Post

By Kim Turner, RN Recent CMS reports have identified that durable medical equipment and complex rehab suppliers are billing HCPCS code K0108 (WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED) for many of the wheelchair accessories being added to the beneficiary’s power or manual wheelchair.  However, the miscellaneous code (HCPC K0108) is not always the correct code to use for billing. Billing the Medicare claim with the proper code is one the many “keys” to filing a clean claim to Medicare and billing the proper code ensures timely processing and correct reimbursement of the services billed. Incorrectly billing an item with the HCPCS K0108 results in the Medicare claim being stopped during processing and thus suspended for manual processing to determine coverage, pricing, and payment which slows processing and payment of the Medicare claim. DME PDAC (Pricing, Data Analysis, and Coding) is the best source to determine if the item being billed has an existing code. Click here to access DME PDAC: Another source to determine if the item being billed has an existing code is the Wheelchair Options and Accessories LCD and related policy articles. To access and view the LCD, click here. The following list includes wheelchair accessories that are commonly being billed incorrectly using the HCPCS K0108. The correct billing code for the accessories is provided below.

Battery Replacement:                                   

• E2358 POWER WHEELCHAIR ACCESSORY, GROUP 34 NON-SEALED LEAD ACID BATTERY, EACH
• E2359 POWER WHEELCHAIR ACCESSORY, GROUP 34 SEALED LEAD ACID BATTERY, EACH
• E2360 POWER WHEELCHAIR ACCESSORY, 22NF NON-SEALED LEAD ACID BATTERY, EACH
• E2361 POWER WHEELCHAIR ACCESSORY, 22NF SEALED LEAD ACID BATTERY, EACH,
• E2362 POWER WHEELCHAIR ACCESSORY, GROUP 24 NON-SEALED LEAD ACID BATTERY, EACH
• E2363 POWER WHEELCHAIR ACCESSORY, GROUP 24 SEALED LEAD ACID BATTERY, EACH
• E2364 POWER WHEELCHAIR ACCESSORY, U-1 NON-SEALED LEAD ACID BATTERY, EACH
• E2365 POWER WHEELCHAIR ACCESSORY, U-1 SEALED LEAD ACID BATTERY, EACH
• E2371 POWER WHEELCHAIR ACCESSORY, GROUP 27 SEALED LEAD ACID BATTERY, EACH
• E2372 POWER WHEELCHAIR ACCESSORY, GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH
• E2397 POWER WHEELCHAIR ACCESSORY, LITHIUM-BASED BATTERY, EACH
• K0733 POWER WHEELCHAIR ACCESSORY, 12 TO 24 AMP HOUR SEALED LEAD ACID BATTERY, EACH

Battery Charger: 

• E2366 POWER WHEELCHAIR ACCESSORY, Battery Charger, SINGLE MODE, FOR USE WITH ONLY ONE BATTERY TYPE, SEALED OR NON-SEALED, EACH OR
• E2367* POWER WHEELCHAIR ACCESSORY, Battery Charger, DUAL MODE, FOR USE WITH ONLY ONE BATTERY TYPE, SEALED OR NON-SEALED, EACH

*A single mode battery charger (E2366) is appropriate for charging a sealed lead acid battery. If a dual mode battery charger (E2367) is provided as a replacement, it will be denied by Medicare as not reasonable and necessary. Bearings

• E2210 BEARINGS, ANY TYPE, REPLACEMENT ONLY, EACH

Drive Wheel Gear Box

• E2369 POWER WHEELCHAIR COMPONENT, DRIVE WHEEL GEAR BOX, REPLACEMENT ONLY.

Fully Padded Footbox Accessory

• E0954 FOOT BOX, ANY TYPE, INCLUDES ATTACHMENT AND MOUNTING HARDWARE, EACH FOOT

Fully Reclining Back

• E1226 MANUAL FULLY RECLINING BACK (RECLINE GREATER THAN 80 DEGREES), EACH.

Semi Reclining Back   

• E1225 MANUAL SEMI-RECLINING BACK (RECLINE GREATER THAN 15 DEGREES, BUT LESS THAN 80 DEGREES), EACH.

Gear Reduction Drive Wheels                    

• E2227 MANUAL WHEELCHAIR ACCESSORY, GEAR REDUCTION DRIVE WHEEL, EACH

Headrest                                                             

• E0955 HEADREST, CUSHIONED, ANY TYPE, INCLUDING FIXED MOUNTING HARDWARE, EACH

O2 Holder                                                          

• E2208 CYLINDER TANK CARRIER, EACH

Replacement Seat Upholstery                   

• E0981 SEAT UPHOLSTERY, REPLACEMENT ONLY, EACH

Replacement Back Upholstery                   

• E0982 BACK UPHOLSTERY, REPLACEMENT ONLY, EACH

Shock Absorber, Power WC       

• E1016 SHOCK ABSORBER FOR POWER WHEELCHAIR, EACH

Shock Absorber, Manual WC                      

• E1015 SHOCK ABSORBER FOR MANUAL WHEELCHAIR, EACH

Thigh and Knee Pads                                      

• E0953 LATERAL THIGH OR KNEE SUPPORT, ANY TYPE INCLUDING FIXED MOUNTING HARDWARE, EACH

Want to feel confident that the power wheelchairs and accessories you are providing meet coverage criteria? Sign up for our clinical prescreen services. Before you put out the equipment, let our clinical staff review your documentation to ensure the equipment meets coverage criteria. Our clinicians will review your documentation and provide you with an “approved” or “denied” status, along with recommendations for your referral source. Get your documentation right before you bill the claim to Medicare, and rest easy knowing you are protected should those claims be audited in the future.  In fact, we feel so confident in our clinical prescreen process, if you receive a denial on a claim that received vHG “approval”, we will appeal on your behalf – for free*! That is how confident we are in our prescreen program. Contact us for more information!