Article ID Number A17918
Wheelchair Seating – Policy Article – Effective January 2009
Primary Geographic Jurisdiction
Connecticut
District of Columbia
Delaware
Massachusetts
Maryland
Maine
New Hampshire
New Jersey
New York – Entire State
Pennsylvania
Rhode Island
Vermont
DME Region Article Covers back to top
Jurisdiction A
Original Article Effective Date back to top
07/01/2004
Article Revision Effective Date back to top
01/01/2009
Article Text back to top
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
For an item addressed in this policy to be covered by Medicare, a written signed and dated order must be received by the supplier prior to delivery of the item. If the supplier delivers the item prior to the receipt of a written order, it will be denied as non-covered. If the written order is not obtained prior to delivery, payment will not be made for that item even if a written order is subsequently obtained. If a similar item is subsequently provided by an unrelated supplier who has obtained a written order prior to delivery, it will be eligible for coverage.
There is no separate payment for a solid insert (E0992) (see definition in Coding Guidelines) 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.
There is no separate payment for mounting hardware for a seat or back cushion.
There is no separate payment for a wheelchair seat or back cushion when it is used with a roll-about chair (E1031).
CMS Approved Audit Issue
Issue Name: Solid Insert with Seat or Back Wheelchair Cushions
Issue Number A000262009
Issue Description: Code E0992 (solid seat insert) is not seperately payable when provided with a seat or a seat back wheelchair cushion. Therefore an issue may exist when E0992 is billed and reimbursed under Medicare Part B with a seat or seat back wheelchair cushion.
Type of Review Automated Review for Over payments (Error Code: 6000)
State(s) Affected: DC, CT, MA, MD, ME, DE, NJ, NY, NH, PA, RI, VT
Providers Affected: DME Suppliers
Date Posted: December 22, 2009
Dates of Service: October 1, 2007 – Present
Issue References LCD Policy Article A17918