DME MAC B Clarifies Billing Protocols for Elevating Legrests

In a news bulletin, the Jurisdiction B DME MAC has clarified how elevating legrests (ELRs) should be billed to Medicare.
In the Jan. 22 “News You Can Use” bulletin, National Government Services (which now includes AdminaStar Federal) sought to clarify “when and how to bill for Elevating Legrests HCPCS codes E0990 and K0195.” The codes, the DME MAC says, “are for elevating legrests which are separately payable from the base/manual power wheelchairs when coverage criteria as outlined in the Local Coverage Determination have been met. Legrests can be an interchangeable item from one wheelchair to another. It is not expected that with every new wheelchair base, a new set of legrests will be needed.”

The DME MAC asked suppliers to consult a diagram provided in the bulletin (see chart).
In addition to asking suppliers to be careful when filling out ELR claims, National Government Services also said, “Suppliers are encouraged to indicate whether or not the previous legrests are interchangeable with the new wheelchair base in the Note (NTE) segment line for electronic claims or Box 19 of the CMS 1500 paper claim form. By providing this information, it will help to ensure claims are processed in a timely manner.”

If that information isn’t included, “the claim will be denied, and the supplier will need to submit additional documentation to support the medical necessity of the item at the appeal level.”

This article originally appeared in the March 2008 issue of Mobility Management.

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