MANUAL WHEELCHAIR BASES


Recently it has been brought to the attention of the Pricing, Data Analysis and Coding Contractor (PDAC) that manufacturers are submitting incomplete wheelchair bases on Coding Verification Review Applications. For Medicare payment purposes a manual wheelchair HCPCS codes describes a complete product as described in the bundling table contained in the Wheelchair Options and Accessories LCD. Column I codes contains all of the items listed in Column II.

Column I

Column II

Power Operated Vehicle (K0800–K0812)

All options and accessories

Rollabout Chair (E1031)

All options and accessories

Transport Chair (E1037, E1038, E1039)

All options and accessories except E0990, K0195

Manual Wheelchair Base (E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009)

E0967, E0981, E0982, E0995, E2205, E2206, E2210, E2220, E2221, E2222, E2224, E2225, E2226, K0015, K0017, K0018, K0019, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0052, K0069, K0070, K0071, K0072

Power Wheelchair Base Groups 1 and 2 (K0813–K0843)

E0971, E0978, E0981, E0982, E0995, E1225, E2366, E2367, E2368, E2369, E2370, E2374, E2375, E2376, E2378, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, K0015, K0017, K0018, K0019, K0037, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0051, K0052, K0098

Power Wheelchair Base Groups 3, 4, and 5 (K0848–K0891)

E0971, E0978, E0981, E0982, E0995, E1225, E2366, E2367, E2368, E2369, E2370, E2374, E2375, E2376, E2378, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, K0015, K0017, K0018, K0019, K0037, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0051, K0052, K0098

E0973

K0017, K0018, K0019

E0950

E1028

E0990

E0995, K0042, K0043, K0044, K0045, K0046, K0047

Power tilt and/or recline seating systems (E1002, E1003, E1004, E1005, E1006, E1007, E1008)

E0973, K0015, K0017, K0018, K0019, K0020, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052

E1009, E1010

E0990, E0995, K0042, K0043, K0044, K0045, K0046, K0047, K0052, K0053, K0195

E2325

E1028

E1020

E1028

K0039

K0038

K0045

K0043, K0044

K0046

K0043

K0047

K0044

K0053

E0990, E0995, K0042, K0043, K0044, K0045, K0046, K0047

K0069

E2220, E2224

K0070

E2211, E2212, E2224

K0071

E2214, E2215, E2225, E2226

K0072

E2219, E2225, E2226

K0077

E2221, E2222, E2225, E2226

K0195

E0995, K0042, K0043, K0044, K0045, K0046, K0047

A manual wheelchair base includes but is not limited to:

  • a complete frame
  • propulsion wheels and brakes
  • casters
  • a seat or seat pan (which can accommodate a wheelchair seat cushion or other seating system)
  • a back frame
  • standard leg and footrests
  • armrests
  • safety accessories (other than those separately billable in the Wheelchair Accessories Local Coverage Determination).
    As described above, the following HCPCS codes are included in the allowance for the base wheelchair on initial issue:
    E0967 MANUAL WHEELCHAIR ACCESSORY HAND RIM WITH PROJECTIONS ANY TYPE EACH
    E0981 WHEELCHAIR ACCESSORY SEAT UPHOLSTERY REPLACEMENT ONLY EACH
    E0982 WHEELCHAIR ACCESSORY BACK UPHOLSTERY REPLACEMENT ONLY EACH
    E0995 WHEELCHAIR ACCESSORY CALF REST/PAD EACH
    E2205 MANUAL WHEELCHAIR ACCESSORY HANDRIM WITHOUT PROJECTIONS (INCLUDES ERGONOMIC OR CONTOURED) ANY TYPE REPLACEMENT ONLY EACH
    E2206 MANUAL WHEELCHAIR ACCESSORY WHEEL LOCK ASSEMBLY COMPLETE EACH
    E2210 WHEELCHAIR ACCESSORY BEARINGS ANY TYPE REPLACEMENT ONLY EACH
    E2220 MANUAL WHEELCHAIR ACCESSORY SOLID (RUBBER/PLASTIC) PROPULSION TIRE ANY SIZE EACH
    E2221 MANUAL WHEELCHAIR ACCESSORY SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE) ANY SIZE EACH
    E2222 MANUAL WHEELCHAIR ACCESSORY SOLID (RUBBER/PLASTIC) CASTER TIRE WITH INTEGRATED WHEEL
    E2224 MANUAL WHEELCHAIR ACCESSORY PROPULSION WHEEL EXCLUDES TIRE ANY SIZE EACH
    E2225 MANUAL WHEELCHAIR ACCESSORY CASTER WHEEL EXCLUDES TIRE ANY SIZE REPLACEMENT ONLY
    E2226 MANUAL WHEELCHAIR ACCESSORY CASTER FORK ANY SIZE REPLACEMENT ONLY EACH
    K0015 DETACHABLE NON-ADJUSTABLE HEIGHT ARMREST EACH
    K0017 DETACHABLE ADJUSTABLE HEIGHT ARMREST BASE EACH
    K0018 DETACHABLE ADJUSTABLE HEIGHT ARMREST UPPER PORTION EACH
    K0019 ARM PAD EACH
    K0042 STANDARD SIZE FOOTPLATE EACH
    K0043 FOOTREST LOWER EXTENSION TUBE EACH
    K0044 FOOTREST UPPER HANGER BRACKET EACH
    K0045 FOOTREST COMPLETE ASSEMBLY
    K0046 ELEVATING LEGREST LOWER EXTENSION TUBE EACH
    K0047 ELEVATING LEGREST UPPER HANGER BRACKET EACH
    K0050 RATCHET ASSEMBLY
    K0052 SWINGAWAY DETACHABLE FOOTRESTS EACH
    K0069 REAR WHEEL ASSEMBLY COMPLETE WITH SOLID TIRE SPOKES OR MOLDED EACH
    K0070 REAR WHEEL ASSEMBLY COMPLETE WITH PNEUMATIC TIRE SPOKES OR MOLDED EACH
    K0071 FRONT CASTER ASSEMBLY COMPLETE WITH PNEUMATIC TIRE EACH
    K0072 FRONT CASTER ASSEMBLY COMPLETE WITH SEMI-PNEUMATIC TIRE EACH
    K0077 FRONT CASTER ASSEMBLY, COMPLETE, WITH SOLID TIRE, EACH
    Manual wheelchairs submitted to the PDAC that are incomplete will receive a “No HCPCS Code Assigned” designation. If the manual wheelchair base is incomplete, any accessories associated with the application will not be processed.

Published by Noridian as the PDAC, March 2014.  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: 03/11/2014