MEDICARE WHEELCHAIR, matress, mobility
JAZZY Powerchair
Platform
JAZZY 1100
JAZZY 1103
JAZZY 1113
JAZZY 1120
JAZZY
1170
JAZZY 1105
JAZZY
1115
JAZZY
1103
MEDICARE*
The K001 HCPCS code is classified by Medicare
as a Capped Rental Item. However, there are special rules for power base
wheelchairs which states that a powerbase wheelchair can be purchased at
the time the equipment is provided (initial issue). Billing a power chair
to Medicare as a purchase requires certain documentation and the use of specific
modifiers. This package illustrates the procedure and paperwork required
when billing a power chair to Medicare as a purchase. If you are interested
in billing Medicare for a power wheelchair through the Capped Rental process,
contact Pride's Reimbursement Department for flirther information. Reimbursement
amounts will vary depending on the state of residence of the beneficiary.
In most cases the fill MSRP amount can be obtained by accepting assignment
on the claim for a Jazzy powerbase
wheelchair.
The Jazzy Powerbase Platform allows you to
provide a stylish, superior performing and highly maneuverable powerbase
wheelchair to qualified Medicare beneficiaries on an assigned
basis.
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The informiadon
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COVERAGE
CRITERIA
BASE
UNIT:
An individual who requires a power wheelchair
is usually totally non-ambulatory and has severe weakness of the upper
extremities that prevents them from self propelling in a manual wheelchair.
Medicare has certain coverage criteria to qualify a patient medically for
a K0011. A Jazzy Powerbase unit could be considered medically necessary when
all of the following coverage criteria are
met:
· The patient's condition
is such that without the use of a wheelchair the patient would be bed
or
chair confined;
and,
· The patient's condition
is such that a wheelchair is medically necessary and the patient is unable
to operate a wheelchair manually; and, (Q7 on
CMN).
· The patient is
capable of safely operating the controls of a power wheelchair (see Documentation
Section).
· The patient requires the use of a wheelchair to move
around in their residence (Q1 on
CMN).
· The patient has
severe weakness of the upper extremities due to a neurological, muscular,
or cardiopulmonary disease or condition (Q6 on
CMN).
· The patient's condition
is such that a power wheelchair will be needed long term (at least six (6)
months).
SEATING:
MEDIUM
BACK
The standard seat configuration (Medium Back
style seat) on the Jazzy is not separately reimbursable by Medicare since
it is considered to be included in the allowance for the power base. If a
special measurement seat is provided, then the specialty dimension could
be billed to Medicare. (See Special Measurement Chart). If there is a medical
need for a different style seat or seating system, Medicare will reimburse
separately. Pride offers several choices of seating options for the
Jazzy.
DELUXE HIGH
BACK w/
HEADREST
The
Deluxe High Back Seat is separately billable
to Medicare using the HCPCS Code K0058-
seat depth of] 7" - 18" for a power wheelchair,
because the seat depth of this
seat is 18" (2" greater than our standard style seat). Please note that when
billing for a Deluxe High Back Seat, the justification needs to be made for
the increased seat depth and not the taller back. Additionally, if other
special measurements are provided, then the specialty dimensions could be
billed to Medicare. (See Special Measurement Chart). Coverage determination
will be based on the patient's height, weight, and overall body shape. The
Headrest that comes standard on the Deluxe High Back Seat is not separately
reimbursable.
SOLID SEAT
PAN
Both the Medium and deluxe High Back Seats
are available with a solid seat pan. This option
allows
A pressure Relieving Cushion(e.g. Roho) to
be placed on the seat. Medicare will reimburse for
a
Cushion if it is medically necessary and
prescribed by a physician for use with the power
wheelchair.
FULLY
RECLINING
BACK
The fully reclining back option is separately
reimbursable if the patient's medical condition justifies the need. A fully
reclining back option (K0028) is covered if the patient spends at least
two hours ~er dav in the wheelchair and has one or more of the following
conditions/needs:
·
Quadriplegia
· Fixed Hip
Angle
· Trunk or lower extremity casts/braces
that require the reclining feature for
positioning.
· Excess extensor tone of the trunk
muscles.
· Patient needs to rest in a recumbent position
two or more times during the day and transfer between wheelchair and bed
is very
difficult.
HEADREST
for Manual
Recline
This option is separately reimbursable if
the patient's medical condition justifies the need. The Headrest (K0025)
option is available on our Fully Manual Reclining Back seat and is covered
if the patient has weak neck muscles and needs a headrest for support, or
the patient meets the criteria and has a reclining back on the
wheelchair.
SPECIALTY
SEAT
This option is not separately reimbursable.
However, this seating system offers a seat width of 20". This dimension may
be billed using K0108 (See Special Measurement Chart). To complete the seating
system for the patient, another seating manufacturer's seat cushion (e.g.
Roho) and seat back (e.g. Sit-Rite) or an orthotic seating system needs to
be placed on the Specialty Seat kit. Depending on the medical necessity of
the patient, the seating items may be separately reimbursable. To determine
correct HCPCS codes and allowables for seating items and seating systems,
contact the SADMERC at 803-736-6809 with the seating manufacturer's name
and item
number.
THE
VERSA-SEAT
The components of the Versa-Seat (framework, rear canes, and solid seat pan) are not separately reimbursable. However, depending on the dimensions
Wheelchairs
| A/C | HCPCS | DESCRIPTION | DCA | MD |
| K0082 | 22 NF DEEP CYCLE LEAD ACID BATTERY, EACH | 94 | 0194 | |
| K0083 | 22 NF GEL CELL BATTERY, EACH | 94 | 0194 | |
| K0084 | GROUP 24 DEEP CYCLE LEAD ACID BATTERY, EACH | 94 | 0194 | |
| K0085 | GROUP 24 GEL CELL BATTERY, EACH | 94 | 0194 | |
| K0086 | U-1 LEAD ACID BATTERY, EACH | 94 | 0194 | |
| K0087 | U-1 GEL CELL BATTERY, EACH | 94 | 0194 |
| A/C | HCPCS | DESCRIPTION | DCA | MD |
| E1210 | MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY SWING AWAY DETACHABLE ELEVATING LEG RESTS | 86 | 0190 | |
| E1211 | MOTORIZED WHEELCHAIRS, DETACHABLE ARMS DESK OR FULL LENGTH SWING AWAY, DETACHABLE EVEVATING LEG REST | 88 | 0190 | |
| E1212 | MOTORIZED WHEELCHAIR,FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS | 88 | 0190 | |
| E1213 | MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESKS OR FULL LENGTH, SWING WASY DETACHABLE FOOT RESTS | 88 | 0190 |
| Manufacturer | Model Name/Number | HCPCS Code |
| 21ST Century Scientific | Big Bounder Bounder Bounder Plus |
K0014 K0011 K0014 |
| Adrono Rogers Technology, Inc. | Adorno ActivX 400 Adorno ActivX 500 |
K0004 K0005 |
| Amigo Mobility | Amigo Excite | K0011 |
| Bruno Independent Living Aids, Inc | Bruno PWC-2200 Bruno PWC-2210 Bruno PWC-2300 Bruno PWC-2310 |
K0011 K0010 K0011 K0010 |
| Convaid | Safari TIlt | K0009 |
| Canadian Wheelchairs | Magic VM Hemi Magic VM Semihemi Magic VM Standard Magic VM SUperlow |
K0003 K0003 K0003 K0003 |
| Custom Adaptive Vans | AMT Power Choice Wheelchair | K0011 |
| DCC Shoprider | Streamer 888W and 888 WS | K0011 |
| Dalton Medical | Jaguar SeaHawk Convertible 790 SeaHawk Super Hemi 799 SeaHawk Super Hemi 799C |
K0004 K0004 K0004(Q) K0004 |
| Damaco | Applause Electro Lite Electro Lite Elite |
K0004 K0004(N) K0001(N) |
| Eagle Parts and Products | Liberty 624 | K0011 |
| Electric Mobility | Chauffeur Model 250 JS (with joystick) Chauffeur 250 PC Chauffeur Model 255 JS HD (with joystick) |
K0010(M) K0010 K0010(M) |
| Electric Mobility (cont'd) | Chauffeur 255 PC Chauffeur Model 270 JS SL (with joystick) Chauffeur Model 275 JS HD SL (with joystick) Rascal Powerchair Rascal Models 250, 255, 270, 275 Rascal 250 PC Rascal 255 PC Viva Powerchair |
K0010 K0010(M) K0010(M) K0011 K0010(M) K0010 K0010 K0011 |
| ETAC | ETAC Twin Swede ACT Swede Basic Swede Cross Swede Elite Swede F3 |
K0004 K0005 K0004 K0005 K0005 K0004 |
| Enduro Wheelchair Co. | Libra Little Star Pegasus Tairus Tyke |
K0009 K0009 K0009 K0002 K0009 |
| Everest & Jennigns | EZ Lite Lancer 2000 Lancer Lightning Lightning LX Magnum Metro Metro LE Metro LX Metro Power MetroXD MX Navigator New Traveler |
K0003 K0011 K0014 K0003 K0004 K0011 K0004 K0004 K0005 K0012 K0007 K0011 K0011 K0006(K)(L) |
| Everest & Jennings (con't d) | New Traveler New Traveler Hemi P2 Plus Premier Classic Premier Classic Quest Sabre Sabre LTD Solaire SPF II Sprint Sprint II Tempest Traveler Traveler Traveler L Traveler XD Universal Universal Universal Vision Barracuda Vision Epic Vision FX Vision Millenium Vision Nitro Vision Reactor Vision Record Vista Vortex Xcaliber |
K0001(I) K0002 K0004 K0007(F) K0001(D) K0012 K0011 K0011 K0011 K0004 K0011 K0010 K0012 K0001(A) K0002(B) K0001 K0007 K0002(B) K0002(C) K0001(A) K0005 K0005 K0005 K0004 K0005 K0005 K0005 K0001 K0011(J) K0014 |
| Evermed | Galaxy High Strenth Lightweight Wheelchair Millennium Recliner Wheelchair Millennium Standard Wheelchair |
K0004 K0009 K0001 |
| Evermed (cont'd) | Value Standard Wheelchair | K0001 |
| Gendron | 2058 2811 2811 4000 5810 5811 5812 5814 5814 5825 5825 5830 5830 6500 7108 7810 7810 8555 58184Q 6518Q 5810LFW Acti-Lite Adult 1000 Acti-Lite Recliner 2000 Acti-Lite Wide 1000 Acti-Lite Youth 3000 Medi-Lite DX 2158 |
K0003 K0003(D) K0007(F) K0004 K0003 K0007(F) K0002(D) K0001(D) K0007(F) K0001(D) K0007(F) K0001(D) K0007(F) K0007 K0001 K0001(D) K0007(F) K0001 K0007 K0007 K0001 K0004 K0001(I) K000(N)(O) K0009 K0003 |
| Golden Technologies | Alante Power WheelChair | K0011 |
| Guardian | GL-2000 GL-2000 GS-2000 GS-2000 |
K0002(B) K0003(H) K0001(A) K0002(B) |
| Guardian (cont'd) | H-1000 H-2000 H-2000 |
K0001 K0001(A) K0002(B) |
| Gunnell | MAC Complete MAC Mobility Base TNT Adult TNT Lite |
K0009 K0009 K0009 K0009 |
| Hoverround | HVR1 HVR2 HVR3 HVR6 HVR7 LTV MPV Teknique HVR 200 |
K0001 K0002 K0003 K0006 K0007 K0011 K0011 K0011 |
| Invacare | 9000 Recliner 9000 SL Series 9000 Tall 9000 XDT 9000 XT Series Action A4 Action AT Action Allegro Action Arrow Action Comet Action Excel Action F4 Action Junior Action MVP Action Orbit Action P7E Action Patriot Action Pro
|
K0001(I) K0004 K0004 K0007 K0004 K0005 K0009 K0005 K0014 K0009 K0010 K0005 K0009 K0005 K0009 K0012 K0004 K0005
|
| Invacare (cont'd) | Action Pro-T Action Style Action Tiger Action TOp End Terminator Action Xtra Careguard Careguard Titan(Formerly Tracer Titan) Futuro 4800, 4130 invacare MG Invacare Patriot (formerly Action Patriot) Patriot SL Pronto R2 with MKIVRII (Model #R2MWD) Power9000 Ranger II Ranger X RideLite 2000 Ride Lite 9000 Rolls 2000 Rolls 4000 Rolls 4000 Rolls 900 Rolls 900 SoloWheelchairSpyder Storm Arrow Storm Ranger X Storm Torque Super Action Pro-T Tracer Tracer EX Tracer DLX Tracer IV Tracer LtTracer LX-Hemi Tracer LX-SA Tracer Plus Tracer SX Tracer Titan XT Youthmobile 9000 Series (Formerly Youthmobile 3000)
|
K0005 K0005 K0014 K0005 K0005 K0001 K0004 K0001 K0001 K0004 K0004 K0011 K0012 K0011 K0011 K0004 K0004 K0003 K0001(D) K0007(F) K0001(D) K0006(E) K0009 K0005 K0014 K0011 K0011 K0005 K0001 K0002 K0007 K0003 K002(B) K0001(A) K0001 K0003 K0004 K0014 K0009
|
| Kareco | Cabbie COmpanion Impct-Hemi Impact-Lite Wide Impact Recliner Impact Wide KLassic-Lite Klassic-Plus Rough Rider
|
K0009 K0002 K0003 K0006(K) K0001(I) K0007(K) K0003 K0003 K0001 |
| Kuschall | Champion 1000 Impact-Hemi Impact-Lite Hemi Impact-Lite Wide Impact Recliner Impact Wide Klassic-Lite Klassic-Plus Rough Rider |
K0009 K0002 K0003 K0006(K) K0001(I) K0007(K) K0003 K0003 K0001 |
| Labac | Btc MRC MTC MTRC |
K0009 K0001(I) K0009 K0009 |
| Leisure-Lift | PaceSaver Scout PaceSaver Scout NP Scout M1 |
K0011 K0010 K0011 |
| Love Lift | Love LIft System 221 4P | K0014 |
| Lumex | 1000 Series 3000 Series 4000 Series 5000 Series 5000 Series Transport 5000 Series Wide 20" 5000 Series Wide 22" 5000 Series Wide 24" 6000 Series Hemi Trekker Trekker C Trekker Full Recliner Trekker H Trekker HEavy Duty Wide Trekker Hemi Trekker L Trekker X (Deluxe) Trekker X (Deluxe)
|
K0001 K0003 K0001 K0002 K0001 K0006(K) K0007(L) K0007(L) K0002 K0004 K0009 K0002(I) K0004 K0002 K0003 K0001(L) K0003(P)
|
| Maple LEaf Wheelchairs | MLT700A MLTR600 Access NRG + Supertilt Swift
|
K0001 K0001 K0003 K0003 K0001(I) K0003
|
| Medbloc | Eclipse 350 Eclipse 600 |
K0007 K0009 |
| Medline | Excel ( MDS806100) Excel 2000 (MDS806100D, MDS806150D, MDS806200D, MDS806250D, MDS806300D Excel Extra Wide (MDS806700) Excel Hemi ( MDS806400) Excel K4 (MDS806400, MDS806550) Excel Lightweight (MDS80660) Excel Narrow (MDS806150N)
|
K0001 K0001 K0007 K0002 K0004 K0003 K0001
|
| Medline (cont'd) | Shuttle (MDS80955, MDS809525, MDS809550, MDS809575) | K0007 |
| Merits | M11 M12 Rover Travelbase MP-3 Power Base Chair Travel-Ease Travel-Ease Hemi (Model M46) Travel Ease 20" Travel Ease 22" Travel Ease 24" |
K0003 K0004 K0011 K0011 K0002 K0006 K0007 K0007 |
| Morgan Tech, Inc. | Microlite SL Microlite SLS SL SLS |
K0003 K0003 K0003 K0003 |
| Natural Access | Landeex All-Terrain Wheelchair | A9270 |
| Optima | EcoStar Premium Sport One Super Junior Super One Ultralight Universal |
K0003 K0003 K0005 K0009 K0009 K0004 K0004 |
| Optiway Technology, Inc. | Corsair | K0011 |
| Ortho Fab | Grizzly Kameleon |
K0011 K0011 |
| Otto Bock Group | Protege Z-700B Z-700C Z-700L Z-750 |
k0004 k0005 k0005 k0005 k0004 |
| Pediatric | Manual Power |
K0009 K0014 |
| Permobil | Avenger Boing Chairman Basic Challenger Eclipse G force Hexior Impact Little Dipper Max 90 Swoosh Xtreme |
K0005 K0005 K0011 K0005 K0005 K0005 K0014(J) K0005 K0009 K0014(J) K0005 K0005 |
| Pillar Technology, Inc. | Deluxe Snappy(TE888W) Snappy (TE888W) |
K0011 K0011 |
| Pride | Jazzy 1100 Jazzy 1113 Jazzy 1115 Jazzy 1400 Jazzy 1420 Jazzy 1470 Jazzy Basic 1104, 1105 Jazzy Mini Power 1103 Jazzy 1120 Jazzy 1143 Jazzy Basic 1104, 1105 Jazzy PHC1, PHC5 Jazzy PHC-10 Jazzy XL Model 1170 Jet 1 Power WheelChair Jet 10 Power wheelchair |
K0011 K0011 K0011 K0014 K0014 K0014 K0011 K0011 K0011 K0011 K0011 K0011 K0010 K0011 K0011 K0010 |
| Quickie | Breezy Breezy 2 Breezy 500 |
K0004 K0004 K0004 |
| Quickie | Breezy 510 (formerly Breezy) Breezy 600 (Formerly Breezy 2) Carbon EX G-424 GP GPS GPS Swing-away GPS TI GPV LX LXI P-100 P-110 P-120 P-190 P-200 P-210 P-300 P-320 Quickie 2 Quickie 2HP Quickie ST-DT (Formerly Shadow) Quickie V-121 (Formerly Quickie P-120) Quickie V-521 Recliner Revolution RX S-525 Shadow T45 TI TNT Triumph TS
|
K0004 K0004 K0005 K0004 k011 K0005 K0005 K0005 K0005 K0005 K0004 K0005 K0012 K0012 K0012 K0011 K0011 K0011(J) K0014 K0014 K0005 K0005 K0005 K0012 K0011 K0001(I) K0005 K0004 K00011 K0005 K0009 K0009 K0005 K0005 K0009
|
| Redman | Chief Ru Chief Sr Geromimo Pr Geromimo RC Power Road Warrior ROad Savage |
K0014 K0014 K0011(J) K0011 K0011 K0011 |
| Summit Durable Medical Equipment | Catalina (Models 120, 120S, 130, 130L/DX, 130S) Dimension (180E, 180LE, 180SE) Excel (340, 340E, 340S, 340SE) Explorer (Models 130XL, 130XXL, 130XL/ECO, 130XXL/EOC Horizon (Models 250,250L, 250S) Junior (Models 190, 190E, 190S, 190SE) Legacy ( 290, 290E, 290L,, 29OLE, 290S, 290SE) Legacey Ultra (310, 310L, 310S) Legacey Ultra X (320,320L, 320X) Lunar (Models 220, 2209S, 220/DLX, 230, 230L, 230S) Newport (Models 140, 150,150L, 150L/DX, 150S) Pioneer( Modeles 140S) Pioneer(Models 140,150,150LL, 150L/DX,150S) Sierra (odels 150XL,150XXL) |
K0001 K001(I) K0003 K0007 K0003 K0009 K0003 K0003 K0003 K0003 K0003 K0003 K0002 K0007
|
| Sutter Medical | World Class Wheeled Chair | K0009 |
| Teftec Corportation | Omega Trac | K0011 |
| Theradyne | Envoy Hemi Envoy Lightweight Envoy Recliner Envoy Standard ENvoy WIde |
K0003 K0004 K0001(I) K0003 K0007(K) |
| Theradyne (cont'd) | Integra Maxim Hemi Maxim Lightweight Maxim Recliner Mazxim SL Maxim SL Hemi Maxim Standard Maxim WIde Rover TS(FOrmerly Vassilli Tilt) Roover R ( FOrmerly Vassilli Recline) Rover LWF Plus ( Formerly Vassilli T2 Rover LWF T i (Formerly VassilliT1) Rover LWF T1 Junior (Formerly Vassilli T1 Junior) T-Bird Adjustable T-Bird Standard T-Bird Youth Vassilli Lifestyle Vassilli Manual stander Vassilli Manual Stander-Junior Vassilli Power Stander Vassilli Power Stander-Junior Vasso;;o Rec;ome Vasso;;o T1 Vassilli T1 Junior Vassilli T2 Vassilli T2 Junior Vassilli Tilt Venture Hemi Venture Hemi Lightweight Venture Lightweight Venture Standard Venture Wide |
K0003 K0003 K0004 K0001 (I) K0003 K0003 K0003 K0007 K0014 K0014 K0011 K0011 K0014 K0005 K0003 K0009 K0014 K0014 K0014 K0014 K0014 K0014 K0011 K0014 K0011 K0014 K0014 K0003 K0003 K0003 K0003 K0007 |
| The Standing Company |
Lifestand | K0009 |
| Tuffcare | Challenger 2000 Challenger DX 1450 Challenger DX 1500 Challenger Extra WIde 2500 Challenger Pediatric 1000 Challenger Recliner 2040 Compact 777 Compact Pediatric 997 Compact SUper Hemi 770/797/797W Eagle Economy 247 Extra Wide Hemi 352/352X/355/357 Extra Wide Recliner 495/497E/497XE Falcon Falcon Hemi/Adult Falcon Hemi/Pediatric Falcon Pediatric Falcon Pediatric Recliner Hawk Convertible 795 Hawk SUper Hemi Hemi Deluxe/ Adult Hemi Deluxe/ Pediatric Newport Extra Wide Newport Recliner 475/477E/477WE (Adult) Newport Recliner 475 (Pediatric) Reliance Super Eagle SUper Extra Wide Tilt-in0Space Recliner 455 Transporter Tuffy Deluxe 867/887 Tuffy Extra Wide 377
|
K0009 K0011 K0010 K0011 K0014 K0014 K0011 K0004 K0009 K0004 K0001 K0003 K0007 K0007(I) K0003 K0003 K0009 K0009 K0009 K0003 K0003 K0002 K0009 K0007(L) K0009 K0009 K0001 K0006 K0007 K0009(I) K0009 K0001 K0007
|
| Tuffare (cont'd) | Tuffy Extra Wide Hemi 356/358 Tuffy Hemi 887/897 Tuffy Hemi Light 687/697 Tuffy Light 667/667 Tuffy Recliner 477 Tuffy Standard 257/267/277 Tuffy Super Extra Wide 397 Ultra Lightweight Transporter |
K0007 K0002 K0003 K0003 K0001(I) K0001 K007 K0009 |
| Wheel Ring, Inc. | Taurus | K0003 |
| Wheelcare, Usa | Powerchair | K00014 |
| Wheelchairs Of Kansas | BCW 600 BCW Power BCW recliner OVerlander /PEV 2000 WIZZ-ard |
K0007 K0014 K0007 K0014 K0006 |
| Winmed Products Company | Tango Power Wheelchair | K0011 |
| Wu Ho Medical | EIM Wheelchair | K0005 |
| XL Manufacturing | Challenger Comp Pacer |
K0009 K0004 K0003 |
FOOTNOTES
Note (A): Use K0001 if seat height is greater than or eequal to 19 inches
and seat width is <22 inches.
Note (B): Use K0002 if seat height is less than 19 inches and seat width
is < 22 inches.
Note (C): Use K0006 if seat height is less than 19 inches and seat width
is < 22 inches.
Note (D): Use K0001 if seat width is < 20 inches.
Note (E): Use K0006 idf seat width is greater than or equal to 20 inches.
Note (F): Use K0007 if seat width is greater than or equal to 20 inches.
Note (G): Use K0002 if seat width is <20 inches.
Note (H): Use K0003 if seat height is less than 19 inches.
Note (I): Codee the reclining back separetely using k0028
Note (J): Code the power recline/ tilt separately using K0108
Note (K): Code seat width of 19 or 20 inches separately using K0057.
Note (L): Code seat width > 18 inches separately using K0108.
Note (M): Use K0010 only if these models come with joystick control.
Use E1230 if they come with side-mounted tiller control.
Note (N): Code the power module separately using K0460 (Was K0108prior to
10/1/98).
NOte (O): Use K0056 if seat depth is less than 17 o requal to or greater
than 21 inches.
Note(P): Use k0003 if seat depth is 16 inches.
Note(Q): Use K0056 if seat height is less than 17 inches or equal to or greater
than 21 inches
Motorized /Power Wheelchair Base
HCPCS CODES
K0010 - Standard weight frame motorized/power wheelchair
K0011 - Standard-weight frame motorized/power wheelchair with programmable control
parameters for speed adjustment, tremor dampening, acceleration control and braking
K0012 - Lightweight portable motorized/power wheelchair
K0014 - Other motorized/power wheelchair base
K0460 - Power add-on, to convert a manual wheelchair to motorized wheelchair, joystick control
BENEFIT CATEGORY
Durable medical equipment
REFERENCE:
Coverage Issues manual 60-6, 60-9
DEFINITIONS:
Motorized/power wheelchair (K0010, K0011, K0012) are characterized by:
Seat Width: 14" - 18"
Seat Depth: 16"
Seat Height: > 19" and < 21"
Back Height Sectional 16" or 18"
Arm Style: Fixed height, detachable
Footplate Extension 16" - 21"
Footrests: Fixed or swingaway detachable
In addition, a lightweight power wheelchair (K0012) is characterized by:
Weight < 80 lbs, without battery
Folding back or collapsible frame
Wheelchair "poundage" (lbs.) represents the weight of the usual configuration of the wheelchair without
Frontriggings
COVERAGE AND PAYMENT RULES:
For any item to be covered by Medicare, it must
1) be eligible for a defined Medicare benefit category
2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve
the functioning of a malformed body member, and
3) meet all other applicable Medicare statutory and regulatory requirements. For the items addressed
in this medical policy, "reasonable and necessary" are defined by the following coverage and payment
rules.
A power wheelchair is covered when all the following criteria are met:
1) The patient's condition is such that without the use of a wheelchair the patient would otherwise
be bed or chair confined and;
2) The patient's condition is such that a wheelchair is medically and the patient is unable to operate a
wheelchair manually and;
4) The patient is capable of safety operating the control for the power wheelchair.
A patient who requires a power wheelchair usually is totally nonambulatory and has severe weakness of
The upper extremities due to a neurologic or muscular disease/condition.
If the documents does not support the medical necessity of a power wheelchair but does support the medical
Necessity of a manual wheelchair payment is based on the allowance for the least costly medical appropriate
Alternative. However, if the power wheelchair has been purchased, and the manual wheelchair on which
Payment is based is in the capped rental category, the power wheelchair will be denied as not medically necessary.
Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are
Noncovered.
A power wheelchair is covered if the patient's condition is such that the requirement for a power wheelchair
Is long term (at least six months).
Payment is made for only one wheelchair at a time. Backup chairs are denied as not medically necessary.
One month's rental of a wheelchair is covered if a patient-owned wheelchair is being repaired.
Reimbursement for the wheelchair codes includes all labor charges involved in the assembly of the wheelchair
And all covered additions or modifications. Reimbursement also includes support services, such as
Emergency services, delivery, set-up, education, and on-going assistance with use of the wheelchair.
CODING GUIDELINES:
Wheelchairs with individualize features which meet the needs of a particular patient are billed by selecting the
Correct code for the wheelchair base and then using appropriate codes for wheelchair options and accessories.
(Refer to the wheelchair Options and accessories policy.) If the frame of the wheelchair is modified in a unique
way to accommodate the patient, bill the code for the wheelchair base and bill the modifications with code
K0108 (wheelchair component or accessory, not otherwise specified).
Codes K0010 - K0014 are not used for manual wheelchair with add-on power packs. Use the appropriate code
For the manual wheelchair base provides (K0001-K0009) and doe K0460.
Codes E1210 - E1220 should only be used to bill for maintenance and service for an item for which the initial
Claim was paid to the local carrier prior to the transition to the DMERC.
A supplier wanting to know which code to use describe a particular product should consult the Wheelchair base
Product Classification List published by the SADMERC. Questions concerning
the coding of items not on the list should be directed to the Statistical Analysis
DMERC(SADMERC). For wheelchair bases not on the list,
Suppliers should use their knowledge of the product and the information in the Definition section of this policy
To determine the correct code until a determination is published by the DMERC or they receive a response to a
Coding inquiry.
DOCUMENTATION:
For an items to be considered for coverage and payment by Medicare, the information submitted by the supplier
Must be corroborated by documentation in the patient's medical records that Medicare coverage criteria have
Been met. The patient's medical records include the physician's office records, hospital records, nursing home
Records, home health agency records, records from other healthcare professionals, or test reports.
This documentation must be available to the DMERC upon request.
A certificate of medical necessity , which has been filled out, signed, and dated by the treating physician, must
Be kept on file by the supplier. The CMN for power wheelchairs is HCFA Form 843. This applies to the
Power add-on code K0460 as well as to the power wheelchair bases K0010-K0014.
The initial claim must include a copy of the CMN, if filed in hard copy. If the claim is filed electronically, the
Information on the CMN must be transcribed exactly into the GU0 record.
(See the DMEPOS National Standard Format Matrix for details.) If additional medical necessity information is included, this would be
Transcribed into the HA0 record.
Power wheelchair described by codes K0011 are eligible for Advance Determination of Medicare Coverage
(ADMC) only when a power tilt and/or power recline seating system or a non-joystick control device (e.g. head
control, sip and puff, switch control) is ordered. Refer to the ADMC section in chapter 9 of the supplier manual
for details concerning the ADMC process.
When billing K0014, the claim must include documentation indicating the brand name and model name/number
Of the base, and statement documenting the medical necessity of this base for the particular
patient including why another base (K0010-K0012) was not acceptable.
Accessories to the wheelchair base should be billed on the same claim.
If additional claim forms are needed, charge should be carried over and the total should be entered on the last page.
Refer to the supplier Manual for more information on orders, CMNs, medical records, and supplier documentation.
EFFECTIVE DATE:
Claims for details of service on or after January 1, 2002
This is revision of a previously published policy.
Used Electric
Wheelchairs
Pride Jazzy
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
XYZ
1
2
3
4
5
6
7
8
9
Electric Scooters
Powerchair-Lifts
Lift-Chairs
Stair-Lifts
Pride-Jazzy Wheelchair-Elevators
Hospital Beds Panasonic-Shiatsu Adjustable Beds
Used
Bariatric-Heavy-Duty
Service-Repair-Parts
Latex Foam
Medicare
will pay 80% of the full amount for the purchase of an electric wheelchair
if you qualify.
To order,
or if you have any questions, please contact Aamcare-Electropedic.com for
complete information:
call toll free 1(800)477-0248