While Medicare announced the coverage for seat elevation in May, many important details needed to process these orders was left unknown.   
With the 8/11/23 LCD Publication we were able to gain clarification on the following outstanding questions: 

• How to process Standard Group 2 and HD Standard Group 2 wheelchairs?
• Does the addition of a seat elevator impact the base code?
• Can a seat elevator be retrofitted to a Complex Group 2 or Group 2 Power Wheelchair?

How to process Standard Group 2 and HD Standard Group 2 wheelchairs?

For Standard Group 2 chair orders, code K0830 or K0831 must be used, and the chair must be PDAC coded as such; E2300 cannot be billed separately; these chairs will be priced as individual consideration without a fixed allowable and will be reimbursed as a rental.

• In scenarios where medical necessity is not met for Seat Elevation, a Client Paid Upgrade can be provided in which the client pays the difference between the K0822/K0823 and K0830/K0831 base. Follow Policy F-300 Medicare Upgrade Guidelines.
• In scenarios where the wheelchair is not PDAC verified as K0830 or K0831, equipment cannot be coded as such. Another PDAC verified wheelchair base will need to be provided.

For Heavy Duty Group 2 Wheelchairs or other Group 2 wheelchairs without power options, there is currently no coverage for Power Seat Elevation available due to the inability to separately bill E2300 with any Standard Group 2 Wheelchair. Seat Elevation will be denied as not reasonable and necessary if billed separately.

• In scenarios where medical necessity is met for a Heavy-Duty Group 2 wheelchair with Seat Elevation, we can provide a supplier upgrade billing the corresponding K0830/K0831 wheelchair that incorporates seat elevation. Follow Policy F-300 Medicare Upgrade Guidelines.
• In scenarios where medical necessity is not met for Seat Elevation, however, is met for the HD wheelchair, a Client Paid Upgrade can be provided in which the client pays the difference between the base provided and the appropriate K0830/K0831 HCPC.

Does the addition of a seat elevator impact the base code for complex wheelchairs?

No, the addition of an E2300 does not impact the SPO or MPO Base HCPC for Complex Group 2 or Group 3 power wheelchairs. Only Power Tilt and Power Recline will impact the SPO/MPO Base HCPC. We have identified Quantum manufacturer quotes may require updating to the correct base HCPC following CMS guidance. Quantum is sending revised quotes as needed.  Please carefully review coding of the Power Wheelchair Base to ensure we are following CMS’s coding guidance. When reviewing coding, if coding has been corrected, please request an update to any applicable prescriptions and/or authorizations as needed.
 

Can Seat Elevation be installed on an existing wheelchair? 

• For beneficiary owned and Medicare covered Complex Group 2 Powerchairs and Group 3 Powerchairs, policy allows coverage and the ability to retrofit Seat Elevation. We are seeking guidance from the DME MACs Council on the payment of labor for the retrofit.

• We are awaiting clarification from the DME MACs Council on the ability to retrofit seat elevation to an existing Standard Group 2 chair since E2300 is not separately payable for these wheelchair bases. Until further notice, this is deemed to be not payable due to the inability to bill E2300 in this scenario.

The following Medicare Resource, which can be found on WNSM, have been updated to include the information above:

• Medicare Seat Elevation Coverage Update
• Medical Necessity Checklist for Power Options and Accessories
• Policy F-300 Medicare Upgrade Guidelines