Change to Wheelchair Cushion HCPCS Codes

Note: Revised coding information regarding the WHEELCHAIR SEATING has been included in the Coding Guidelines in the updated “Local Coverage Article for Wheelchair Seating – Policy Article.” Additional updates will also be in Local Coverage Determination entitled, “Local Coverage Determination (LCD) for Wheelchair Seating.”

Effective November 1, 2004, wheelchair cushions containing a fluid medium (air, gas, liquid, or gel) that has the capability for the immersion characteristics of the cushion to be altered by addition or removal of fluid will be considered adjustable. The adjustment may be in the manner of direct addition or removal of the fluid (e.g. add or remove air) or indirectly by addition or removal of packets of fluid.

Adjustment applies to the skin protection portion of the cushion's function only.

All cushions are considered to be adjustable up to the point of delivery to the patient. Fitting of the cushion to the individual patient may involve various forms of adjustment. Adjustable as applied here requires that the procedure is capable of being performed by the patient or caregiver using items supplied at the time of initial issue of the device in response to the patient's need for more or less skin protection because of weight loss or gain or muscle tone changes.

Even if the adjustment is done in the supplier's office after delivery of the cushion at patient's request, the alteration of the cushion by removal of the fluid or packets of fluid cannot require the cutting, ungluing or other destruction of the basic cushion.

Cushions determined to be adjustable by the SADMERC must otherwise fully meet the requirements for skin protection or skin protection and positioning as previously developed for wheelchair cushions. Cushions so categorized will be coded K0108 and placed into the Classification List as such with an additional designation as to whether they are skin protection only or the combination of skin protection and positioning. Pricing will be done by the DMERCs on an individual basis until a fee schedule can be developed.

The SADMERC is developing testing to further define this class of cushions. Those test requirements will be published sometime after the first of the year with intentions of having new codes in place by April 1, 2005 for the adjustable cushions.

If any company feels that they have a cushion that qualifies as adjustable under these guidelines, please contact the SADMERC for a review.

Published by Palmetto GBA as the SADMERC, December 2004. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto GBA as the PDAC, January 2019.