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Wheelchair Seating - Policy Article
Article A52505 · 53 versions, 2015 to today · last changed 2025-10-01 (R27)
Version 16 of Article A52505: in force by CMS's dates 2018-01-01 to 2017-12-31. The policy text on this page comes from this archived version.
DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
source
CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.
Sections in this version: Article Text · Coding Information. Plus 1 section marked N/A in this version.
Full verbatim text serves to customers · Customer? Log in
Version history, Article A52505
CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.
v22015-10-01, superseded same dayv22015-10-01, superseded same dayv32015-10-01, superseded same dayv32015-10-01, superseded same dayv52015-10-01, superseded same dayv52015-10-01 to 2016-06-30v62016-07-01, superseded same dayv62016-07-01 to 2016-12-31v92017-01-01, superseded same dayv92017-01-01, superseded same dayv112017-01-01, superseded same dayv112017-01-01, superseded same dayv132017-01-01, superseded same dayv132017-01-01 to 2017-12-31v162018-01-01, superseded same dayv162018-01-01, superseded same dayv192018-01-01, superseded same dayv192018-01-01 to 2018-12-31v242019-01-01, superseded same dayv242019-01-01 to 2019-07-31v272019-08-01, superseded same dayv272019-08-01 to 2019-12-31v302020-01-01, superseded same dayv302020-01-01 to 2020-09-30v332020-10-01, superseded same dayv332020-10-01, superseded same dayv382020-10-01, superseded same dayv382020-10-01 to 2021-05-31v412021-06-01, superseded same dayv412021-06-01 to 2021-09-30v442021-10-01, superseded same dayv442021-10-01, superseded same dayv472021-10-01, superseded same dayv472021-10-01 to 2022-09-30v532022-10-01, superseded same dayv532022-10-01 to 2023-09-30v582023-10-01, superseded same dayv582023-10-01 to 2023-10-11v612023-10-12, superseded same dayv612023-10-12 to 2023-12-19v632023-12-20, superseded same dayv632023-12-20 to 2024-06-26v652024-06-27, superseded same dayv652024-06-27 to 2024-08-28v672024-08-29, superseded same dayv672024-08-29 to 2024-09-30v692024-10-01, superseded same dayv692024-10-01 to 2024-10-16v712024-10-17, superseded same dayv712024-10-17 to 2025-03-31v742025-04-01 to 2025-09-30v772025-10-01, superseded same dayv802025-10-01 to today
Revision history, every version
CMS's own change log, quoted, 51 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.
R27 · 2025-10-01 · v80
Revision Effective Date: 10/01/2025 CODING GUIDELINES: Added: “Code E1033 must not be billed in addition to codes E0953, E0956, E0957, or E0960. Code E1033 must not be used for mounting hardware related to a wheelchair seat cushion or back cushion code.” as clarification Added: “Code E1034 must not be billed in addition to codes E0953, E0955, E0957, or E0960. Code E1034 must not be used for mounting hardware related to a wheelchair seat cushion or back cushion code.” as clarification 05/28/2026: 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.
R26 · 2025-10-01 · v77
Revision Effective Date: 10/01/2025 MODIFIERS: Removed: “(refer to the Group 1 codes in the ICD-10 code list section)” and “due to one of the diagnoses listed as a covered diagnosis in the Group 2 ICD-10 code list section” from the language that notes when a KX modifier must be added to a skin protection seat cushion code Removed: “due to one of the diagnoses listed as a covered diagnosis in Group 2 or Group 3 of the ICD-10 code list section” from the language that notes when a KX modifier must be added to a positioning seat cushion, positioning back cushion, or positioning accessory code Removed: “(refer to the Group 1 codes in the ICD-10 code list section),” “due to one of the diagnoses listed as a covered diagnosis for skin protection cushions (refer to the Group 2 codes in the ICD-10 code list section),” “due one of the diagnoses listed as a covered diagnosis for skin protection cushions (refer to the Group 2 codes in the ICD-10 code list section),” and “due to one of the diagnoses listed as a covered diagnosis for positioning cushions (refer to the Group 2 and Group 3 codes in the ICD-10 code list section)” from the language that notes when a KX modifier must be added to a combination skin protection and positioning seat cushion code Removed: “due to one of the diagnoses listed as a covered diagnosis for skin protection cushions (refer to the ICD-10 code list section)” and “due to one of the diagnoses listed as a covered diagnosis for positioning cushions (refer to the ICD-10 code list section)” from the language that notes when a KX modifier must be added to a custom fabricated seat or back cushion code ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: Group 1 Paragraph, Group 2 Paragraph, Group 3 Paragraph, and Group 4 Paragraph Removed: Group 1 Codes, Group 2 Codes, Group 3 Codes, and Group 4 Codes Added: “N/A” ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY: Removed: Group 1 Paragraph Removed: Group 1 Codes information Added: “N/A” 10/02/2025: 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.
R25 · 2025-04-01 · v74
Revision Effective Date: 04/01/2025 MODIFIERS: Revised: “GA, GY, AND GZ MODIFIERS:” to “GA, GY, GZ, LT, and RT MODIFIERS:” Added: RT and LT modifier information (relocated from the CODING GUIDELINES section) CODING GUIDELINES: Revised: “Code E1028 (swingaway or removable mounting hardware upgrade) may be billed in addition to codes E0953, E0955, E0956, E0957. It must not be billed in addition to code E0960. It must not be used for mounting hardware related to a wheelchair seat cushion or back cushion code.” to “Code E1028 (swingaway or removable mounting hardware upgrade) may be billed in addition to codes E0953 and E0957. It must not be billed in addition to codes E0955, E0956 or E0960. Code E1028 must not be used for mounting hardware related to a wheelchair seat cushion or back cushion code.” Added: Coding guidelines for HCPCS codes E1033 and E1034 Added: “For initial claims or new rental periods for swingaway, retractable, or removable mounting hardware for wheelchair accessories described by headrests and lateral trunk or hip supports, with dates of service on or after April 1, 2025, suppliers must use HCPCS code E1033 and E1034, respectively.” Added: “If the rental period for the swingaway, retractable, or removable mounting hardware for wheelchair accessories described by headrests or lateral trunk or hip supports began prior to April 1, 2025, then suppliers must use HCPCS code E1028 for ongoing claims in the rental period. In this scenario, if an E0955 or E0956 rental period also began prior to April 1, 2025 and is still in a rental period after April 1, 2025, then the E0955 or E0956 will continue to be billed with the E1028.” Removed: RT and LT modifier information 04/03/2025: 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.
R24 · 2024-10-17 · v71
Revision Effective Date: 10/17/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code G72.41 to Group 2 and Group 4 Codes 10/17/2024: 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.
R24 · 2024-10-17 · v71
Revision Effective Date: 10/17/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code G72.41 to Group 2 and Group 4 Codes 10/17/2024: 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.
R23 · 2024-10-01 · v69
Revision Effective Date: 10/01/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code M62.85 to Group 2 and Group 4 Codes, due to ICD-10-CM code updates 09/12/2024: 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.
R23 · 2024-10-01 · v69
Revision Effective Date: 10/01/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code M62.85 to Group 2 and Group 4 Codes, due to ICD-10-CM code updates 09/12/2024: 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.
R22 · 2024-08-29 · v67
Revision Effective Date: 08/29/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes G70.00 and G70.01 to Group 2 and Group 4 Codes 08/29/2024: 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.
R22 · 2024-08-29 · v67
Revision Effective Date: 08/29/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes G70.00 and G70.01 to Group 2 and Group 4 Codes 08/29/2024: 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.
R21 · 2024-06-27 · v65
Revision Effective Date: 06/27/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes M48.00, M48.01, M48.02, M48.03, M48.04, M48.05, M48.061, M48.062, M48.07, M48.08, Q03.0, Q03.1, Q03.8, Q03.9 to Group 2 and Group 4 Codes 06/27/2024: 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.
R21 · 2024-06-27 · v65
Revision Effective Date: 06/27/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes M48.00, M48.01, M48.02, M48.03, M48.04, M48.05, M48.061, M48.062, M48.07, M48.08, Q03.0, Q03.1, Q03.8, Q03.9 to Group 2 and Group 4 Codes 06/27/2024: 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.
R20 · 2023-12-20 · v63
Revision Effective Date: 12/20/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: Information, to Group 1 Paragraph and Group 4 Paragraph, which specifies Z87.2 ICD-10-CM code must be appended when the beneficiary has a history of a healed pressure ulcer on the area of contact with the seating surface, Z87.2 is not for use to describe a current pressure ulcer on the area of contact with the seating surface, and other ICD-10-CM codes in the Group 1 Codes and Group 4 Codes are not for use to represent a history of a healed pressure ulcer on the area of contact with the seating surface Added: ICD-10-CM code Z87.2 to Group 1 Codes and Group 4 Codes 11/09/2023: 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.
R20 · 2023-12-20 · v63
Revision Effective Date: 12/20/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: Information, to Group 1 Paragraph and Group 4 Paragraph, which specifies Z87.2 ICD-10-CM code must be appended when the beneficiary has a history of a healed pressure ulcer on the area of contact with the seating surface, Z87.2 is not for use to describe a current pressure ulcer on the area of contact with the seating surface, and other ICD-10-CM codes in the Group 1 Codes and Group 4 Codes are not for use to represent a history of a healed pressure ulcer on the area of contact with the seating surface Added: ICD-10-CM code Z87.2 to Group 1 Codes and Group 4 Codes 11/09/2023: 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.
R19 · 2023-10-12 · v61
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.” ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: “E0955” to Group 2 Paragraph and Group 3 Paragraph Added: Information pertaining to the diagnosis code requirements for E0955 ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY: Added: “Exception: For HCPCS code E0955, the ICD-10-CM codes specified in the preceding section are not an exhaustive list. See Group 2 and Group 3 in the preceding section, for additional information.” to Group 1 Paragraph Removed: “E0955” from language that noted “There are no specified ICD-10 codes” 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.
R19 · 2023-10-12 · v61
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.” ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: “E0955” to Group 2 Paragraph and Group 3 Paragraph Added: Information pertaining to the diagnosis code requirements for E0955 ICD-10-CM CODES THAT DO NOT SUPPORT MEDICAL NECESSITY: Added: “Exception: For HCPCS code E0955, the ICD-10-CM codes specified in the preceding section are not an exhaustive list. See Group 2 and Group 3 in the preceding section, for additional information.” to Group 1 Paragraph Removed: “E0955” from language that noted “There are no specified ICD-10 codes” 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.
R18 · 2023-10-01 · v58
Revision Effective Date: 10/01/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10-CM codes G20 and G37.8 from Group 2 and Group 4 Codes, due to ICD-10-CM code updates Added: ICD-10-CM codes E75.27, E75.28, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, G31.80, G31.86, G37.81, and G37.89 to Group 2 and Group 4 Codes, due to ICD-10-CM code updates Added: ICD-10-CM code G31.89 to Group 2 and Group 4 Codes 09/21/2023: 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.
R18 · 2023-10-01 · v58
Revision Effective Date: 10/01/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10-CM codes G20 and G37.8 from Group 2 and Group 4 Codes, due to ICD-10-CM code updates Added: ICD-10-CM codes E75.27, E75.28, G20.A1, G20.A2, G20.B1, G20.B2, G20.C, G31.80, G31.86, G37.81, and G37.89 to Group 2 and Group 4 Codes, due to ICD-10-CM code updates Added: ICD-10-CM code G31.89 to Group 2 and Group 4 Codes 09/21/2023: 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.
R17 · 2022-10-01 · v53
Revision Effective Date: 10/01/2022 CODING GUIDELINES: Added: CAD/CAM technology details to the fabrication technique information Revised: Format of language pertaining to fabrication techniques for cushions ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, G31.83, G60.0, Q79.60, Q79.61, Q79.62, Q79.63, Q79.69, Q90.0, Q90.1, Q90.2, and Q90.9 to Group 2 Codes Added: ICD-10-CM codes Q72.01, Q72.02, Q72.03, Q72.11, Q72.12, and Q72.13 to Group 3 Codes Added: ICD-10-CM codes F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, G31.83, G60.0, Q72.01, Q72.02, Q72.03, Q72.11, Q72.12, Q72.13, Q79.60, Q79.61, Q79.62, Q79.63, Q79.69, Q90.0, Q90.1, Q90.2, and Q90.9 to Group 4 Codes Added: ICD-10-CM codes G71.031, G71.032, G71.033, G71.0340, G71.0341, G71.0342, G71.0349, G71.035, G71.038, and G71.039 to Group 2 and Group 4 Codes, due to ICD-10-CM code updates 09/22/2022: 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.
R17 · 2022-10-01 · v53
Revision Effective Date: 10/01/2022 CODING GUIDELINES: Added: CAD/CAM technology details to the fabrication technique information Revised: Format of language pertaining to fabrication techniques for cushions ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM codes F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, G31.83, G60.0, Q79.60, Q79.61, Q79.62, Q79.63, Q79.69, Q90.0, Q90.1, Q90.2, and Q90.9 to Group 2 Codes Added: ICD-10-CM codes Q72.01, Q72.02, Q72.03, Q72.11, Q72.12, and Q72.13 to Group 3 Codes Added: ICD-10-CM codes F03.90, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, G31.83, G60.0, Q72.01, Q72.02, Q72.03, Q72.11, Q72.12, Q72.13, Q79.60, Q79.61, Q79.62, Q79.63, Q79.69, Q90.0, Q90.1, Q90.2, and Q90.9 to Group 4 Codes Added: ICD-10-CM codes G71.031, G71.032, G71.033, G71.0340, G71.0341, G71.0342, G71.0349, G71.035, G71.038, and G71.039 to Group 2 and Group 4 Codes, due to ICD-10-CM code updates 09/22/2022: 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.
R16 · 2021-10-01 · v47
Revision Effective Date: 10/01/2021 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.
R16 · 2021-10-01 · v47
Revision Effective Date: 10/01/2021 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.
R15 · 2021-10-01 · v44
Revision Effective Date: 10/01/2021 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Revised: ICD-10-CM code G71.20 description in Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates Added: ICD-10-CM code G04.82 to Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates 10/07/2021: 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.
R15 · 2021-10-01 · v44
Revision Effective Date: 10/01/2021 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Revised: ICD-10-CM code G71.20 description in Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates Added: ICD-10-CM code G04.82 to Group 2 and Group 4 Codes, due to annual ICD-10-CM code updates 10/07/2021: 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.
R14 · 2021-06-01 · v41
Revision Effective Date: 06/01/2021 CODING GUIDELINES: Revised: Flame resistance standards language to include “or equivalent” with reference to ASTM, EPA, or other national or international standards agencies 05/27/2021: 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.
R14 · 2021-06-01 · v41
Revision Effective Date: 06/01/2021 CODING GUIDELINES: Revised: Flame resistance standards language to include “or equivalent” with reference to ASTM, EPA, or other national or international standards agencies 05/27/2021: 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.
R13 · 2020-10-01 · v38
Revision Effective Date: 10/01/2020 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: References to refer to group codes in the ICD-10 code list section CODING GUIDELINES: Revised: References of positioning back cushion HCPCS codes, from “E2314” and “E2315” to “E2614” and “E2615” respectively Added: HCPCS code E2610 to list of HCPCS codes for which products require written coding verification review Added: "CVR" after reference to "coding verification review" Added: “(PCL)” after reference to “Product Classification List” Revised: Coding verification review language for products that must be billed with HCPCS code K0669 Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review 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.
R13 · 2020-10-01 · v38
Revision Effective Date: 10/01/2020 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: References to refer to group codes in the ICD-10 code list section CODING GUIDELINES: Revised: References of positioning back cushion HCPCS codes, from “E2314” and “E2315” to “E2614” and “E2615” respectively Added: HCPCS code E2610 to list of HCPCS codes for which products require written coding verification review Added: "CVR" after reference to "coding verification review" Added: “(PCL)” after reference to “Product Classification List” Revised: Coding verification review language for products that must be billed with HCPCS code K0669 Added: Incorrect coding denial language for products billed using HCPCS that require written coding verification review 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.
R12 · 2020-10-01 · v33
Revision Effective Date: 10/01/2020 CODING GUIDELINES: Added: RT and LT modifier billing instructions, for use when applicable ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10 codes G11.1 and G71.2 from Group 2 and Group 4 codes, due to annual ICD-10 Code updates Added: ICD-10 codes G11.10, G11.11, and G11.19 to Group 2 and Group 4 codes, due to annual ICD-10 Code updates Added: ICD-10 codes G71.20, G71.21, G71.220, G71.228, and G71.29 to Group 2 and Group 4 codes, due to annual ICD-10 Code updates 09/24/2020: 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.
R12 · 2020-10-01 · v33
Revision Effective Date: 10/01/2020 CODING GUIDELINES: Added: RT and LT modifier billing instructions, for use when applicable ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10 codes G11.1 and G71.2 from Group 2 and Group 4 codes, due to annual ICD-10 Code updates Added: ICD-10 codes G11.10, G11.11, and G11.19 to Group 2 and Group 4 codes, due to annual ICD-10 Code updates Added: ICD-10 codes G71.20, G71.21, G71.220, G71.228, and G71.29 to Group 2 and Group 4 codes, due to annual ICD-10 Code updates 09/24/2020: 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.
R11 · 2020-01-01 · v30
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: “ICD-10 Codes that are Covered” to “ICD-10 code list” 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 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” Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS, in Groups 2 and 3 Paragraphs 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” 03/12/2020: 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.
R11 · 2020-01-01 · v30
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: “ICD-10 Codes that are Covered” to “ICD-10 code list” 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 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” Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS, in Groups 2 and 3 Paragraphs 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” 03/12/2020: 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.
R10 · 2019-08-01 · v27
Revision Effective Date: 08/01/2019 ICD-10 CODES THAT ARE COVERED: Added: ICD-10 Codes G61.0 and G71.11 to Groups 2 and 4 diagnosis codes 06/13/2019: 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.
R10 · 2019-08-01 · v27
Revision Effective Date: 08/01/2019 ICD-10 CODES THAT ARE COVERED: Added: ICD-10 Codes G61.0 and G71.11 to Groups 2 and 4 diagnosis codes 06/13/2019: 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.
R9 · 2019-01-01 · v24
Revision Effective Date: 01/01/2019 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Removed: Statement to refer to diagnosis codes that support medical necessity section in the LCD Added: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related Policy Article ICD-10 CODES THAT ARE COVERED: Added: All diagnosis codes formerly listed in the LCD Added: ICD-10 I69.342 to Group 3 due to clerical oversight Added: ICD-10 codes M62.3, M62.89, Q67.8, Q68.1, and Q74.3 to Group 4 due to clerical oversight Removed: References to Group 5 ICD-10 CODES THAT ARE NOT COVERED: Added: Notation excluding all unlisted diagnosis codes from coverage for specified the HCPCS codes. Notation excluding all ICD-10 codes from coverage for E2610 and K0669. Added: Notation (formerly referenced in the Group 5 Paragraph of the ICD-10 Codes that Support Medical Necessity section within the LCD) indicating that for HCPCS codes E0955, E2601, E2602, E2611, E2612 and E2619, diagnosis codes are not specified. 05/23/2019: 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.
R9 · 2019-01-01 · v24
Revision Effective Date: 01/01/2019 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Removed: Statement to refer to diagnosis codes that support medical necessity section in the LCD Added: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related Policy Article ICD-10 CODES THAT ARE COVERED: Added: All diagnosis codes formerly listed in the LCD Added: ICD-10 I69.342 to Group 3 due to clerical oversight Added: ICD-10 codes M62.3, M62.89, Q67.8, Q68.1, and Q74.3 to Group 4 due to clerical oversight Removed: References to Group 5 ICD-10 CODES THAT ARE NOT COVERED: Added: Notation excluding all unlisted diagnosis codes from coverage for specified the HCPCS codes. Notation excluding all ICD-10 codes from coverage for E2610 and K0669. Added: Notation (formerly referenced in the Group 5 Paragraph of the ICD-10 Codes that Support Medical Necessity section within the LCD) indicating that for HCPCS codes E0955, E2601, E2602, E2611, E2612 and E2619, diagnosis codes are not specified. 05/23/2019: 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.
R8 · 2018-01-01 · v19
Revision Effective Date: 01/01/2018 CODING GUIDELINES: Revised: Positioning cushion language placement for clarification Added: Wheelchair seat and back cushion codes are all-inclusive 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.
R8 · 2018-01-01 · v19
Revision Effective Date: 01/01/2018 CODING GUIDELINES: Revised: Positioning cushion language placement for clarification Added: Wheelchair seat and back cushion codes are all-inclusive 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.
R7 · 2018-01-01 · v16
Revision Effective Date: 01/01/2018 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS Added: E0953 to modifier instructions CODING GUIDELINES: Added: E0953 coding instructions 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.
R7 · 2018-01-01 · v16
Revision Effective Date: 01/01/2018 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS Added: E0953 to modifier instructions CODING GUIDELINES: Added: E0953 coding instructions 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.
R6 · 2017-01-01 · v13
Revision Effective Date: 01/01/2017 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: 42 CFR 410.38(g) language, previously in Policy Specific Documentation Requirements section
R6 · 2017-01-01 · v13
Revision Effective Date: 01/01/2017 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: 42 CFR 410.38(g) language, previously in Policy Specific Documentation Requirements section
R5 · 2017-01-01 · v11
Revision Effective Date: 01/01/2017 CODING GUIDELINES: Revised: Coding guidelines for E0956 due to a narrative description error
R5 · 2017-01-01 · v11
Revision Effective Date: 01/01/2017 CODING GUIDELINES: Revised: Coding guidelines for E0956 due to a narrative description error
R4 · 2017-01-01 · v9
Revision Effective Date: 01/01/2017 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: 42 CFR 410.38(g) and Modifiers requirements CODING GUIDELINES: Changed: The third bullet for one characteristic of a positioning back cushion (E2613-E2616, E2620, E2621) from “vertical” to “horizontal”. Revised: Description of headrest (E0955) and fixed mounting hardware Added: Coding guideline for E0956 to specify that these items may be used on trunk, hip, thigh, and knee RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements Language Article
R4 · 2017-01-01 · v9
Revision Effective Date: 01/01/2017 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: 42 CFR 410.38(g) and Modifiers requirements CODING GUIDELINES: Changed: The third bullet for one characteristic of a positioning back cushion (E2613-E2616, E2620, E2621) from “vertical” to “horizontal”. Revised: Description of headrest (E0955) and fixed mounting hardware Added: Coding guideline for E0956 to specify that these items may be used on trunk, hip, thigh, and knee RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements Language Article
R3 · 2016-07-01 · v6
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.
R3 · 2016-07-01 · v6
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.
R2 · 2015-10-01 · v5
Revision Effective Date: 10/01/2015 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: Start date verbiage from Prescription Requirements
R2 · 2015-10-01 · v5
Revision Effective Date: 10/01/2015 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: Start date verbiage from Prescription Requirements
R1 · 2015-10-01 · v3
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
R1 · 2015-10-01 · v3
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
Receipts for auditors
Version 16 of Article A52505, shown on this page: in force by CMS's dates 2018-01-01 to 2017-12-31. Archived 2026-10-02. CMS's copy · Our archived file. 3 of 3 sections are proven word-identical to the archived file.
Every archived version of Article A52505 (53 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| Article A52505 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 2 | 2015-10-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 3 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 3 | 2015-10-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 5 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 5 | 2015-10-01 to 2016-06-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 6 | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 6 | 2016-07-01 to 2016-12-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 9 | 2017-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 9 | 2017-01-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 11 | 2017-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 11 | 2017-01-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 13 | 2017-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 13 | 2017-01-01 to 2017-12-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 16 | 2018-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 16 shown | 2018-01-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 19 | 2018-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 19 | 2018-01-01 to 2018-12-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 24 | 2019-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 24 | 2019-01-01 to 2019-07-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 27 | 2019-08-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 27 | 2019-08-01 to 2019-12-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 30 | 2020-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 30 | 2020-01-01 to 2020-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 33 | 2020-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 33 | 2020-10-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 38 | 2020-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 38 | 2020-10-01 to 2021-05-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 41 | 2021-06-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 41 | 2021-06-01 to 2021-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 44 | 2021-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 44 | 2021-10-01, superseded same day | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 47 | 2021-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 47 | 2021-10-01 to 2022-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 53 | 2022-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 53 | 2022-10-01 to 2023-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 58 | 2023-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 58 | 2023-10-01 to 2023-10-11 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 61 | 2023-10-12, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 61 | 2023-10-12 to 2023-12-19 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 63 | 2023-12-20, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 63 | 2023-12-20 to 2024-06-26 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 65 | 2024-06-27, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 65 | 2024-06-27 to 2024-08-28 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 67 | 2024-08-29, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 67 | 2024-08-29 to 2024-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 69 | 2024-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 69 | 2024-10-01 to 2024-10-16 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 71 | 2024-10-17, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52505 | version 71 | 2024-10-17 to 2025-03-31 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 74 | 2025-04-01 to 2025-09-30 | 2026-10-02 | CMS's copy · Our archived file |
| Article A52505 | version 77 | 2025-10-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52505 | version 80 | 2025-10-01 to today | 2026-09-26 | CMS's copy · Our archived file |
Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.
CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.
Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.