CGS Administrators, the Jurisdictions B and C DME MAC, has released a newly revised documentation checklist for manual wheelchair bases to explain what a supplier must provide for Medicare claims, including information on the beneficiary’s home assessment as well as documentation that rules out provision of a cane or walker.
CGS provided the document in early October.
The checklist, which is available as a pdf, has sections about standard written orders/written orders prior to delivery; medical records; and additional documentation requirements for specific wheelchair bases, including transport chairs (HCPCS codes E1037, E1038, E1039); standard hemi-height (K0002); lightweight (K0003); high-strength lightweight (K0004); ultralightweight (K0005); heavy-duty (K0006); extra heavy-duty (K0007); custom manual (K0008); and manual wheelchair with tilt in space (E1161).
The checklist noted that medical records must support all the following criteria for manual wheelchair bases:
— Beneficiary has a mobility limitation that significantly impairs performance of mobility-related activities of daily living (MRADLs) in customary locations in the home. MRADLs include toileting, feeding, bathing, dressing and grooming. And:
— The mobility limitation cannot be sufficiently addressed by using an appropriately fitted cane or walker, and:
— Using a manual wheelchair will significantly improve the beneficiary’s ability to participate in MRADLs, and the beneficiary is willing to use the wheelchair regularly in the home, and:
— The beneficiary has not expressed an unwillingness to use the manual wheelchair in the home, and:
— The beneficiary has the upper-extremity function and other physical and cognitive capabilities to safely self propel the provided manual wheelchair inside the home or has a caregiver who is available, willing and able to provide assistance with the wheelchair as needed.
Image: pexels.com/Marcus Aurelius
