CMS proposes new codes for power wheelchairs

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Sunday, August 15, 2004

August 16, 2004

WASHINGTON - CMS proposed new codes for power wheelchairs last week that would eliminate the existing code set and create three broad categories with multiple sub-groups.
The proposed new categories would cover about 95% of typical code combinations billed now under K0010, K0011, K0012 and K0014. The proposed categories are Standard, Heavy Duty and Bariatric. Chairs that do not require medical necessity review for coverage are included in a Basic Equipment package.
CMS has scheduled a public meeting on the proposed power wheelchair codes at their offices in Baltimore on Sept. 1 from 1:00 to 5:00 p.m. To read CMS’s in-depth discussion of the codes, log on to http://www.cms.hhs.gov/medicare/hcpcs/SADMERC_PWC.pdf
The three main groups are subdivided on the basis of the patient’s weight and on the platform’s ability to accept options and accessories.
The “standard chair” is for the average weight (up to and including 300 pounds) patient with a stable condition that renders them non-ambulatory. It accommodates standard proportional joysticks, standard programmable electronics, non-expandable controllers, and non-powered seating systems, including cushions, positioning features such as wedges, pommels, thigh and back supports, and manually operated reclining backs and legrests. Power options and accessories are not associated with these chairs as their
adaptability for progressive disease or severe disability is limited.
This group is divided into portable lightweight, standard, standard-wide, standard-rehab, standard-wide rehab and standard-rehab-high activity.
The next two groups reflect increasing industry requests for codes for higher weight patients. These codes represent the majority of what was K0014 since most of those chairs were adapted to accommodate higher weight patients. Chairs coded to these groups and sub-groups are expected to have manufacturing techniques and materials selected to accommodate larger size patients. Upgrades for upholstery, brackets, motors, gearboxes, etc., billed at initial issue will be denied as not medically necessary.
The “heavy suty” chair is for the over 300 to 450 pound patient with a stable condition that renders them non-ambulatory. It accommodates standard proportional joysticks, standard programmable electronics, non-expandable controllers, and non-powered seating systems, including cushions, positioning features such as wedges, pommels, thigh and back supports, and manually operated reclining backs and legrests. Power options and accessories are not to be used on these chairs as their adaptability for progressive disease or severe disability is limited.
This group is divided into heavy duty-wide,  heavy duty-rehab and heavy duty-rehab-high activity.
The “bariatric” chair is for the 451 to 600 pound patient with a stable condition that renders them non-ambulatory. It accommodates standard proportional joysticks, standard programmable electronics, non-expandable controllers, and non-powered seating systems, including cushions, positioning features such as wedges, pommels, thigh and back supports, and manually operated reclining backs and legrests. Power options and accessories are not to be used on these chairs as their adaptability for progressive disease or severe disability is limited.

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