Billing HCPCS Code K0108 - Wheelchair Component or Accessory, Not Otherwise Specified - JA DME
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). If multiple miscellaneous accessories are provided, each should be billed on a separate claim line using code K0108. When billing more than one line item with code K0108, ensure that the additional information can be matched to the appropriate line item on the claim. It is also helpful to reference the line item to the submitted charge.
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:
- Description of the item or service
- Manufacturer name
- Product name and number
- Supplier Price List (PL) amount
- HCPCS code of related item (if applicable)
The NTE 2400 Field of an electronic claim is limited to 80 characters; therefore, suppliers are encouraged to use our list of Common Abbreviations to Use as Narratives to condense all of the required information into this field.
Miscellaneous HCPCS codes billed without this information will be rejected and will need to be resubmitted with the missing information included.
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. There is no separate billing for actuators. Actuators are included in the code for the components that contain them. Separate billing for an actuator is allowed only for replacement of a malfunctioning item. When billing for a replacement actuator, the correct code to bill is:
E2378 - POWER WHEELCHAIR COMPONENT, ACTUATOR, REPLACEMENT ONLY
Another example of incorrect coding is billing the K0108 for a wheelchair tray. The wheelchair tray has a correct HCPCS code, the correct code to bill is:
E0950 WHEELCHAIR ACCESSORY, TRAY, EACH
The fee schedule for items for which charge data is not available or published is calculated based on:
- Fee schedule amounts for comparable equipment
- Fee schedule amounts of other DME MACs
- Supplier price lists
- Manufacturers wholesale price
Where supplier price lists are used, efforts are made to obtain prices in effect during the base year. Mail order catalogs are often used as sources of price information. A deflation factor is applied if the price information is from a period other than the base period. This is done to approximate the base year price for gap filling purposes. For more information on the pricing methodology used for unpublished fee schedules review Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Fee Schedule Administration and Coding Requirements.
Refer to the Wheelchair Options/Accessories LCD (L33792) and related Wheelchair Options/Accessories - Policy Article (A52504) for additional information. For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor
Last Updated Tue, 26 Apr 2022 13:09:26 +0000