Article - Power Mobility Devices - Policy Article (A52498)

Have all components in the PWC Basic Equipment PackageHave the seat option listed in the code descriptorSeat Width: Any width appropriate to weight groupSeat Depth: Any depth appropriate to weight groupSeat Height: Any height (adjustment requirements-none)Back Height: Any height (minimum back height requirement-none)Seat to Back Angle: Fixed or adjustable (adjustment requirements  none)May include semi-reclining backMeet the following testing requirements:Fatigue test  200, 000 cyclesDrop test  6,666 cyclesAll Group 1 PWCs (K0813, K0814, K0815,K0816) must have the specified components and meet the following requirements:Standard integrated or remote proportional joystickNon-expandable controllerIncapable of upgrade to expandable controllerIncapable of upgrade to alternative control devicesMay have crossbrace constructionAccommodates non-powered options and seating systems (e.g., recline-only backs, manually elevating legrests) (except captains chairs)Length - less than or equal to 40 inchesWidth - less than or equal to 24 inchesMinimum Top End Speed - 3 MPHMinimum Range - 5 milesMinimum Obstacle Climb - 20 mmDynamic Stability Incline - 6 degreesFor Group 1 portable wheelchairs (K0813, K0814), the largest single component may not exceed 55 pounds.All Group 2 PWCs (K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842,K0843) must have the specified components and meet the following requirements:Standard integrated or remote proportional joystickMay have crossbrace constructionAccommodates seating and positioning items (e.g., seat and back cushions, headrests, lateral trunk supports, lateral hip supports, medial thigh supports) (except captains chairs)Length - less than or equal to 48 inchesWidth - less than or equal to 34 inchesMinimum Top End Speed - 3 MPHMinimum Range - 7 milesMinimum Obstacle Climb - 40 mmDynamic Stability Incline - 6 degreesFor Group 2 portable PWCs (K0820, K0821), the largest single component may not exceed 55 pounds.Group 2 no power option PWCs (K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828,K0829) must have the specified components and meet the following requirements:Non-expandable controllerIncapable upgrade to expandable controllerIncapable of upgrade to alternative control devicesIncapable of accommodating a power tilt, recline, standing systemAccommodates non-powered options and seating systems (e.g., recline-only backs, manually elevating legrests) (except captains chairs)Group 2 seat elevator PWCs (K0830, K0831) must have the specified components and meet the following requirements:Non-expandable controllerIncapable of upgrade to expandable controllerIncapable of upgrade to alternative control devicesAccommodates only a power seat elevating systemGroup 2 single power option PWCs (K0835, K0836, K0837, K0838, K0839,K0840) must have the specified components and meet the following requirements:Non-expandable controllerCapable of upgrade to expandable controllerCapable of upgrade to alternative control devicesSee Single Power Option definition for seating system capabilityGroup 2 multiple power option PWCs (K0841, K0842,K0843) must have the specified components and meet the following requirements:Non-expandable controllerCapable of upgrade to expandable controllerCapable of upgrade to alternative control devicesSee Multiple Power Options definition for seating system capabilityAccommodates a ventilatorAll Group 3 PWCs (K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863,K0864) must have the specified components and meet the following requirements:Standard integrated or remote proportional joystickNon-expandable controllerCapable of upgrade to expandable controllerCapable of upgrade to alternative control devicesMay not have crossbrace constructionAccommodates seating and positioning items (e.g., seat and back cushions, headrests, lateral trunk supports, lateral hip supports, medial thigh supports) (except captains chairs)Drive wheel suspension to reduce vibrationLength - less than or equal to 48 inchesWidth - less than or equal to 34 inchesMinimum Top End Speed - 4.5 MPHMinimum Range - 12 milesMinimum Obstacle Climb - 60 mmDynamic Stability Incline - 7.5 degreesAll Group 4 PWCs (K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886) must have the specified components and meet the following requirements:Standard integrated or remote proportional joystickNon-expandable controllerCapable of upgrade to expandable controllerCapable of upgrade to alternative control devicesMay not have crossbrace constructionAccommodates seating and positioning items (e.g., seat and back cushions, headrests, lateral trunk supports, lateral hip supports, medial thigh supports) (except captains chairs)Drive wheel suspension to reduce vibrationLength - less than or equal to 48 inchesWidth - less than or equal to 34 inchesMinimum Top End Speed - 6 MPHMinimum Range - 16 milesMinimum Obstacle Climb - 75 mmDynamic Stability Incline - 9 degreesGroup 3 and 4 no power option PWCs (K0848, K0849, K0850, K0851, K0852, K0853, K0854,K0855, K0868, K0869, K0870, K0871) must have the specified components and meet the following requirements:Incapable of accommodating a power tilt, recline, standing systemAccommodates non-powered options and seating systems (e.g., recline-only backs, manually elevating legrests)Group 3 and 4 single power option PWCs (K0856, K0857, K0858, K0859, K0860, K0877, K0878, K0879, K0880) must have the specified components and meet the following requirements:See Single Power Option definition for seating system capabilityGroup 3 and 4 multiple power option PWCs (K0861, K0862, K0863, K0864, K0884, K0885,K0886) must have the specified components and meet the following requirements:See Multiple Power Options definition for seating system capabilityAccommodates a ventilatorAll Group 5 PWCs (K0890, K0891) must have the specified components and meet the following requirements:Standard integrated or remote proportional joystickNon-expandable controllerCapable of upgrade to expandable controllerCapable of upgrade to alternative control devicesSeat Width: minimum of 5 one-inch optionsSeat Depth: minimum of 3 one-inch optionsSeat Height: adjustment requirements- 3 inchesBack Height: adjustment requirements minimum of 3 optionsSeat to Back Angle: range of adjustment-minimum of 12 degreesAccommodates non-powered options and seating systemsAccommodates seating and positioning items (e.g., seat and back cushions, headrests, lateral trunk supports, lateral hip supports, medial thigh supports)Adjustability for growth (minimum of 3 inches for width, depth and back height adjustment)Special developmental capability (i.e., seat to floor, standing, etc.)Drive wheel suspension to reduce vibrationLength - less than or equal to 48 inchesWidth - less than or equal to 34 inchesMinimum Top End Speed - 4 MPHMinimum Range - 12 milesMinimum Obstacle Climb - 60 mmDynamic Stability Incline - 9 degreesCrash testing - PassedGroup 5 single power option PWC (K0890) must have the specified components and meet the following requirements:See Single Power Option definition for seating system capabilityGroup 5 multiple power option PWC (K0891) must have the specified components and meet the following requirements:See Multiple Power Options definition for seating system capabilityAccommodates a ventilatorMISCELLANEOUS:The only products that may be billed using codes K0800, K0801, K0802, K0806, K0807, K0808, K0812, 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, 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, K0898 are those products for which a written coding verification review (CVR) has been made by the Pricing, Data Analysis, and Coding (PDAC) contractor. Information concerning the documentation that must be submitted to the PDAC for a written CVR can be found on the PDAC web site or by contacting the PDAC. A Product Classification List (PCL) with products which have received a written CVR can be found on the PDAC web site. Note that code K0013 is not included in the list of products requiring CVR.Manufacturers and suppliers should refer to the PDAC web site or contact the PDAC for information concerning testing requirements.If a power mobility device has not received a written CVR from the PDAC or if the PDAC has reviewed and determined that the product does not meet the requirements of any code, then it must be billed with code K0899.If a product is billed to Medicare using one of the HCPCS codes that requires written CVR, but the product is not on the PCL for that particular HCPCS code, then the claim line will be denied as incorrect coding.Suppliers should contact the PDAC contractor for guidance on the correct coding of these items.