New LCDs Released for Power Mobility & Wheelchair Options

WASHINGTON—The durable medical equipment Medicaid administrative contractors (DME MACs) have released two new local coverage determinations for wheelchairs, the American Association for Homecare reported.

The future efective local coverage determinations (LCDs) go into effect Dec. 20 and clarify coverage of seat elevators for non-complex Group 2 chairs, AAHomecare said. They are:

1. For Group 2 power wheelchairs, the LCD L33789: Power Mobility Devices states that a non-complex Group 2 seat elevator PWC (K0830, K0831) is covered if all the following criteria are met:

• All of the coverage criteria (a)-(e) for a PWC are met; and
• The wheelchair is appropriate for the beneficiary’s weight; and
• The beneficiary relies on a PWC as the primary means of mobility within the home; and
• Either 1)the beneficiary relies upon their upper extremities to perform transfers; or 2)the beneficiary performs reaching from the power wheelchair to perform one or more MRADLs such as toileting, feeding, dressing, grooming, and bathing in customary locations within the home; and 
• The beneficiary needs substantial mobility assistance (at least 50% of the effort required), as determined by a standardized rating scale, to accomplish transfers or to perform one or more mobility-related activity of daily living (MRADLs); and
• The beneficiary has had a specialty evaluation that was performed by a licensed/certified medical professional
• The wheelchair is provided by a supplier that employs a Rehabilitation Engineering and Assistive Technology Society of North America-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the beneficiary.

2. For power seat elevation on non-complex power wheelchairs, L33792: Wheelchair Options/Accessories states:

A power seat elevation system (E2298) will be covered if a beneficiary meets the coverage criteria for either a Group 2 single power option or multiple power option power-driven wheelchair, or a Group 3 power-driven wheelchair as described in the Power Mobility Devices LCD and meets the coverage criteria for seat elevation equipment as described in CMS Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03) Chapter 1, Part 4, Section 280.16 Seat Elevation Equipment (Power Operated) on Power Wheelchairs.

If all of the above criteria are not met, the power seat elevation system (E2298) will be denied as not reasonable and necessary.

A power seat elevation system (K0108) is covered if a beneficiary meets the coverage criteria for a non-complex Group 2 no power option, Group 5 single power option, or Group 5 multiple power option power-driven wheelchair (K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0890, K0891), as described in the Power Mobility Devices LCD, and the following criteria are met: 

• The beneficiary relies on a PWC as the primary means of mobility within the home; and
• Either the beneficiary relies upon their upper extremities to perform transfers; or the beneficiary performs reaching from the power wheelchair to perform one or more MRADLs; and the beneficiary needs substantial mobility assistance (at least 50% of the effort required), as determined by a standardized rating scale, to accomplish transfers or to perform one or more MRADLs; and
• The beneficiary has had a specialty evaluation.