CORRECT CODING AND BILLING OF CANTILEVER TYPE ARMREST


Cantilever or flip up armrest is a non-detachable or fixed armrest that combines 2 separate functions. It provides (1) height adjustability and (2) the pivot feature moves the armrest in a fashion analogous to a swing away armrest.

There is no additional payment or billable HCPCS code for cantilever flip-up armrests as the function which it provides is included in the Basic Equipment Package for power wheelchairs and /or in the power seating systems sections of the Coding Guidelines. If billed separately, use A9900.

Please refer to the Wheelchair Options/Accessories - Policy Article. The Policy article states:
GENERAL:

Power Wheelchair Basic Equipment Package - Each power wheelchair code is required to include all these items on initial issue (i.e., no separate billing/payment at the time of initial issue, unless otherwise noted). The statement that an item may be separately billed does not necessarily indicate coverage.

  • Armrests. There is no separate billing/ payment if fixed, swing away, or detachable non-adjustable height armrests with arm pad are provided (K0015). Detachable, adjustable height armrests (K0017, K0018, K0020) may be billed separately.
    POWER SEATING SYSTEMS
    A power tilt seating system (E1002) includes: a solid seat platform and a solid back; any frame width and depth; detachable or flip-up fixed height or adjustable height armrests; fixed or swing away detachable leg rests; fixed or flip-up footplates; a motor and related electronics with or without variable speed programmability; a switch control which is independent of the power wheelchair drive control interface; any hardware that is needed to attach the seating system to the wheelchair base. It does not include a headrest. It must have the following features: ability to tilt to greater than or equal to 20 degrees from horizontal; back height of at least 20 inches; ability for the supplier to adjust the seat to back angle; ability to support beneficiary weight of at least 250 pounds.

    A power recline seating system (E1003-E1005) includes: a solid seat platform and a solid back; any frame width and depth; detachable or flip-up fixed height or adjustable height arm rests; fixed or swing away detachable leg rests; fixed or flip-up footplates; a motor and related electronics with or without variable speed programmability; a switch control which is independent of the power wheelchair drive control interface; any hardware that is needed to attach the seating system to the wheelchair base. It does not include a headrest. It must have the following features: ability to recline to greater than or equal to 150 degrees from horizontal; back height of at least 20 inches; ability to support beneficiary weight of at least 250 pounds.

    A power tilt and recline seating system (E1006-E1008) includes: a solid seat platform and a solid back; any frame width and depth; detachable or flip-up fixed height or adjustable height armrests; fixed or swing away detachable leg rests; fixed or flip-up footplates; two motors and related electronics with or without variable speed programmability; a switch control which is independent of the power wheelchair drive control interface; any hardware that is needed to attach the seating system to the wheelchair base. It does not include a headrest. It must have the following features: ability to tilt to greater than or equal to 20 degrees from horizontal; ability to recline to greater than or equal to 150 degrees from horizontal; back height of at least 20 inches; ability to support beneficiary weight of at least 250 pounds.

Published by Noridian as the PDAC, October 2013.  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: 10/01/2013