RETIRED - Correct Coding - WHILL Powered Personal Mobility Devices - Revised - JD DME

DME MAC Joint Publication

This is a revision to the article, "Correct Coding - WHILL Powered Personal Mobility Devices", published in July 2016. This article updates the HCPCS Code assignment for WHILL Model M.

WHILL, Inc., (San Carlos, CA), is the manufacturer of WHILL powered personal mobility devices. They currently have two power wheelchair (PWC) products, Model A and Model M.

WHILL Model A

The FDA has not approved the WHILL Model A. FDA approval is required by Medicare; therefore, it not considered a medical device. Consequently, this item is non-covered (no Medicare benefit). For Medicare billing purposes, claims for the WHILL Model A must be submitted using the following HCPCS code:

• A9270 - NONCOVERED ITEM OR SERVICE

This code is considered as all-inclusive for this product. None of the existing HCPCS codes for wheelchair bases, options, accessories, seating, etc. are appropriate for use with this product. Claims for this item using existing wheelchair-related codes will be denied as incorrect coding.

WHILL Model M

The WHILL Model M received a 510(k) FDA clearance for marketing as a Class II Powered Wheelchair on February 12, 2016. A HCPCS code request for this product has been submitted to the Pricing, Data Analysis and Coding (PDAC) Contractor and a HCPCS code assignment has been made. The WHILL Model M is a four-wheel drive PWC. Four-wheel drive is a capability that is not needed for use in the home. PWCs with functionality that is not needed in the home are classified into PWC Group 4; however, this product failed to meet several other Group 4 performance-testing requirements. Therefore, for Medicare billing purposes, claims for this device must be submitted using the following HCPCS code:

• K0898 - POWER WHEELCHAIR, NOT OTHERWISE CLASSIFIED

This code is considered as all-inclusive for this product. None of the existing HCPCS codes for wheelchair bases, options, accessories, seating, etc. are appropriate for use with this product. Claims for this item using existing wheelchair-related codes other than HCPCS code K0898 will be denied as incorrect coding.

Items billed with any HCPCS code with a narrative description that indicates miscellaneous, not otherwise classified (NOC), unlisted, or non-specified, must also include the following information in loop 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)

Miscellaneous HCPCS codes billed without this information will be rejected and will need to be resubmitted with the missing information included.

General Information

DMEPOS Suppliers are reminded that:

• As noted in the DME MAC Power Mobility Devices Local Coverage Determination and related Policy Article, products with capabilities that exceed what is required in the home setting are considered not reasonable and necessary.
• There is no Medicare reimbursement available for repairs or replacement of non-covered items.

Refer to the Power Mobility Devices, Wheelchair Options and Accessories, and Wheelchair Seating LCDs and related Policy Articles for additional information on coverage, coding and documentation requirements.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contractor Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form at https://www.dmepdac.com/.

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