Wheelchair Options/Accessories - Policy Article - Effective October 2015

Revision Effective Date: 10/01/2025
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: Information pertaining to the assistive technology professional assessment, including “The supplier ATP assessment date must be on or after the beginning of the face-to-face process with the treating practitioner and/or licensed/certified medical professional (LCMP).,” as clarification


04/09/2026: 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: 10/01/2025
CODING GUIDELINES:
Revised: “For information concerning a push-rim activated power assist device for a manual wheelchair, refer to the Power Mobility Devices medical policy.” to “For information concerning a power assist system for a manual wheelchair, refer to the Power Mobility Devices medical policy.”
Revised: Information pertaining to non-expandable controller, by revising “power seating actuators through the drive control” to “power actuators” and by revising “power seating actuators though” to “power actuators through”
Revised: Information pertaining to expandable controller, by revising “powered seating actuators through the drive control” to “powered actuators,” by adding examples of powered actuators, by revising “power seating actuators though” to “power actuators through,” and by removing “E2310 or” from the reference of an additional component required when control of the power actuators is through the Control Input Device
10/30/2025: 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: 04/01/2025
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: HCPCS noted as swingaway, retractable, or removable hardware, from “(E1028)” to “(E1028, E1032)”
Added: “A wheelchair transportation securement system (E1022) and a wheelchair transit securement system (E1023) are non-covered as they do not meet the definition of DME.”
MODIFIERS:
Revised: “KX, GA, GY, AND GZ MODIFIERS:” to “KX, GA, GY, GZ, LT, and RT MODIFIERS:”
Added: RT and LT modifier information (relocated from the CODING GUIDELINES section)
CODING GUIDELINES:
Removed: RT and LT modifier information
Revised: Coding guideline for HCPCS code E1028
Added: Coding guideline for HCPCS code E1032
Added: “For initial claims or new rental periods for swingaway, retractable, or removable mounting hardware for wheelchair accessories described by joysticks or other drive control interfaces, with dates of service on or after April 1, 2025, suppliers must use HCPCS code E1032.”
Added: “If the rental period for the swingaway, retractable, or removable mounting hardware for wheelchair accessories described by joysticks or other drive control interfaces began prior to April 1, 2025, then suppliers must use HCPCS code E1028 for ongoing claims in the rental period.”
Revised: Information in the table that pertains to codes included in the allowance of other codes; in the table, “E1028” was revised to “E1032” in Column II of the row that contains “E2325” in Column I


04/03/2025: 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: 04/01/2024
CODING GUIDELINES:
Revised: “(E2300)” to “(E2300 or E2298 depending on DOS - See below)”
Added: Information pertaining to coding of seat elevation systems on claims for DOS on or before March 31, 2024 and on or after April 1, 2024
05/02/2024: 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: 04/01/2024
CODING GUIDELINES:
Revised: “(E2300)” to “(E2300 or E2298 depending on DOS - See below)”
Added: Information pertaining to coding of seat elevation systems on claims for DOS on or before March 31, 2024 and on or after April 1, 2024
05/02/2024: 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: 10/26/2023
CODING GUIDELINES:
Revised: Information pertaining to the RT and LT modifiers
Removed: “The right (RT) and left (LT) modifiers must be used when appropriate.”
Added: “The right (RT) and left (LT) modifiers are optional on claim lines billed for wheelchair options and accessories.”
Added: “If RT and LT modifiers are not appended, then the bilateral items (left and right) with a unit of service “each” may be billed on a single claim line with 2 UOS.”
10/26/2023: 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: 10/26/2023
CODING GUIDELINES:
Revised: Information pertaining to the RT and LT modifiers
Removed: “The right (RT) and left (LT) modifiers must be used when appropriate.”
Added: “The right (RT) and left (LT) modifiers are optional on claim lines billed for wheelchair options and accessories.”
Added: “If RT and LT modifiers are not appended, then the bilateral items (left and right) with a unit of service “each” may be billed on a single claim line with 2 UOS.”
10/26/2023: 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: 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: 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: 05/16/2023
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “POWER SEATING SYSTEMS” to “POWER STANDING SYSTEM”
Removed: Language that specified a power seat elevation feature (E2300) is non-covered
08/17/2023: 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: 05/16/2023
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: “POWER SEATING SYSTEMS” to “POWER STANDING SYSTEM”
Removed: Language that specified a power seat elevation feature (E2300) is non-covered
08/17/2023: 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
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
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:
Removed: Reference to HCPCS codes for replacement-only items
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
CODING GUIDELINES:
Removed: Reference to HCPCS codes for replacement-only items
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
CODING GUIDELINES:
Removed: Reference to ICD-10 codes for replacement of E2398
Revised: Column II of table, removing E2398 for manual wheelchair bases and power wheelchair bases
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: Group 1 paragraph information, HCPCS code E2398 reference, and Group 1 ICD-10 Codes
10/08/2020: 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: 01/01/2020
CODING GUIDELINES:
Removed: Reference to ICD-10 codes for replacement of E2398
Revised: Column II of table, removing E2398 for manual wheelchair bases and power wheelchair bases
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Removed: Group 1 paragraph information, HCPCS code E2398 reference, and Group 1 ICD-10 Codes
10/08/2020: 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: 01/01/2020
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: Information related to GY modifier use, as a result of Final Rule 1713
CODING GUIDELINES:
Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
Revised: Column II of table, to include E2398 for manual wheelchair bases and power wheelchair bases

03/19/2020: 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: 01/01/2020
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: Information related to GY modifier use, as a result of Final Rule 1713
CODING GUIDELINES:
Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
Revised: Column II of table, to include E2398 for manual wheelchair bases and power wheelchair bases

03/19/2020: 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: 01/01/2020
CODING GUIDELINES:
Added: E2398 Coding Guideline
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”
Added: Group 1 ICD-10 codes G80.0, G80.1, G80.2 , G80.3 , G80.4 , G80.8, G80.9, G93.1, S06.2X0S, S06.2X1S, S06.2X2S, S06.2X3S, S06.2X4S, S06.2X5S, S06.2X6S, S06.2X9S
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”
12/19/2019: 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: 01/01/2020
CODING GUIDELINES:
Added: E2398 Coding Guideline
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”
Added: Group 1 ICD-10 codes G80.0, G80.1, G80.2 , G80.3 , G80.4 , G80.8, G80.9, G93.1, S06.2X0S, S06.2X1S, S06.2X2S, S06.2X3S, S06.2X4S, S06.2X5S, S06.2X6S, S06.2X9S
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”
12/19/2019: 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: 01/01/2019
CODING GUIDELINES:
Removed: K0037 from “replacement only” items
Revised: RT and LT modifier billing instructions (Effective 03/01/2019)

02/14/2019: 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: 01/01/2019
CODING GUIDELINES:
Removed: K0037 from “replacement only” items
Revised: RT and LT modifier billing instructions (Effective 03/01/2019)

02/14/2019: 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
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: 42 CFR language previously in Policy Specific Documentation section
CODING GUIDELINES:
Revised: Coding Guidelines for E1012
Added: PDAC contact information


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: 01/01/2018
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Added: 42 CFR language previously in Policy Specific Documentation section
CODING GUIDELINES:
Revised: Coding Guidelines for E1012
Added: PDAC contact information


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: 01/01/2018


Coding Guidelines:


Added: HCPCS code E0954
 Added: HCPCS code E0954 to bundling table


 12/21/2017: 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: 01/01/2018


Coding Guidelines:


Added: HCPCS code E0954
 Added: HCPCS code E0954 to bundling table


 12/21/2017: 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:
Removed: Non-coverage language for E0950 due to clerical error

Revision Effective Date: 01/01/2017
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Removed: Non-coverage language for E0950 due to clerical error

Revision Effective Date: 01/01/2017
NON MEDICAL NECESSITY PAYMENT RULES:
Added: Coverage rule for E0950
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: 42 CFR 410.38(g) and Modifier requirements
Added: Instructions for replacement codes
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article

Revision Effective Date: 01/01/2017
NON MEDICAL NECESSITY PAYMENT RULES:
Added: Coverage rule for E0950
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Added: 42 CFR 410.38(g) and Modifier requirements
Added: Instructions for replacement codes
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements 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.

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: 01/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
CODING GUIDELINES:
Added: HCPCS code E1012
Added: HCPCS code E1012 to bundling table

Revision Effective Date: 01/01/2016
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015)
CODING GUIDELINES:
Added: HCPCS code E1012
Added: HCPCS code E1012 to bundling table

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
CODING GUIDELINES:
Revised: Removed HCPCS K0017 and K0018 from the initial package verbiage for armrest separate billing due to being parts of the whole assembly E0973 and only separately billed for replacement parts.
Added: E0973 was added to the initial package verbiage for armrest separate billing due to being the whole assembly.
Removed: The word “adjustable” was removed from the initial package verbiage for armrest separate billing due to fixed armrests K0020 being included

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
CODING GUIDELINES:
Revised: Removed HCPCS K0017 and K0018 from the initial package verbiage for armrest separate billing due to being parts of the whole assembly E0973 and only separately billed for replacement parts.
Added: E0973 was added to the initial package verbiage for armrest separate billing due to being the whole assembly.
Removed: The word “adjustable” was removed from the initial package verbiage for armrest separate billing due to fixed armrests K0020 being included