Wheelchair Options/Accessories - Policy Article

**NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:**  
For any item to be covered by Medicare, it must 1) be eligible for a defined
Medicare benefit category, 2) be reasonable and necessary for the diagnosis or
treatment of illness or injury or to improve the functioning of a malformed
body member, and 3) meet all other applicable Medicare statutory and
regulatory requirements. Information provided in this policy article relates
to determinations other than those based on Social Security Act 1862(a)(1)(A)
provisions (i.e. "reasonable and necessary").  
  
Wheelchair options and accessories are covered under the Durable Medical
Equipment benefit (Social Security Act 1861(s)(6)). In order for a
beneficiary's equipment to be eligible for reimbursement the reasonable and
necessary (R&N) requirements set out in the related Local Coverage
Determination must be met. In addition, there are specific statutory payment
policy requirements, discussed below, that also must be met.  
  
The allowance for a power operated vehicle (POV) includes all options and
accessories that are provided at the time of initial issue, including but not
limited to batteries, battery chargers, seating systems, etc. If a
beneficiary-owned POV meets coverage criteria, medically necessary replacement
items are covered.  
  
The allowance for a rollabout chair includes all options and accessories that
are provided at the time of initial issue. The allowance for a transport chair
includes all options and accessories that are provided at the time of initial
issue except for elevating legrests (E0990, K0195). If a rollabout chair or
transport chair are covered, medically necessary replacement items are
covered.  
  
An option/accessory that is beneficial primarily in allowing the beneficiary
to perform leisure or recreational activities is non-covered.  
  
If an option or accessory that is included in another code is billed
separately, the claim line will be denied as not separately payable. (Refer to
Coding Guidelines section for additional information on correct coding.)  
  
BATTERIES/ CHARGERS:  
  
A sealed battery (E2359, E2361, E2363, E2365, E2371, E2397, K0733) is
separately payable from a power wheelchair base.  
  
There is no additional/separate payment when a dual mode battery charger is
provided at the time of initial issue of a power wheelchair.  
  
A battery charger (E2366, E2367) is included in the allowance for a power
wheelchair base.  
  
POWER STANDING SYSTEM:  
  
A power standing feature (E2301) is non-covered because it is not primarily
medical in nature. If a wheelchair has an electrical connection device
described by code E2310 or E2311 and if the sole function of the connection is
for a power standing feature, it will be denied as non-covered.  
  
POWER WHEELCHAIR DRIVE CONTROL SYSTEMS:  
  
If an attendant control (E2331) is provided in addition to a beneficiary-
operated drive control system, it will be denied as non-covered. (See the
related LCD for situations in which it is provided in place of a beneficiary-
operated system.)  
  
OTHER POWER WHEELCHAIR ACCESSORIES:  
  
An electronic interface used to control lights or other electrical devices is
non-covered because it is not primarily medical in nature.  
  
The following features of a power wheelchair will be denied as non-covered:
stair climbing (A9270), electronic balance (A9270), ability to elevate the
seat by balancing on two wheels (A9270), and remote operation (A9270).  
  
MISCELLANEOUS ACCESSORIES:  
  
Swingaway, retractable, or removable hardware (E1028) is non-covered if the
primary indication for its use is to allow the beneficiary to move close to
desks or other surfaces. If it is ordered for this indication, a GY modifier
must be added to the code.  
  
A manual standing system for a manual wheelchair (E2230) is non-covered (no
benefit category) because it is not primarily medical in nature.  
  
 **REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO Final Rule 1713 (84 Fed.
Reg Vol 217) **  
****

Final Rule 1713 (84 Fed. Reg Vol 217) requires a face-to-face encounter and a
Written Order Prior to Delivery (WOPD) for specified HCPCS codes. CMS and the
DME MACs provide a list of the specified codes, which is periodically updated.
The required Face-to-Face Encounter and Written Order Prior to Delivery List
is available [here](https://www.cms.gov/Research-Statistics-Data-and-
Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-
Review/FacetoFaceEncounterRequirementforCertainDurableMedicalEquipment).

Claims for the specified items subject to Final Rule 1713 (84 Fed. Reg Vol
217) that do not meet the face-to-face encounter and WOPD requirements
specified in the LCD-related Standard Documentation Requirements Article
(A55426) will be denied as not reasonable and necessary.

If a supplier delivers an item prior to receipt of a WOPD, it will be denied
as not reasonable and necessary. If the WOPD is not obtained prior to
delivery, payment will not be made for that item even if a WOPD is
subsequently obtained by the supplier. If a similar item is subsequently
provided by an unrelated supplier who has obtained a WOPD, it will be eligible
for coverage.

  
**POLICY SPECIFIC DOCUMENTATION REQUIREMENTS**  
  
In addition to policy specific documentation requirements, there are general
documentation requirements that are applicable to all DMEPOS policies. These
general requirements are located in the DOCUMENTATION REQUIREMENTS section of
the LCD.  
  
Refer to the LCD-related Standard Documentation Requirements article, located
at the bottom of this Policy Article under the Related Local Coverage
Documents section for additional information regarding GENERAL DOCUMENTATION
REQUIREMENTS and the POLICY SPECIFIC DOCUMENTATION REQUIREMENTS discussed
below.

SPECIALTY EVALUATION:

The specialty evaluation provides detailed information explaining why each
option and accessory - e.g., power tilt and/or recline seating systems, or
gear reduction drive wheel - is needed to address the beneficiary's mobility
limitation. There must be a written report of this evaluation available on
request. The PT, OT, or practitioner who performs the specialty evaluation may
have no financial relationship with the supplier. (Exception: If the supplier
is owned by a hospital, the PT, OT, or practitioner working in the inpatient
or outpatient hospital setting may perform the specialty evaluation.)

  
MODIFIERS  
  
KX, GA, GY, AND GZ MODIFIERS:  
  
For accessories for a power mobility device (PMD), if the requirements related
to a standard written order (SWO) for the PMD base and face-to-face encounter
in the Power Mobility Devices Policy Article have not been met, the GY
modifier must be added to the codes for all accessories.  
  
For accessories provided with a manual wheelchair or power mobility device, if
it is only needed for mobility outside the home, the GY modifier must be added
to the codes for all accessories.  
  
If the conditions for use of the GY modifier are not met, the KX modifier must
be added to the code for the accessory only if (a) the coverage criteria that
are specified in the Manual Wheelchair Bases or Power Mobility Devices LCD
have been met and (b) any specific coverage criteria for the accessory in the
related LCD have been met. If the coverage criteria are not met, the KX
modifier must not be used.  
  
If the conditions for use of the GY modifier are not met and if the
requirements for use of the KX modifier are not met, the GA or GZ modifier
must be added to a claim line for the accessory. When there is an expectation
of a medical necessity denial, suppliers must enter the GA modifier on the
claim line if they have obtained a properly executed Advance Beneficiary
Notice (ABN) or the GZ modifier if they have not obtained a valid ABN.  
  
If the GY modifier is used, the KX, GA, and GZ modifiers should not be used.  
  
Claim lines billed without a GA, GY, GZ, or KX modifier will be rejected as
missing information.  
  
 **CODING GUIDELINES**  
  
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.

  * Lap belt or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately.

  * Battery charger, single mode

  * Complete set of tires and casters, any type

  * 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 (K0015). Adjustable height armrests (E0973, K0020) may be billed separately.

  * Any weight specific components (braces, bars, upholstery, brackets, motors, gears, etc.) as required by beneficiary weight capacity.

  * Any seat width and depth. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed separately:

    * For Standard Duty, seat width and/or depth greater than 20 inches;

    * For Heavy Duty, seat width and/or depth greater than 22 inches;

    * For Very Heavy Duty, seat width and/or depth greater than 24 inches;

    * For Extra Heavy Duty, no separate billing

  * Any back width. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed separately:

    * For Standard Duty, back width greater than 20 inches;

    * For Heavy Duty, back width greater than 22 inches;

    * For Very Heavy Duty, back width greater than 24 inches;

    * For Extra Heavy Duty, no separate billing

  * Controller and Input Device. There is no separate billing/payment if a non-expandable controller and a standard proportional joystick (integrated or remote) is provided. An expandable controller, a nonstandard joystick (i.e., non-proportional or mini, compact or short throw proportional), or other alternative control device may be billed separately.

Power Operated Vehicle (POV) Basic Equipment Package - Each POV is to include
all these items on initial issue (i.e., no separate billing/payment at time of
initial issue):

  * Lap belt or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately

  * Battery or batteries required for operation

  * Battery charger, single mode

  * Weight appropriate upholstery and seating system

  * Tiller steering

  * Non-expandable controller with proportional response to input

  * Complete set of tires

  * All accessories needed for safe operation

A table at the end of this section defines the bundling guidelines for
wheelchair bases and options/accessories. Codes listed in Column II are not
separately payable from the wheelchair base and must not be billed separately
at the time of initial purchase or rental of the wheelchair.  
  
A replacement option/accessory for POV is billed using a wheelchair
option/accessory code. All options and accessories provided at the time of
initial issue of a POV are not separately billable.  
  
Accessories provided at the time of initial issue of a rollabout chair are not
separately billable. Accessories provided with the initial issue of a
transport chair are not separately billable with the exception of elevating
legrests (E0990, K0195). A replacement accessory for a rollabout or transport
chair is billed using code E1399.  
  
The RB modifier is used when an option or accessory is provided as a
replacement for the same part which has been worn or damaged (e.g., replacing
a tire of the same type). The RB modifier must not be used for an upgrade
subsequent to providing the wheelchair base (e.g., replacing a standard seat
of a power wheelchair with a power seating system). The RB modifier must not
be used if the accessory is provided at the same time as the wheelchair base,
even if the option/accessory is the same as one that the beneficiary had on a
prior wheelchair. (See section on Power Wheelchair Drive Control Systems for
instructions on the use of the KC replacement modifier.)  
  
Miscellaneous options, accessories, or replacement parts for wheelchairs that
do not have a specific HCPCS code and are not included in another code should
be coded K0108. If multiple miscellaneous accessories are provided, each
should be billed on a separate claim line using code K0108. When billing more
than one line item with code K0108, ensure that the additional information can
be matched to the appropriate line item on the claim. It is also helpful to
reference the line item to the submitted charge. If a supplier chooses to bill
separately for a component that is included in another code, code A9900 must
be used.  
  
The right (RT) and left (LT) modifiers are optional on claim lines billed for
wheelchair options and accessories. Effective for claims with dates of service
(DOS) on or after 3/1/2019, if RT and LT modifiers are appended to claim lines
billed for bilateral wheelchair options and accessories (left and right) and
the unit of service of the code is "each," then bill each item on two separate
claim lines with the RT modifier on one line and the LT modifier on the other,
and 1 unit of service (UOS) on each claim line. If the RT and LT are appended,
do not use the RTLT modifier on the same claim line and billed with 2 UOS.
Claims with RTLT on the same claim line and 2 UOS will be rejected as
incorrect coding. If RT and LT modifiers are not appended, then the bilateral
items (left and right) with a unit of service "each" may be billed on a single
claim line with 2 UOS. If bilateral items are provided and the unit of service
is "pair," the LT and RT modifiers are not applicable.  
  
Codes E0968, E0969, E0970, E0980, E0994, E1227, E1228, E1296, E1297, E1298,
and E2340, E2341, E2342, E2343 are not valid for claim submission.  
  
FOOTREST/ LEGREST:

A footbox, E0954, is a padded box designed to position a beneficiary's foot.
This item comes in multiple configurations, i.e., it may be for a single foot
or for both feet. Regardless of configuration, the unit of service (UOS) is
per foot. E0954 includes both prefabricated and custom fabricated products.
The code also includes all mounting hardware.

Elevating legrests that are used with a wheelchair that is purchased or owned
by the beneficiary are coded E0990. This code is per legrest. Elevating
legrests that are used with a capped rental wheelchair base are coded K0195.
This code is per pair of legrests.  
  
NONSTANDARD SEAT FRAME DIMENSIONS:  
  
For all adult manual wheelchairs (E1161, K0001, K0002, K0003, K0004, K0005,
K0006, K0007, K0008, K0009), payment for seat widths and/or seat depths of
15-19 inches is included in the payment for the base code. These seat
dimensions should not be billed separately. Codes E2201, E2202, E2203, E2204
describe seat widths and/or depths of 20 inches or more for manual
wheelchairs.  
  
For power wheelchairs, there is no separate billing for nonstandard seat frame
dimensions (width, depth, or height) with the following exceptions: For Group
3 and 4 power wheelchairs, with a sling/solid seat/back, the following items
may be billed separately using code K0108:

  * For Standard Duty, seat width and/or depth greater than 20 inches;

  * For Heavy Duty, seat width and/or depth greater than 22 inches;

  * For Very Heavy Duty, seat width and/or depth greater than 24 inches;

  * For Extra Heavy Duty, no separate billing

For Group 3 and 4 PWCs with a sling/solid seat/back, the following items may
be billed separately using code K0108:

  * For Standard Duty, back width greater than 20 inches;

  * For Heavy Duty, back width greater than 22 inches;

  * For Very Heavy Duty, back width greater than 24 inches;

  * For Extra Heavy Duty, no separate billing

Code K0108 may not be billed for nonstandard dimensions of a power tilt and/or
recline seating system (E1002, E1003, E1004, E1005, E1006, E1007, E1008). The
definition of those codes includes any frame width and depth.  
  
WHEELS/TIRES FOR MANUAL WHEELCHAIRS:  
  
A propulsion wheel is a large wheel which can be used by a beneficiary to
propel the wheelchair with his/her arms.  
  
A caster is a small wheel that is in contact with the ground during normal
operation of the wheelchair and which cannot be used for arm propulsion. This
includes rear tires on tilt-in-space wheelchairs that are not used for arm
propulsion.  
  
A lever activated drive (E0988) is an alternative drive mechanism for
propulsion of a manual wheelchair. It includes a user-powered lever-arm
mechanism attached to one or both wheel hub(s). The lever activates
adjustable-ratio gears and has the capability to shift between forward,
reverse and braking.  
  
A pneumatic tire (E2211, E2214) is a rubber tire which is used in conjunction
with a separate tube (E2212, E2215) which is filled with air.  
  
A flat free insert (E2213) is a removable ring of firm material that is placed
inside of a pneumatic tire to allow the wheelchair to continue to move if the
pneumatic tire is punctured. This code may not be used for a foam filled tire.  
  
A foam filled tire (E2216, E2217) is one in which a rubber tire shell has been
filled with foam which is non-removable.  
  
A foam tire (E2218, E2219) is one which is made entirely of self-skinning
urethane.  
  
A replacement only solid tire (E2220, E2221, E2222) is one which is made of
hard plastic or rubber.  
  
A gear reduction drive wheel (E2227) is one that has more than one gear ratio
option. Pushing on the rim allows the user to manually shift between the gears
in order to provide additional leverage to assist propulsion of a manual
wheelchair.  
  
A wheel braking and lock system (E2228) is a caliper or disc type braking
system that permits the controlled slowing of a manual wheelchair or the
controlled descent on inclines. It also has full wheel lock capability.  
  
A replacement only rear wheel assembly (K0069, K0070) includes a wheel rim
plus a tire. For pneumatic tires, it also includes the tire tube, but not a
flat free insert.  
  
A replacement only caster assembly (K0071, K0072, K0077) includes a caster
fork, wheel rim, and tire.  
  
For information concerning a push-rim activated power assist device for a
manual wheelchair, refer to the Power Mobility Devices medical policy.  
  
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 swingaway detachable legrests; 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, E1004, 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 swingaway detachable
legrests; 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, E1007, 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 swingaway
detachable legrests; 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.  
  
Coding for a power tilt system (E1002), power recline system (E1003, E1004 and
E1005), and tilt/recline system (E1006, E1007 and E1008) are all-inclusive.
Usage of K0108 to bill for additional heavy duty or bariatric features is
considered unbundling and is not allowed.  
  
A power tilt seating system or power tilt and recline seating system which
does not achieve a tilt of greater than or equal to 20 degrees is considered
to be the same as the standard seat included in the base wheelchair. Codes
E1002, E1003, E1004, E1005, E1006, E1007, E1008 must not be used to describe a
power tilt seating system or a power tilt and recline seating system which
does not achieve a tilt of greater than or equal to 20 degrees. These seating
systems must be coded as A9900 and are not separately payable.  
  
A mechanical shear reduction feature (E1004 and E1007) consists of two
separate back panels. As the posterior back panel reclines or raises there is
a mechanical linkage between the two panels which allows the beneficiary's
back to stay in contact with the anterior panel without sliding along that
panel.  
  
A power shear reduction feature (E1005 and E1008) consists of two separate
back panels. As the posterior back panel reclines or raises there is a
separate motor which controls the linkage between the two panels and allows
the beneficiary's back to stay in contact with the anterior panel without
sliding along that panel.  
  
A mechanically linked leg elevation feature (E1009) involves a pushrod which
connects the legrest to a power recline seating system. With this feature,
when the back reclines, the legrest elevates; when the back raises, the
legrest lowers.  
  
A power leg elevation feature (E1010, E1012) involves dedicated motor(s) and
related electronics with or without variable speed programmability which
allows the legrest to be raised and lowered independently of the recline
and/or tilt of the seating system. It includes a switch control which may or
may not be integrated with the power tilt and/or recline control(s). It
includes either articulating or non-articulating legrests. The unit of service
of code E1010 is a pair. The unit of service for code E1012 is each.

HCPCS code E1012 includes all components of the leg rest, including fixed
angle footplates and foot platforms. Adjustable angle footplates coded K0040
(ADJUSTABLE ANGLE FOOTPLATE, EACH) are separately payable when provided with
leg rests coded as E1012.

A power seat elevation system (E2300) includes: 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 must provide a seat elevation of at least 6 inches.  
  
A power standing system (E2301) includes: a solid seat platform and a solid
back; detachable or flip-up fixed height armrests; hinged legrests; anterior
knee supports; fixed or flip-up footplates; a motor and related electronics
with or without variable speed programmability; a basic 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 move
the beneficiary to a standing position; ability to support beneficiary weight
of at least 250 pounds.  
  
Codes E2310 and E2311 describe the electronic components that allow the
beneficiary to control two or more of the following motors from a single
interface (e.g., proportional joystick, touchpad, or non-proportional
interface): power wheelchair drive, power tilt, power recline, power shear
reduction, power leg elevation, power seat elevation, power standing. It
includes a function selection switch which allows the beneficiary to select
the motor that is being controlled and an indicator feature to visually show
which function has been selected. When the wheelchair drive function has been
selected, the indicator feature may also show the direction that has been
selected (forward, reverse, left, right). This indicator feature may be in a
separate display box or may be integrated into the wheelchair interface.
Payment for the code includes an allowance for fixed mounting hardware for the
control box and for the display box (if present).  
  
POWER WHEELCHAIR DRIVE CONTROL SYSTEMS:  
  
The term interface in the code narrative and definitions describes the
mechanism for controlling the movement of a power wheelchair. Examples of
interfaces include, but are not limited to, joystick, sip and puff, chin
control, head control, etc. (Note: In the Power Mobility Devices policy, the
term "control input device" is used instead of "interface".)  
  
A proportional interface is one in which the direction and amount of movement
by the beneficiary controls the direction and speed of the wheelchair. One
example of a proportional interface is a standard joystick.  
  
A non-proportional interface is one which involves a number of switches.
Selecting a particular switch determines the direction of the wheelchair, but
the speed is pre-programmed. One example of a non-proportional interface is a
sip-and-puff mechanism.  
  
The term controller describes the microprocessor and other related electronics
that receive and interpret input from the joystick (or other drive control
interface) and convert that input into power output which controls speed and
direction. A high power wire harness connects the controller to the motor and
gears.  
  
A non-expandable controller has the following features:

  * May have the ability to control up to 2 power seating actuators through the drive control (for example, seat elevator and single actuator power elevating legrests). (Note: Control of the power seating actuators though the Control Input Device would require the use of an additional component, E2310 or E2311.)

  * Can accommodate only an integral joystick or a standard proportional remote joystick

  * May allow for the incorporation of an attendant control

  
An expandable controller is capable of accommodating one or more of the
following additional functions:

  * Other types of proportional input devices (e.g., mini-proportional or compact joysticks, touchpads, chin control, head control, etc.)

  * Non-proportional input devices (e.g., sip and puff, head array, etc.)

  * Operate 3 or more powered seating actuators through the drive control. (Note: Control of the power seating actuators though the Control Input Device would require the use of an additional component, E2310 or E2311.)

An expandable controller may also be able to operate one or more of the
following:

  * A separate display (i.e., for alternate control devices)

  * Other electronic devices (e.g., control of an augmentative speech device or computer through the chair's drive control)

  * An attendant control

For power wheelchairs which are capable of being upgraded to an expandable
controller (K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843,
K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856 K0857, K0858,
K0859, K0860, K0861 K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877,
K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891), E2377 is used if an
expandable controller is provided at the time of initial issue. Code E2376 is
used with complete replacement of an expandable controller.  
  
A harness (E2313) describes all of the wires, fuse boxes, fuses, circuits,
switches, etc. that are required for the operation of an expandable
controller. It also includes all the necessary fasteners, connectors, and
mounting hardware. Code E2313 is separately billable in addition to an
expandable controller both at initial issue and with complete replacement of
the expandable controller. Code K0108 must not be used for any component or
feature of an expandable controller at the time of initial issue. The
reimbursement for any type of complete expandable controller is included in
the allowance for codes E2377/E2376 plus E2313. However, if individual
components of the harness are replaced, code K0108 should be used.  
  
A switch is an electronic device which turns power to a particular function
either "on" or "off". The external component of a switch may be either
mechanical or non-mechanical. Mechanical switches involve physical contact in
order to be activated. Examples of the external components of mechanical
switches include, but are not limited to, toggle, button, ribbon, etc.
Examples of the external components of non-mechanical switches include, but
are not limited to, proximity, infrared, etc. Some of the codes include
multiple switches. In those situations, each functional switch may have its
own external component or multiple functional switches may be integrated into
a single external switch component or multiple functional switches may be
integrated into the wheelchair control interface without having a distinct
external switch component.  
  
A stop switch allows for an emergency stop when a wheelchair with a non-
proportional interface is operating in the latched mode. (Latched mode is when
the wheelchair continues to move without the beneficiary having to continually
activate the interface.) This switch is sometimes referred to as a kill
switch.  
  
A direction change switch allows the beneficiary to change the direction that
is controlled by another separate switch or by a mechanical proportional head
control interface. For example, it allows a switch to initiate forward
movement one time and backward movement another time.  
  
A function selection switch allows the beneficiary to determine what operation
is being controlled by the interface at any particular time. Operations may
include, but are not limited to, drive forward, drive backward, tilt forward,
recline backward, etc.  
  
An integrated proportional joystick and controller is an electronics package
in which a joystick and controller electronics are in a single box, which is
mounted on the arm of the wheelchair.  
  
The interfaces described by codes E2312, E2321, E2322, E2325, E2327, E2328,
E2329, E2330, E2373, E2374, E2375, E2376, E2377 must have programmable control
parameters for speed adjustment, tremor dampening, acceleration control, and
braking.  
  
A remote joystick is one in which the joystick is in one box that is typically
mounted on the arm of the wheelchair and the controller electronics are
located in a different box that is typically located under the seat of the
wheelchair. The joystick is connected to the controller through a low power
wire harness. A remote joystick may be used for either hand control, chin
control, or attendant control.  
  
A standard proportional remote joystick is one which requires approximately
340 grams of force to activate and which has an excursion (length of throw) of
approximately 25 mm from neutral position. It can be used with a non-
expandable or an expandable controller. There is no separate billing for a
standard proportional remote joystick when it is provided at the time of
initial issue of a power wheelchair whether it is used for hand or chin
control by the beneficiary or whether it is used as an attendant control in
place of a beneficiary-operated drive control interface.  
  
A mini-proportional (short throw) remote joystick (E2312) is one which can be
activated by a very low force (approximately 25 grams) and which has a very
short displacement (a maximum excursion of approximately 5 mm from neutral).
It can only be used with an expandable controller. It can be used for hand or
chin control or control by other body part (e.g., tongue, lip, fingertip,
etc.). There is no separate billing for control buttons, displays, switches,
etc. There is no separate billing for fixed mounting hardware, regardless of
the body part used to activate the joystick.  
  
A compact proportional remote joystick (E2373) is one which has a maximum
excursion of about 15 mm from neutral position but requires approximately 340
grams of force to activate. It can only be used with an expandable controller.
It can be used for hand or chin control or control by other body part (e.g.,
foot, amputee stump, etc.). There is no separate billing for control buttons,
displays, switches, etc. There is no separate billing for fixed mounting
hardware, regardless of the body part used to activate the joystick.  
  
A touchpad is an interface similar to the pad-type mouse found on portable
computers. It is billed with code K0108.  
  
Code E2321 is used for a non-proportional remote joystick, regardless of
whether it is used for hand or chin control.  
  
When code E2312, E2321, E2373, or E2374 is used for a chin control interface,
the chin cup is billed separately with code E2324.  
  
Code E2322 describes a system of 3-5 mechanical switches which are activated
by the beneficiary touching the switch. The switch that is selected determines
the direction of the wheelchair. A mechanical stop switch and a mechanical
direction change switch, if provided, are included in the allowance for the
code.  
  
Code E2323 includes prefabricated joystick handles that have shapes other than
a straight stick - e.g., U shape or T shape - or that have some other
nonstandard feature - e.g., flexible shaft.  
  
A sip and puff interface (E2325) is a non-proportional interface in which the
beneficiary holds a tube in their mouth and controls the wheelchair by either
sucking in (sip) or blowing out (puff). A mechanical stop switch is included
in the allowance for the code. E2325 does not include the breath tube kit
which is described by code E2326.  
  
A proportional, mechanical head control interface (E2327) is one in which a
headrest is attached to a joystick-like device. The direction and amount of
movement of the beneficiary's head pressing on the headrest control the
direction and speed of the wheelchair. A mechanical direction control switch
is included in the code.  
  
A proportional, electronic head control interface (E2328) is one in which a
beneficiary's head movements are sensed by a box placed behind the
beneficiary's head. The direction and amount of movement of the beneficiary's
head (which does not come in contact with the box) control the direction and
speed of the wheelchair. A proportional, electronic extremity control
interface (E2328) is one in which the direction and amount of movement of the
beneficiary's arm or leg control the direction and speed of the wheelchair.  
  
A non-proportional, contact switch head control interface (E2329) is one in
which a beneficiary activates one of three mechanical switches placed around
the back and sides of their head. These switches are activated by pressure of
the head against the switch. The switch that is selected determines the
direction of the wheelchair. A mechanical stop switch and a mechanical
direction change switch are included in the allowance for the code.  
  
A non-proportional, proximity switch head control interface (E2330) is one in
which a beneficiary activates one of three switches placed around the back and
sides of their head. These switches are activated by movement of the head
toward the switch, though the head does not touch the switch. The switch that
is selected determines the direction of the wheelchair. A mechanical stop
switch and a mechanical direction change switch is included in the allowance
for the code.  
  
An attendant control is one which allows a caregiver to drive the wheelchair
instead of the beneficiary. The attendant control is usually mounted on one of
the rear canes of the wheelchair. This code is limited to proportional control
devices, usually a joystick. Code E2331 is used when an attendant control is
provided in addition to a beneficiary-operated drive control interface.  
  
Codes E2374, E2375, E2376 describe components of drive control systems. They
may only be used for replacements other than at the time of initial issue.  
  
Code K0108 is appropriately used at the time of initial issue only when the
drive control interface that is provided is not included in the base code and
there is no specific E code which describes it. K0108 must not be used for
additional features of a joystick.  
  
Code K0108 is appropriately used at the time of replacement in the following
situations:

    1. An integrated proportional joystick and controller box are being replaced due to damage; or

    2. An interface other than a remote joystick (e.g. sip and puff, head control) is being replaced but the controller is not being replaced; or

    3. There is no specific E code which describes the type of drive control interface system which is provided.

The KC modifier (replacement of special power wheelchair interface) is used in
the following situations:

    1. Due to a change in the beneficiary's condition an integrated joystick and controller is being replaced by another drive control interface - e.g., remote joystick, head control, sip and puff, etc.; or

    2. The beneficiary had a drive control interface described by codes E2321, E2322, E2325, E2327, E2328, E2329, E2330, or E2373 and both the interface (e.g., joystick, head control, sip and puff) and the controller electronics are being replaced due to irreparable damage.

The KC modifier would never be used at the time of initial issue of a
wheelchair. The KC modifier specifically states replacement, therefore, the RB
modifier is not required.  
  
OTHER POWER WHEELCHAIR ACCESSORIES:  
  
A drive wheel is one which is directly controlled by the motor of the power
wheelchair. It may be either a rear wheel, mid wheel, or front wheel,
depending on the model of the power wheelchair.  
  
A caster is a smaller wheel that is in contact with the ground during normal
operation of the wheelchair and which not directly controlled by the motor. It
may be in the front and/or rear, depending on the location of the drive wheel.  
  
A pneumatic tire (E2381, E2384) is a rubber tire which is used in conjunction
with a separate tube (E2382, E2385) which is filled with air.  
  
A flat free insert (E2383) is a removable ring of firm material that is placed
inside of a pneumatic tire to allow the wheelchair to continue to move if the
pneumatic tire is punctured. This code may not be used for a foam filled tire.  
  
A foam filled tire (E2386, E2387) is one in which a rubber tire shell has been
filled with foam which is non-removable.  
  
A foam tire (E2388, E2389) is one which is made entirely of self-skinning
urethane.  
  
A solid tire (E2390, E2391, E2392) is one which is made of hard plastic or
rubber.  
  
All types of tires and wheels are included in the code for a power mobility
base. Codes E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389,
E2390, E2391, E2392, E2393, E2394, E2395, E2396 may only be used for
replacements other than at the time of initial issue.  
  
Code E2351 describes an electronic interface used with a speech generating
device. An electronic interface that is used to allow lights or other
electrical devices to be operated using the power wheelchair control interface
must be billed with code A9270 (non-covered item).  
  
Codes E2368, E2369, E2370 are for a replacement motor and/or gearbox. These
codes are not used at the time of initial issue. If the item is a rebuilt
component, the UE (used DME) modifier must be added to the code.  
  
MISCELLANEOUS:  
  
Code E1028 is used for

    1. Swingaway hardware used with remote joysticks or touchpads,

    2. Swingaway or flip-down hardware for head control interfaces E2327, E2328, E2329, E2330, and

    3. Swingaway hardware for an indicator display box that is related to the multi-motor electronic connection codes E2310 or E2311.

Code E1028 is not to be used for swingaway hardware used with a sip and puff
interface (E2325) because swingaway hardware is included in the allowance for
that code. Code E1028 is not to be used for hardware on a wheelchair tray
(E0950). Do not use E1028 in addition to E1020 (Residual limb support system)
as it includes swingaway hardware.  
  
Code E1029 describes a ventilator tray which is attached in a fixed position
to the wheelchair base or back. Code E1030 describes a ventilator tray which
is attached to the seat back and is articulated so that the tray will remain
horizontal when the seat back is raised or lowered.  
  
Code E1225 describes a manually operated reclining back that can recline
greater than 15 degrees but less than 80 degrees. Code E1226 describes a
manually operated reclining back that reclines 80 degrees or greater.

Code E2398 describes a wheelchair component attached to a wheelchair frame
that allows for dynamic movement of the seat back or pelvis component in
response to increased musculoskeletal tone or spasticity.

A Column II code is included in the allowance for the corresponding Column I
code when provided at the same time. When multiple codes are listed in column
I, all the codes in column II relate to each code in column I

**Column I** | **Column II**  
---|---  
Power Operated Vehicle (K0800, K0801, K0802, K0806, K0807, K0808, 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, K0077  
Power Wheelchair Base Groups 1 and 2 (K0813, K0814, K0815, K0816, K0820,
K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831,
K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, 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, K0077,
K0098  
Power Wheelchair Base Groups 3, 4, and 5 (K0848, K0849, K0850, K0851, K0852,
K0853, K0854, K0855, K0856 K0857, K0858, K0859, K0860, K0861 K0862, K0863,
K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885,
K0886, K0890, 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, K0077, K0098  
E0973 | K0017, K0018, K0019  
E0950 | E1028  
E0954 | 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, E1012 | 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  
  


Suppliers should contact the Pricing, Data Analysis, and Coding (PDAC)
contractor for guidance on correct coding of these items.