Manual Wheelchair Bases - Policy Article

Revision Effective Date: 10/01/2026
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: E0150 benefit category coverage information for dates of service on or after October 1, 2025 through September 30, 2026 and for dates of service on or after October 1, 2026
MODIFIERS:
Added: KX modifier information for E0150 for claims with dates of service on or after October 1, 2026 when coverage criteria in the Walkers LCD (L33791) and in the Manual Wheelchair Bases LCD (L33788) have been met
Revised: GY modifier information, to include that the GY modifier must be appended to E0150 if E0150 is only to be used for mobility outside the home
CODING GUIDELINES:
Revised: “Manual Wheelchair Bases” to “Other Manual Wheelchairs,” as clarification
Added: “Combination wheeled walker with seat and transport chair (E0150)” to the list of manual wheelchair bases that describe a complete product
Revised: “Adult manual wheelchairs (K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009, E1161) are” to “Adult manual wheelchairs described by HCPCS codes K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009, E1161 are,” as clarification
Revised: “Manual wheelchair bases (K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, and K0009) include” to “Manual wheelchair bases coded K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, and K0009 include,” as clarification
Added: Coding guideline information for E0150
10/01/2026: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 07/01/2024
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: “When the home assessment is based upon indirectly obtained information, the supplier must, at the time of delivery, verify that the item delivered meets the requirements specified in criterion C."
Revised: "Issues such as the physical layout of the home, surfaces to be traversed, and obstacles must be addressed by and documented in the home assessment.” to “Regardless of the method used for the home assessment, issues such as the physical layout of the home, surfaces to be traversed, and obstacles to the use of the selected manual wheelchair must be addressed by and documented in the home assessment.”
06/13/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 10/12/2023
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the specialty evaluation
Added: “If the supplier is owned by a hospital, the PT, OT, or practitioner working in the inpatient or outpatient hospital setting may perform the specialty evaluation.”


10/12/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Reference to ADMC program-specific information
05/26/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 FED. REG VOL 217):
Removed: “The link will be located here once it is available.”
Added: “The required Face-to-Face Encounter and Written Order Prior to Delivery List is available here.” with a hyperlink to the list


04/14/2022: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
CODING GUIDELINES:
Added: Coding verification review information for HCPCS code K0009 (effective for dates of service on or after 06.01.2013)
Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review
Removed: Reference to HCPCS codes for billing of maintenance and service
03/25/2021: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2020
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “physician” to “practitioner”
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g):
Removed: Section due to Final Rule 1713
REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217):
Added: Section and related information based on Final Rule 1713
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
CODING GUIDELINES:
Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity”
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity”
02/20/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2019
CODING GUIDELINES:
Added: Clarification of materials used in construction of manual wheelchair bases


02/07/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2018
CODING GUIDELINES:
Added: Clarification of what is included in a manual wheelchair base code
Added: Clarification of titanium unbundling in manual wheelchair bases


04/12/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.

Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Added: 42 CFR 410.38(g)
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Home assessment requirements, ADMC eligible bases, medical necessity documentation requirements for K0005, K0008, E1037, E1038, E1039,  and Modifier instructions
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements Language Article

Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.

Revision Effective Date: 10/31/2014
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES
Removed: “When required by state law” from ACA new prescription requirements
Revised: Face-to-Face Requirements for treating practitioner