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Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.

E2603

Wheelchair Seating

LCD L33312 · CMS's HCPCS descriptor for E2603: Skin protection wheelchair seat cushion, width less than 22 inches, any depth.

Not on CMS's Required Prior Authorization List for DMEPOS on 2026-10-13. source

LCD L33312 · 26 versions, 2015 to today · last changed 2025-10-01 (R13)

Version 10 of LCD L33312: in force by CMS's dates 2016-07-01 to 2016-06-30. The policy text on this page comes from this archived version. On its start date, 2016-07-01, the companion Article in force was Article A52505 version 6.

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.

You are viewing version 10 (2016-07-01, superseded same day). Version 40 is in force today.

Codes CMS lists in this LCD's current version (version 40, 42 codes). CMS's download carries no list for version 10: A9900 E0953 E0955 E0956 E0957 E0960 E0966 E0992 E1028 E1033 E1034 E2231 E2291 E2292 E2293 E2294 E2601 E2602 E2603 E2604 E2605 E2606 E2607 E2608
18 more codes

Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information. Plus 4 sections marked N/A in this version.

Full verbatim text serves to customers · Customer? Log in

Version history, LCD L33312

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 Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask.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.

Revision history, every version

CMS's own change log, quoted, 24 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.

R13 · 2025-10-01 · v40
Revision Effective Date: 10/01/2025
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: “as reflected in a diagnosis code listed in Group 1 of the ICD-10 code list in the LCD-related Policy Article” and “as reflected in a diagnosis code listed in Group 2 of the ICD-10 code list in the LCD-related Policy Article” from the skin protection seat cushion coverage criteria language
Removed: “that are due to one of the following (a or b):,” “a. A diagnosis code listed in Group 2 of the ICD-10 code list in the LCD-related Policy Article; or,” and “b. A diagnosis code listed in Group 3 of the ICD-10 code list in the LCD-related Policy Article” from the positioning seat cushion, positioning back cushion, and positioning accessory coverage criteria language
Removed: “(Note special instructions for a combination skin protection and positioning cushion in the ICD-10 code list in the LCD-related Policy Article.)”
10/02/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-substantive updates.
R12 · 2025-04-01 · v37
Revision Effective Date: 04/01/2025
HCPCS CODES:
Revised: Long description for HCPCS code E1028
Added: HCPCS codes E1033 and E1034 to Group 3 Codes
04/03/2025: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.
R11 · 2020-01-01 · v34
Revision Effective Date: 01/01/2020
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
Added: Statement to refer to the ICD-10 code list in the LCD-related Policy Article
Revised: Order information as a result of Final Rule 1713
CODING INFORMATION:
Removed: Field titled “Bill Type”
Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
DOCUMENTATION REQUIREMENTS:
Revised: “physician’s” to “treating practitioner’s”
GENERAL DOCUMENTATION REQUIREMENTS:
Revised: Prescriptions (orders) to SWO

03/12/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).
R11 · 2020-01-01 · v34
Revision Effective Date: 01/01/2020
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Revised: Format of HCPCS code references, from code 'spans' to individually-listed HCPCS
Removed: Statement to refer to ICD-10 Codes that are Covered section in the LCD-related PA
Added: Statement to refer to the ICD-10 code list in the LCD-related Policy Article
Revised: Order information as a result of Final Rule 1713
CODING INFORMATION:
Removed: Field titled “Bill Type”
Removed: Field titled “Revenue Codes”
Removed: Field titled “ICD-10 Codes that Support Medical Necessity”
Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity”
Removed: Field titled “Additional ICD-10 Information”
DOCUMENTATION REQUIREMENTS:
Revised: “physician’s” to “treating practitioner’s”
GENERAL DOCUMENTATION REQUIREMENTS:
Revised: Prescriptions (orders) to SWO

03/12/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713, HCPCS code changes, and non-substantive corrections (listing individual HCPCS codes instead of a HCPCS code-span).
R10 · 2019-01-01 · v29
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Moved: Statement about noncovered diagnosis codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction
R10 · 2019-01-01 · v29
Revision Effective Date: 01/01/2019
COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:
Removed: Statement to refer to diagnosis code section below
Added: Refer to Covered ICD-10 Codes in the LCD-related Policy Article
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Moved: All diagnosis codes to the LCD-related Policy Article diagnosis code section per CMS instruction
ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY:
Moved: Statement about noncovered diagnosis codes moved to LCD-related Policy Article noncovered diagnosis code section per CMS instruction
R9 · 2018-10-01 · v27
Revision Effective Date: 10/01/2018


ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:


Removed: ICD-10 code G71.0 from Group 2 and Group 4 due to annual ICD-10 Code updates


Added: New expanded ICD-10 codes, to Group 2 and Group 4, for those removed


09/27/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R9 · 2018-10-01 · v27
Revision Effective Date: 10/01/2018


ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:


Removed: ICD-10 code G71.0 from Group 2 and Group 4 due to annual ICD-10 Code updates


Added: New expanded ICD-10 codes, to Group 2 and Group 4, for those removed


09/27/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R8 · 2018-01-01 · v22
Revision Effective Date: 01/01/2018


Coverage Indications, Limitations, and/or Medical Necessity:


Added: E0953 to positioning items


HCPCS CODES:


Added: E0953 to Group 3 (Positioning Accessories) codes per 2018 annual HCPCS code update


ICD-10 Codes that Support Medical Necessity:


Added: E0953 to paragraphs for Group 2 and Group 3 codes


12/21/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R8 · 2018-01-01 · v22
Revision Effective Date: 01/01/2018


Coverage Indications, Limitations, and/or Medical Necessity:


Added: E0953 to positioning items


HCPCS CODES:


Added: E0953 to Group 3 (Positioning Accessories) codes per 2018 annual HCPCS code update


ICD-10 Codes that Support Medical Necessity:


Added: E0953 to paragraphs for Group 2 and Group 3 codes


12/21/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R7 · 2017-10-01 · v19
Revision Effective Date: 10/01/2017


ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
 Added: New ICD-10 codes G12.23, G12.24, G12.25 to Group 2 and Group 4


10/01/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R7 · 2017-10-01 · v19
Revision Effective Date: 10/01/2017


ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
 Added: New ICD-10 codes G12.23, G12.24, G12.25 to Group 2 and Group 4


10/01/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R6 · 2017-01-01 · v16
Revision Effective: 01/01/2017


ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:


Added: Z codes for acquired absence of limb to Group 3 and Group 4 Diagnosis Codes


POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:


Clarified: Verbiage  in Policy Specific Documentation Requirements


08/24/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R6 · 2017-01-01 · v16
Revision Effective: 01/01/2017


ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:


Added: Z codes for acquired absence of limb to Group 3 and Group 4 Diagnosis Codes


POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:


Clarified: Verbiage  in Policy Specific Documentation Requirements


08/24/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
R5 · 2017-01-01 · v14
Revision Effective: 01/01/2017
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and directions to Standard Documentation Requirements
Removed: HCPCS codes for Group 4 wheelchairs not available in Captain’s chair model.
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
The diagnosis code groups were reorganized to more closely reflect the disease conditions described in the reasonable and necessary section. This resulted in a consolidation/collapsing of the 4 diagnosis code groups for 3 types of items (skin protection, positioning items and combination skin protection and positioning items) into 3 groups.  Diagnosis code Groups 5 and 6 were renamed to 4 and 5. Effective 10/01/2015
Added: General Requirements
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: Instructions to summarize the coverage criteria for the wheelchair seating options
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and Directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: Information under Miscellaneous and Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article
R5 · 2017-01-01 · v14
Revision Effective: 01/01/2017
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Removed: Standard Documentation Language
Added: New reference language and directions to Standard Documentation Requirements
Removed: HCPCS codes for Group 4 wheelchairs not available in Captain’s chair model.
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
The diagnosis code groups were reorganized to more closely reflect the disease conditions described in the reasonable and necessary section. This resulted in a consolidation/collapsing of the 4 diagnosis code groups for 3 types of items (skin protection, positioning items and combination skin protection and positioning items) into 3 groups.  Diagnosis code Groups 5 and 6 were renamed to 4 and 5. Effective 10/01/2015
Added: General Requirements
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY:
Added: Instructions to summarize the coverage criteria for the wheelchair seating options
DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: General Documentation Requirements
Added: New reference language and Directions to Standard Documentation Requirements
POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:
Removed: Standard Documentation Language
Added: Direction to Standard Documentation Requirements
Removed: Information under Miscellaneous and Appendices
RELATED LOCAL COVERAGE DOCUMENTS:
Added: LCD-related Standard Documentation Requirements article
R4 · 2016-07-01 · v10
Effective July 1, 2016 oversight for DME MAC LCDs 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 LCDs.
R4 · 2016-07-01 · v10
Effective July 1, 2016 oversight for DME MAC LCDs 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 LCDs.
R3 · 2015-10-01 · v8
Revision Effective: 10/1/2015
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY
Added: ICD-10 codes for Stage 1 Pressure Ulcers
DOCUMENTATION REQUIREMENTS
Removed: Start date verbiage from Prescription Requirements
Added: Standard documentation language for dates on orders
R3 · 2015-10-01 · v8
Revision Effective: 10/1/2015
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY
Added: ICD-10 codes for Stage 1 Pressure Ulcers
DOCUMENTATION REQUIREMENTS
Removed: Start date verbiage from Prescription Requirements
Added: Standard documentation language for dates on orders
R2 · 2015-10-01 · v5
Revision Effective: 10/1/2015
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY
Added: Inadvertently omitted ICD10’s; G and Q codes, subsequent visit and sequela
R2 · 2015-10-01 · v5
Revision Effective: 10/1/2015
ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY
Added: Inadvertently omitted ICD10’s; G and Q codes, subsequent visit and sequela
R1 · 2015-10-01 · v3
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Deleted: Reference to refill of supplies from Continued Use
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Repair/Replacement section
R1 · 2015-10-01 · v3
Revision Effective Date: 10/31/2014
COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY:
Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility
DOCUMENTATION REQUIREMENTS:
Deleted: Reference to refill of supplies from Continued Use
Revised: Standard Documentation Language to add who can enter date of delivery date on the POD
Added: Repair/Replacement section
Receipts for auditors

Version 10 of LCD L33312, shown on this page: in force by CMS's dates 2016-07-01 to 2016-06-30. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.

Every archived version of LCD L33312 (26 versions, CMS's dates, window by the as-of rule).

DocumentVersionIn forceArchived onVerify
LCD L33312version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 22015-10-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33312version 32015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 32015-10-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33312version 52015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 52015-10-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33312version 82015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 82015-10-01 to 2016-06-302026-10-02CMS's copy · Our archived file
LCD L33312version 10 shown2016-07-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 102016-07-01 to 2016-12-312026-10-02CMS's copy · Our archived file
LCD L33312version 142017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 142017-01-01, superseded same day2026-10-02CMS's copy · Our archived file
LCD L33312version 162017-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 162017-01-01 to 2017-09-302026-10-02CMS's copy · Our archived file
LCD L33312version 192017-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 192017-10-01 to 2017-12-312026-10-02CMS's copy · Our archived file
LCD L33312version 222018-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 222018-01-01 to 2018-09-302026-10-02CMS's copy · Our archived file
LCD L33312version 272018-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 272018-10-01 to 2018-12-312026-10-02CMS's copy · Our archived file
LCD L33312version 292019-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 292019-01-01 to 2019-12-312026-10-02CMS's copy · Our archived file
LCD L33312version 342020-01-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33312version 342020-01-01 to 2025-03-312026-10-02CMS's copy · Our archived file
LCD L33312version 372025-04-01 to 2025-09-302026-10-02CMS's copy · Our archived file
LCD L33312version 402025-10-01 to today2026-09-26CMS's copy · Our archived file

The related Articles each have their own receipts: Article A55426 · Article A52505.

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.

Governing policies, as CMS lists them:

  • LCD L33312 · Wheelchair Seating
    CMS lists E2603 in group 1 of version 40. CMS's description, quoted: “SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH”.
    Related Articles, as CMS lists them: Article A55426 · Article A52505

From CMS's LCD code table. HCPCS Level II codes only.

source

CMS's LCD code table in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.

Watch E2603

One email when any policy cited for E2603 changes or gains a future effective date. Nothing else, ever.