Medicare Reimbursement and Rules for Electric Wheelchairs

MEDICARE WHEELCHAIR, matress, mobility

Electric Wheelchair Medicare will pay on TV

Medicare information on Powerchairs and Electric Wheelchairs

Used Electric Wheelchairs
Pride Jazzy
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)727-1954

JAZZY Powerchair Platform

1999 Reimbursement Guide

JAZZY 1100

JAZZY 1103

JAZZY 1113

JAZZY 1120

JAZZY 1170 JAZZY 1105

JAZZY 1115 JAZZY 1103

MEDICARE*

The Pride Jazzy 1100, 1120, 1105, 1115, 1103 and the 1170 are classified as standard-weight frame power wheelchairs with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking. The Jazzy's indicated above have been acknowledged by the SADMERC and the DMERCS as payable under the HCPCS Code of K0011. The SADMERC approval letters are on file and are available for your records upon request.

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.

· The informiadon provided rqarding Medicare reinibursenieni wm as

· as possible it £i£ time

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

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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)727-1954

E-Mail

Bruno

MEDICARE WHEELCHAIR, matress, mobility WORLDS LOWEST PRICES 1(800)727-1954

Now! for the WORD'S LOWEST PRICES on OVER 1001 Electric Home Care Products[Adjustable Beds]. The Electric Adjustable Bed comes in your choice of Twin, Full, Queen, King, Dual Queen and Dual King; Options include 3-motor High-Low, Heavy-Duty, Wall-Hugger, Remote and Dual Massage. [Bariatric Eq.] Heavy Duty Hospital Beds, Lift-Chairs, Electric Scooters & Wheelchairs and Patient Lifts[Hospital Beds]come in your choice of all sizes with all mattresses. 2-motor semi-electric and 3 motor fully electric are available.[Lift-Chairs] allow you to sit, stand and recline at the simple touch of your finger [Massage Chairs]. The finest Massage Chair in the world - the Panasonic Shiatsu EP3222.[Mattresses] Choose from Air, Innerspring, Latex and Tempur-Pedic Mattresses. [Patient-Lifts]or Hoyer Lifts. [Ramps][Scooters]3 & 4 Wheel Scooters. [Scooter-Lifts] and Wheelchair lifts for cars, auto's, SUV's, RV's, trucks, etc. [Sleep-Room] [Stair-Lifts]for Residential Used. [Used][Wheelchairs]Jazzy Specialists [Wheelchair-Elevators]Vertical Platform Wheel Chair Elevator Lift. Compare Price, Quality, Guarantee and Service, then call (800)733-1818 for the WORLD'S LOWEST PRICES.