MANUAL WHEELCHAIR BASES - CORRECT CODING - REVISED


Joint DME MAC Publication

This replaces a previous version published February 13, 2014

Recently, manual wheelchair coding applications describing products that are not complete, functional manual wheelchairs have been received by the Pricing, Data Analysis and Coding (PDAC) contractor.

For Medicare coding purposes, all manual wheelchair base codes describe a complete product. A complete manual wheelchair base includes:

  • A complete frame
  • Propulsion wheels
  • Casters
  • Brakes
  • A sling seat, seat pan which can accommodate a wheelchair seat cushion, or a seat frame structured in such a way as to be capable of accepting a seating system
  • A sling back, other seat back support which can accommodate a wheelchair back cushion, or a back frame structured in such a way as to be capable of accepting a back system
  • Standard leg and footrests
  • Armrests
  • Safety accessories (other than those separately billable in the Wheelchair Accessories Local Coverage Determination)
    The bundling table contained in the Wheelchair Options and Accessories LCD related Policy Article CODING GUIDELINES section describes the items included as part of the following bases:
  • Rollabout Chair (E1031)
  • Transport Chairs (E1037, E1038, E1039)
  • Manual Wheelchair Bases (E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009)

PDAC coding applications for manual wheelchairs that describe incomplete products will receive a "No HCPCS Code Assigned" determination. If the manual wheelchair base is incomplete, any accessories associated with the application will not be processed.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding contractor (PDAC) at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.

 

Published by Noridian as the PDAC, April 2016.  Republished by Palmetto GBA as the PDAC, February 2019. Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.



Last Updated: 04/27/2016