By: Kim Turner, RN – Clinical Consultant
Although the major manufacturers of complex rehab mobility equipment consider the Medicare policies and equipment specifications for manual and power mobility equipment, the manufacturers’ order forms do not always align with the wheelchair options and accessories that can or cannot be billed separately with the initial issue of the mobility device. Often, a manufacturer will list a separate cost for a wheelchair option and/or accessory that is actually considered bundled in the Medicare allowance (payment) for other equipment.
The following is a list of the most common wheelchair options and accessories that The van Halem Group has recognized as being billed incorrectly with separate costs and HCPCs with the INITIAL ISSUE/BILLING of the mobility device:
Power Mobility (PWC)
- Joystick (standard, non-expandable remote joystick) – No separate billing/payment if a non-expandable controller and a standard proportional joystick (integrated or remote) is provided with the initial issue of a power wheelchair.
- Battery charger (single mode) is included in the Medicare allowance for the power mobility device.
- Complete set of tires and casters (any type) is included in the Medicare allowance for the power mobility device.
- Legrests – There is no separate billing/payment if fixed, swingaway or detachable, non-elevating legrests with or without calf pad are provided. Elevating legrests may be billed separately.
- Footrests/foot platform – There is no separate billing/payment if fixed, swingaway or detachable footrests or a foot platform without angle adjustment are provided. There is no separate billing for angle adjustable footplates with Group 1 or 2 PWCs. Angle adjustable footplates may be billed separately with Group 3, 4 and 5 PWCs.
- Armrests – There is no separate billing/payment if fixed, swingaway or detachable, non-adjustable height armrests with arm pad are provided. Adjustable height armrests may be billed separately.
- Power adaptable frame is included in the power assist (E0986).
- E-motion treaded tire style is included in the power assist (E0986).
Wheelchair Seating and Positioning Accessories
- Custom fabricated seating (back E2617 and seat E2909) is all inclusive. Billing the K0108 for seating components of the back and/or seat is not allowed.
- The Medicare allowance for the positioning back (E2620) includes the cost for lateral trunk pads (E0956) and any type of mounting hardware (E1028).
- With the initial issue of the wheelchair seat cushion (example, E2622) or back (example, E2620), the cost for a cushion COVER is included in the allowance for the seat cushion. E2619 can be billed for a replacement cushion cover.
- There is no separate payment for a solid insert (E0992) that is used with a seat or back cushion because a solid base is included in the allowance for a wheelchair seat or back cushion.
- Use code E2231 for a solid support base that is used with a manual wheelchair. A solid support base is included in the allowance for the power wheelchair codes. There should be no separate billing with power wheelchairs.
- Wheel lock assembly (E2206) is included in the Medicare allowance for the manual wheelchair base wheelchair.
- Any seat to floor height is included in the Medicare allowance for the manual wheelchair base.
- All types of rear propulsion wheels are included in Medicare allowance for the manual wheelchair base.
- All types of front casters.
- 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 fixed, swing away or detachable legrests and footrests.
- Fixed height, non-adjustable armrests. Adjustable height armrests may be billed separately.
Wheelchair Options and Accessories
- Cost for the tray strap and tray buckets are included in the Medicare allowance for a tray (E0950).
- A seat belt (E0978) included in the basic equipment package for the power wheelchair. A seat belt may be billed on a power wheelchair base for replacement only.
- The Medicare allowance for the tray (E0950) includes the cost for any type of mounting hardware. The E1028 cannot be billed with the E0950.
- A mini-cup switch, blue/green/red/yellow switches included in the allowance for the single or multiple through drive electronic upgrades (E2310 or E2311).