If the wheelchair accessory code changes earlier this year weren't enough, CMS also introduced new wheelchair cushion codes that became effective in July.
by Jane Bunch

If the wheelchair accessory code changes earlier this year
weren't enough, CMS also introduced new wheelchair cushion codes
that became effective in July. To avoid increased DSO (days sales
outstanding), denials and other headaches, it is vital for
providers to keep up with these changes.

If you have any questions about cushion codes, call the SADMERC
to verify the HCPCS code for the cushion that has been prescribed
for your patient, because a “cross-walk” has not been
furnished from the old codes to the new codes. I suggest you keep a
SADMERC logbook documenting the make, model, manufacturer, serial
number or model number, the person you spoke with, and the time and
date. Because these codes are so important, you should refer to the
SADMERC about the new codes.

The two most used wheelchair cushions have always been the E0178
and the E0192. Now, there are many new “K” codes for
wheelchair cushions. Providers should verify what they have in
inventory, and then assign an employee to call and verify the
proper HCPCS codes for those cushions. Billing the old codes will
simply result in a denial. Remember that a “KX”
modifier is required on wheelchair cushions stating to Medicare
that you have the documentation as required by policy in the
patient's file.

The original determination effective date was July 1, and the
final effective date was Oct. 1. Log on to your DMERC Web site, and
click on the medical policies section to view the information they
have posted on wheelchair seating. Print the entire new policy,
have your employees read it thoroughly, and pull down the new fee
schedule as well. Make sure your staff understands the new

The basic coverage guidelines below may assist you in
understanding this complicated policy.

Covered if patient meets criteria for a wheelchair:

  • K0650, K0651 — general use seat cushion
  • K0060, K0061 — general use back cushion

The “skin protection” seat cushions (K0652, K0653)
are covered if:

  • The patient qualifies for a wheelchair
  • The patient has either of the following:

a) A current or a past pressure ulcer located on the area of
contact with the cushion qualifying diagnosis codes 707.03 through

b) Cannot shift weight, or has absent or impaired sensation in
the area of contact. Qualifying ICD-9s: 344.00-344.1, 336.0-336.3,
340, 341.0-341.9, 343.0-343.9, 335.0-335.21, 335.23-335.9, 138,
344.09, 741.00-741.93, 330.0-330.9, 331.0, or 332.

Make sure to update the Physicians Order to include the new
coverage criteria and diagnosis stated.

  • The positioning seat cushion (K0654, K0655), positioning back
    cushion (K0662 - K0665) and positioning accessory (E0955-E0957,
    E0960) is covered for patients who meet both of the following:

    Patient meets criteria for and has a wheelchair; and

  • The patient has any significant postural asymmetries caused by
    one of the diagnoses above or to any of the following ICD-9 codes:
    344.30-344.32, 438.40-438.42, 342.00-342.92, 438.20-438.22, 359.0,
    359.1, 333.4, 333.6, 333.7), 334.0-334.9.

  • For HCPCS codes K0656, K0657, combination skin protection and
    positioning seat cushions are covered for patients who meet the
    criteria for both a skin-protection and positioning seat

    Be certain you have a Written Order Prior to Delivery (WOPD) in
    your hand before delivering any of these cushions to your patients.
    If you do not obtain a WOPD, the item will require an
    “EY” modifier, and you will not be reimbursed.

    And remember, there are more changes coming as CMS has said it
    plans to bundle wheelchair billing with the most common accessories
    into a collection of new codes next year. Then it will be even more
    important for providers to stay educated on and aware of any coding
    changes, and to make certain that everything they deliver is billed

    Jane Bunch is CEO of Kennesaw, Ga.-based JB&CS. A
    reimbursement specialist, Bunch delivers educational seminars
    worldwide, helps develop corporate compliance plans, and serves as
    a consultant for fraud and abuse cases. She can be reached at
    678/445-1221 or via e-mail at target="_blank">BILLHME@aol.com.