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June 8, 2023

Payment of Power Seat Elevation Equipment on Power Wheelchairs

CMS has issued a national coverage decisionExternal website that establishes coverage for power seat elevation for power wheelchairs, effective May 16, 2023. Information about coverage of these items will be included in future updates to the Wheelchair Options/Accessories and Power Mobility Devices Local Coverage Determination (LCDs) and LCD-related Policy Articles.

The following HCPCS codes should be used for power seat elevation equipment, effective with dates of service on or after May 16, 2023:

Type of base equipment HCPCS for power seat elevation equipment Payment Modifier Requirements
Complex rehabilitative and Group 5 power-driven wheelchairs for individuals who meet criteria in the NCD. E2300 (Wheelchair accessory, power seat elevation system, any type) Capped Rental (RR) or Lump Sum (NU/UE)*
Group 2 power wheelchairs that are not complex rehabilitative power-driven wheelchairs: K0830 (Power Wheelchair, Group 2 Standard, Seat Elevator, Sling/Solid Seat/Back, Patient Weight Capacity Up to and Including 300 Pounds)
Or
K0831 (Power Wheelchair, Group 2 Standard, Seat Elevator, Captains Chair, Patient Weight Capacity Up to and Including 300 Pounds)
Capped Rental (RR)*

*Capped rental modifiers KH, KI, or KJ and/or rent/purchase modifiers BP or BR apply depending on the billed month and rental/purchase option chosen.

Payment

Until CMS sets fee schedule amounts for E2300, K0830, and K0831, allowed amounts for these HCPCS will be calculated per regulations for gap-filling. Additional information about gap-filling is available here: Supplier Manual Chapter 10 – PricingPDF

When the purchase price exceeds $150, payment is made on a capped rental basis. DME wheelchair accessories normally classified as capped rental items are also payable under the lump sum purchase method when used as part of a complex rehabilitative power-driven wheelchair.

HCPCS coding and national fee schedule amounts for power wheelchairs with power seat elevation will be addressed as part of an upcoming HCPCS public meeting. Additional details on the timing and agenda of the public meetings that will include power seat elevation coding and payment will be provided in the future at https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfoExternal website

Reminder:

All HCPCS in the Wheelchair Options/Accessories and Power Mobility Devices LCDs require a KX modifier to indicate the coverage criteria are met or a GA, GY or GZ modifier to indicate the coverage criteria are not met. Claim lines billed without a GA, GY, GZ, or KX modifier will be rejected as missing information.

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