Wheelchair Options/Accessories - JA DME

Guidelines for appropriate billing of HCPCS Code K0108 are provided in the article Billing HCPCS Code K0108 - Wheelchair Component or Accessory, Not Otherwise Specified.

The KU modifier is used for certain wheelchair accessories and seat back cushions used with complex rehabilitative manual wheelchairs and certain manual wheelchairs. The impacted accessories and wheelchair codes include K0005, E1161, E1231-E1238 and K0008. The use of this modifier started with claims submitted on July 6, 2020 for dates of service from January 1, 2020 through June 30, 2021 and per CMS Medicare Learning Network (MLN) Matters (MM) 12345 continues for dates of service July 1, 2021.

Effective for claims with dates of service (DOS) on/after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 UOS on each claim line. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding. See Correct Coding - RT and LT Modifier Usage Change for more information

Supplier that transfers title to a capped rental item, such as a power wheelchair, to a beneficiary remains responsible for furnishing replacement equipment at no cost to the beneficiary or to the Medicare program for the 5-year reasonable useful lifetime for the equipment. In making this determination, the DME MACs may consider whether the accumulated costs of repair exceed 60 percent of the cost to replace the item.

E2298 (complex rehabilitative power wheelchair accessory, power seat elevation system, any type) is covered for Group 5 and complex rehabilitative power-driven wheelchairs. For coverage criteria review the Original Consideration for Seat Elevation Systems as an Accessory to Power Wheelchairs (Group 3) within the Mobility Assistive Equipment (MAE) (280.3) National Coverage Determination (NCD).

Payment may be made for reasonable and necessary charges for maintenance and servicing of beneficiary-owned equipment. Reasonable and necessary charges are those made for parts and labor not otherwise covered under a manufacturers or supplier's warranty. Suppliers must maintain copies of any manufacturer or supplier warranties for equipment being repaired and furnish this documentation upon request.