Manual Wheelchairs

The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic Details
ADMC (Review Type)
  • Manual wheelchairs described by HCPCS E1161, E1231 - E1234, K0005, K0008, and K0009 are eligible for ADMC
Criteria C (Review Type)
  • For manual wheelchairs, a home assessment may be provided directly, by visiting beneficiary's home, or indirectly, based upon information provided by beneficiary or his/her designee. When a home assessment is based upon indirectly obtained information, supplier must, at time of delivery, verify that item delivered meets requirements specified in criterion C. Issues such as physical layout of home, surfaces to be traversed and obstacles must be addressed by and documented in home assessment
KU Modifier January 1, 2020 The use of the KU modifier will start with claims submitted on July 6, 2020 and be effective for dates of service from January 1, 2020 through June 30, 2021 for certain wheelchair accessories and seat back cushions used with complex rehabilitative manual wheelchairs and certain manual chairs. The full list of accessories impacted start on page 9 of the CMS Change Request 11635 and apply to wheelchair codes K0005, E1161, E1231-E1238 and K0008.
RT/LT Modifiers Effective for claims with dates of service (DOS) on/after 3/1/2019, suppliers must bill each item on two separate claim lines 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. See Correct Coding - RT and LT Modifier Usage Change for more information

 

Last Updated Mon, 08 Jun 2020 19:36:25 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

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