Manual Wheelchairs - JA DME
Manual Wheelchairs
Coverage
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Custom Manual Wheelchair - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Heavy Duty Wheelchairs - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Lightweight Wheelchairs - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Standard Wheelchair - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Tilt-in-Space and Standard Hemi Wheelchairs - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist Transport Chairs - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Documentation of Continued Medical Necessity - Letter may be sent to clinicians to help obtain documentation
- Clinician Letter - Medical Records - Letter may be sent to clinicians to help obtain documentation
- Manual Wheelchair Documentation Checklist - Checklist to ensure suppliers gather all required documentation
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Tips
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
The article Billing HCPCS Code K0108 - Wheelchair Component or Accessory, Not Otherwise Specified contains guidelines for appropriate billing of HCPCS Code K0108.
Home Assessment for Manual Wheelchairs Criteria C (Review Type)
For manual wheelchairs, 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. Regardless of the method used for the home assessment, issues such as the physical layout of the home, surfaces to be traversed, and obstacles to the use of the selected manual wheelchair must be addressed by and documented in the home assessment. Information from the beneficiary's medical record and the supplier's records must be available upon request.
KU Modifier
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.
RT/LT Modifiers
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.
Resources
- CMS Change Request (CR) 13610 - Replacement Wheelchair Equipment When the Manufacturer Exits Wheelchair Business
