Manual Wheelchairs

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
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 Mar 19, 2019

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.

Manual Wheelchair Targeted Probe and Educate Review Updates: October - December 2018  Mar 05, 2019
Correct Coding - RT and LT Modifier Usage Change  Feb 28, 2019
Manual Wheelchair Targeted Probe and Educate Review Updates: July - September 2018  Dec 31, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 to Bill for Wheelchair Ventilator Tray DMD   Jul 05, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 to Bill for Wheelchair Tray DMD   Jul 05, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 to Bill for Replacement of Wheelchair Seat and Back Upholstery DMD   Jul 05, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 to Bill for a Wheelchair Headrest DMD   Jul 05, 2018
Manual Wheelchairs Targeted Probe and Educate Review Updates: January - March 2018  Jun 07, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings - Shoe Holder or Shoe Holder Replacement Straps DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Front Riggings - Calf Pad or Calf Support DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Transit System and Associated Bracket DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Labor Charges DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for Anti-Tip Devices for Manual Wheelchairs DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Wheel Lock Brake Extension for Manual Wheelchairs DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for a Privacy Flap DMD   Mar 22, 2018
Correct Coding - Incorrect Use of HCPCS Code K0108 To Bill for an Actuator DMD   Mar 22, 2018
Correct Coding - Custom Fabricated Wheelchair Seat and Back Cushions DMD   Feb 22, 2018
Manual Wheelchair (HCPCS K0001, K0003) Quarterly Results of Service Specific Prepayment Review  Jun 09, 2017
Manual Wheelchairs (HCPCS K0001, K0003) Quarterly Results of Service Specific Prepayment Review  Mar 06, 2017