Wheelchair Options & Accessories

Affected Providers

Treating practitioners and DME suppliers who bill for wheelchair options and accessories.

HCPCS & CPT Codes

Local Coverage Determination (LCD): Wheelchair Options/Accessories (L33792) has the current HCPCS and CPT codes. 

Background

According to the 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for wheelchair options and accessories is 35.4%, with a projected improper payment amount of $106 million.

We outline other policy requirements in LCD L33792 and Article: Wheelchair Options/Accessories (A52504).

Denial Reasons

Medical necessity accounted for 95.3% of improper payments for wheelchair options and accessories during the 2024 reporting period, while insufficient documentation (3.9%) and other errors (0.9%) also caused improper payments. “Other” errors include duplicate payment, non-covered or unallowable service, or ineligible Medicare patient errors.

Preventing Denials

We cover options and accessories for wheelchairs if the patient has a wheelchair that meets our coverage criteria and the option or accessory itself is medically necessary. We deny items as not reasonable and necessary if the patient doesn’t meet these criteria.

Arm of Chair

We cover an adjustable arm height option (HCPCS codes E0973, K0017, K0018, and K0020) if the patient needs an arm height different from what’s available using non-adjustable arms, and the patient spends at least 2 hours per day in the wheelchair.

We cover an arm trough (HCPCS code E2209) if the patient has quadriplegia, hemiplegia, or uncontrolled arm movements.

Foot Rest or Leg Rest

We cover elevating leg rests (HCPCS codes E0990, K0046, K0047, K0053, and K0195) if the patient:

• Has a musculoskeletal condition or a cast or brace that prevents a 90-degree flexion at the knee
• Has significant lower extremities edema that requires an elevating leg rest
• Meets criteria for and has a reclining back on the wheelchair

Non-Standard Seat Frame Dimensions

We cover a non-standard seat width or depth for a manual wheelchair (HCPCS codes E2201 – E2204) if the patient’s physical dimensions justify the need.

Wheels & Tires for Manual Wheelchairs

We cover a gear reduction drive wheel (HCPCS code E2227) if all these criteria are met:

• The patient has self-propelled in a manual wheelchair for at least 1 year.
• The patient gets a specialty evaluation by a licensed or certified medical provider (for example, a physical therapist (PT) or occupational therapist (OT)) or a treating practitioner who has specific training and experience in rehabilitation wheelchair evaluations. This person must document the need for a device in the patient’s home. The PT, OT, or treating practitioner must have no financial relationship with the supplier.
• The wheelchair is provided by a supplier that employs a Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)-certified assistive technology professional (ATP) who specializes in wheelchairs and has direct, in-person involvement in the patient’s wheelchair choice.

Batteries & Chargers

• We allow up to 2 batteries (HCPCS codes E2359, E2361, E2363, E2365, E2371, and K0733) at any 1 time if required for a power wheelchair.
• We deny a non-sealed battery (HCPCS codes E2358, E2360, E2362, E2364, and E2372) as not reasonable and necessary.
• We allow a single-mode battery charger (HCPCS code E2366) for charging a sealed lead acid battery. We deny a dual-mode battery charger (HCPCS code E2367) as a replacement as not reasonable and necessary.
• The usual greatest frequency of replacement for a lithium-based battery (HCPCS code E2397) is once every 3 years. We allow 1 battery at a time.

Power Tilt & Recline Seating Systems (HCPCS codes E1002 – E1010, E1012)

We cover a power seating system—tilt only, recline only, or combination tilt and recline, with or without power elevating leg rests—if you meet criteria in 1–3, and if you meet criterion 4, 5, or 6:

1. The patient meets all coverage criteria for a power wheelchair described in LCD: Power Mobility Devices (L33789).
2. A licensed or certified medical provider (for example, a PT, OT, or treating practitioner who has specific training and experience in rehabilitation wheelchair evaluations) does a specialty evaluation of the patient’s seating and positioning needs. The PT, OT, or treating practitioner must have no financial relationship with the supplier.
3. The wheelchair is provided by a supplier that employs a RESNA-certified ATP who specializes in wheelchairs and has direct, in-person involvement in the patient’s wheelchair choice.
4. The patient is at high risk for developing pressure ulcers and can’t do a functional weight shift.
5. The patient uses intermittent catheterization for bladder management and can’t independently transfer from wheelchair to bed.
6. The patient needs a power seating system to manage increased tone or spasticity.

We cover a power seat elevation system (HCPCS code E2298) if a patient meets the coverage criteria for either a Group 2 single power option or multiple power option power-driven wheelchair or a Group 3 power-driven wheelchair, as described in LCD L33789, and meets the coverage criteria for seat elevation equipment, as described in National Coverage Determination (NCD): Seat Elevation Equipment (Power Operated) on Power Wheelchairs (280.16).

We consider power seat elevation equipment as reasonable and necessary for patients using complex rehabilitative power-driven wheelchairs when the patient meets these conditions:

• The patient has had a specialty evaluation that confirms their ability to safely work the seat elevation equipment in the home. A licensed or certified medical provider — like a PT, an OT, or another practitioner — who has specific training and experience in rehabilitation wheelchair evaluations must do this evaluation.
• At least 1 of these apply:
• The patient does weight bearing transfers to and from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer or their lower extremities during a sit-to-stand transfer. The patient may do a transfer with or without caregiver help and assistive equipment (for example, sliding board, cane, crutch, or walker).
• The patient requires a non-weight bearing transfer (for example, a dependent transfer) to and from the power wheelchair while in the home. The patient may do transfers with or without a floor or mounted lift.
• The patient can reach from the power wheelchair to complete 1 or more mobility-related activities of daily living (MRADLs), like toileting, feeding, dressing, grooming, and bathing in customary locations within the home. The patient may do MRADLs with or without caregiver help and assistive equipment.

Use these HCPCS codes for power seat elevation equipment:

• E2298 – Complex rehabilitative power wheelchair accessory, power seat elevation system, any type. Use this code to submit claims for people using:
• Complex rehabilitative power-driven wheelchairs (K0835 – K0864)
• Group 5 wheelchairs (K0890 and K0891)
• K0830 – Power wheelchair, Group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds.
• K0831 – Power wheelchair, Group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds.

Power Wheelchair Drive Control Systems

We cover an attendant control in place of a patient-operated drive control system if the patient meets coverage criteria for a wheelchair, can’t work a manual or power wheelchair, and has a caregiver who can’t work a manual wheelchair but can work a power wheelchair.

Other Power Wheelchair Accessories

We cover an electronic interface (HCPCS code E2351) that allows a power wheelchair control interface to use a speech-generating device if the patient has a covered speech-generating device. LCD: Speech Generating Devices (SGD) (L33739) has more information.

Miscellaneous Accessories

• Anti-rollback device (HCPCS code E0974): We cover an anti-rollback device if the patient self-propels and needs the device because of ramps.
• Safety belt or pelvic strap (HCPCS code E0978): We cover a safety belt or pelvic strap if the patient has weak upper body muscles, upper body instability, or muscle spasticity requiring this item for proper positioning.

• Swingaway, retractable, or removable hardware (HCPCS codes E1028 and E1032): We cover swingaway, retractable, or removable hardware if the patient has a covered indication documented in their medical record. One example, not all-inclusive, of a covered indication for swingaway, retractable, or removable hardware is to move the component out of the way so the patient can do a slide transfer to a chair or bed.

  Note: For dates of service on or after April 1, 2025, use E1032 for initial claims or new rental periods for swingaway, retractable, or removable mounting hardware for wheelchair accessories described by joysticks or other drive control interfaces. If the rental period for this hardware started before April 1, 2025, use E1028 for ongoing claims in the rental period.

• Push-rim activated power assist device: Article: Power Mobility Devices (A52498) has information on push-rim activated power assist devices for manual wheelchairs.
• Manual fully reclining back option (HCPCS code E1226): We cover a manual fully reclining back option if the patient has 1 or more of these conditions:
  • Is high-risk for developing pressure ulcers and can’t do a functional weight shift
  • Uses intermittent catheterization for bladder management and can’t independently transfer from wheelchair to bed

Documentation Requirements

To justify payment, you must meet specific requirements when ordering DMEPOS.