Manual Wheelchairs and Advance Determination of Medicare Coverage

Certain manual wheelchairs are eligible for Advance Determination of Medicare Coverage (ADMC), a voluntary program for suppliers or beneficiaries, to request in advance of delivery of the item, to determine whether payment for the item may be made or not.

HCPCS codes K0005 (ultra-lightweight wheelchair), E1161, E1231, E1232, E1233, and E1234 (tilt in space wheelchairs), K0008 (custom wheelchair), and K0009 (other wheelchair) are eligible for ADMC.

The request is mailed or faxed, with a coversheet, to Noridian. The DME MAC determines if there is sufficient medical documentation that supports whether the item is reasonable and necessary. Noridian renders a determination within 30 calendar days.

For complete information, see the ADMC webpage.

Last Updated Jan 03 , 2024