wheelchair cost.
Can a DME provider provide a prior authorization for a wheelchair?
If your physician prescribes one of these wheelchairs to you, your DME supplier will, in most cases, submit a prior authorization request and all documentation to Medicare on your behalf . Medicare will review the information to make sure that you’re eligible and meet all requirements for power wheelchair coverage.
Billing HCPCS Code K0108 - Wheelchair Component or Accessory, Not Otherwise Specified
Miscellaneous options, accessories, or replacement parts for wheelchairs that do not have a specific Healthcare Common Procedure Coding System (HCPCS) code and are not included in another code should be coded K0108 (wheelchair component or accessory, not otherwise specified).
Claim Narrative
To accurately identify and price the K0108 billed products suppliers must include the following information in the NTE 2400 (line note), segment NTE02 (NTE01=ADD) of the ANSI X12N, version 5010A1 professional electronic claim format or on Item 19 of the paper claim form:
Correct Coding
The K0108 should not be utilized to bill items that are bundled into other items or have their own specific HCPCS code. An example of incorrect coding is billing the K0108 for a wheelchair actuator. An actuator is a device that receives signals from a controller then translates those signals into either rotary or linear movement.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Coverage Guidance
For any item to be covered by Medicare, it must: 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. The purpose of a Local Coverage Determination (LCD) is to provide information regarding “reasonable and necessary” criteria based on Social Security Act § 1862 (a) (1) (A) provisions. In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement:.
A0130 - Noner transport wheelch van
Non-emergency transportation: wheelchair van Code effective 01/01/1982 - present
E0954 - Foot box, any type each foot
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot Code effective 01/01/2018 - present
E0955 - Cushioned headrest
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each Code effective 07/01/2016 - present
E0958 - Whlchr att- conv 1 arm drive
Manual wheelchair accessory, one-arm drive attachment, each Code effective 01/01/2004 - present
E0959 - Amputee adapter
Manual wheelchair accessory, adapter for amputee, each Code effective 01/01/2004 - present
E0961 - Wheelchair brake extension
Manual wheelchair accessory, wheel lock brake extension (handle), each Code effective 01/01/2004 - present
E0966 - Wheelchair head rest extensi
Manual wheelchair accessory, headrest extension, each Code effective 01/01/2004 - present
