Article Detail - JD DME

Original Effective Date: 06/04/2010
Revision Effective Date: 11/01/2013

Recently it has come to the attention of the DME MACs that there is confusion regarding the billing of wheelchair electronics. This article provides instructions on appropriate billing of power wheelchair electronics, such as motors, controllers, harnesses and interfaces.

When one power seating function/actuator/motor is provided on a power wheelchair, one unit of E2310 (electronic connection between wheelchair controller and one power seating system motor) is allowed. An expandable controller (E2377) and harness (E2313) are not allowed in this situation unless a specialty interface is used.

Example: E1002 (power seating system, tilt only) is added to a power wheelchair. A power tilt system uses one power seating motor/actuator.

When two power seating functions/actuators/motors are provided, one unit of E2311 (electronic connection between wheelchair controller and two or more power seating system motors) is allowed. An expandable controller (E2377) and harness (E2313) are not allowed in this situation unless a specialty interface is used.

Example: E1006 (Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction) is added to a power wheelchair. The tilt and the recline functions each have one actuator or power seating system motor, for a total of two.

When three or more power seating functions/actuators/motors are provided, one unit of E2311 (electronic connection between wheelchair controller and two or more power seating system motors), one unit of E2377 (expandable controller), and one unit of E2313 (harness for upgrade to expandable controller) are allowed.

Example: E1008 (Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction) is added to a power wheelchair. The tilt, recline, and power shear reduction features each have one actuator or power seating system motor, for a total of three.

An expandable controller (E2377) and the wiring harness (E2313) are also allowed when a specialty interface is required, i.e., head control interface (E2327, E2328, E2329, E2330), sip-n-puff interface (E2325), joystick other than a standard proportional joystick (E2312, E2321, E2373), or multi-switch hand control interface (E2322).

There is no separate billing/payment for electronics if a non-expandable controller and a standard proportional joystick (integrated or remote) are provided.

Codes E2310 and E2311 describe electronic components that allow the patient to control two or more of the following motors from a single interface, e.g., proportional joystick, touchpad, or nonproportional interface:

• Power tilt
• Power recline, with or without shear reduction
• Combination power tilt and recline, with or without shear reduction
• Power leg elevation with or without articulation, power center mount elevating foot platform with or without articulating properties.

The interface includes a function selection switch that allows the patient to select the motor that is being controlled and an indicator feature to visually show which function has been selected. When the wheelchair drive function has been selected, the indicator feature may also show the direction that has been selected (forward, reverse, left, right). This indicator feature may be in a separate display box or may be integrated into the wheelchair interface. Payment for the interface code includes an allowance for fixed mounting hardware for the control box and the display box, if present.

A harness (E2313) describes all the wires, fuse boxes, fuses, circuits, switches, etc. that are required for the operation of an expandable controller (E2377). It also includes all the necessary fasteners, connectors, and mounting hardware.

There is no separate billing for control buttons, displays, switches, etc. There is no separate billing for fixed mounting hardware, regardless of the body part used to activate the joystick.

Suppliers are encouraged to read the entire DME MAC local coverage determination and policy article for Wheelchair Options and Accessories for additional coverage, coding and documentation requirements.