- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
|Advance Determination of Medicare Coverage (ADMC)
|Manual wheelchairs described by HCPCS E1161, E1231, E1232, E1233, E1234, K0005, K0008, and K0009 are eligible for ADMC
|Billing HCPCS Code K0108 - Wheelchair Component or Accessory, Not Otherwise Specified
|Guidelines for appropriate billing of HCPCS Code K0108
|Home Assessment for Manual Wheelchairs Criteria C (Review Type)
|DMD Reminder - Information about whether the beneficiary’s home can accommodate a manual wheelchair (Criterion C), also called the home assessment, must be fully documented in the beneficiary’s medical record or the supplier’s records. The home assessment may be done directly by visiting the beneficiary’s home or indirectly based upon information provided by the beneficiary or their designee. When performed indirectly, for example, in order to expedite discharge from a hospital or skilled nursing facility, the supplier must still confirm in person at the time of delivery that the item delivered meets the requirements specified in Criterion C. Issues including, but not limited to, the physical layout of the home, surfaces to be traversed, and obstacles must be addressed by and documented in the home assessment to support medical necessity. The requirement for a direct, in-person assessment of the home environment remains whether the supplier delivers the wheelchair directly to the beneficiary or if a caregiver picks up the chair from the supplier. The confirmation of the home assessment may not be met by indirect methods such as telephone or virtual conversations with the beneficiary or their caregiver, regardless of where or by whom the wheelchair is delivered. The supplier ultimately remains responsible for the completion and documentation of the home assessment.
|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 03/01/2019, suppliers must bill each item on two separate claim lines when 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.
Last Updated Feb 19 , 2024