By: Kay Koch, OTR/L, ATP, Rehab Clinical and Education Consultant
This DME MAC Joint Publication was posted on June 22, 2017. It is a good reminder to those who are billing the E1012 center mount elevating leg rest on power wheelchairs.
Recently it has come to the attention of the DME MACs that suppliers are billing separately for footplates (K0040 ADJUSTABLE ANGLE FOOTPLATE, EACH) or foot platforms (K0108 WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED) used with a center mount elevating leg rest (E1012 WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, CENTER MOUNT POWER ELEVATING LEG REST/PLATFORM, COMPLETE SYSTEM, ANY TYPE, EACH) for power wheelchairs when the leg rest is initially billed to Medicare. This practice is incorrect billing.
HCPCS code E1012 describes a complete leg rest system. It is an all-inclusive HCPCS code, meaning that all components of the leg rest, including footplates and foot platforms, are included in HCPCS code E1012. Medicare claims for codes K0040 or K0108 (when used for foot platforms) billed in conjunction with code E1012 will be denied as unbundling.
Refer to the Power Mobility Devices and the Wheelchair Options and Accessories LCDs and related Policy Articles for additional information about coverage, coding, and documentation.
For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form at https://www.dmepdac.com/ .