The Centers for Medicare & Medicaid Services (CMS) has released lists of HCPCS coding changes effective April 1, 2025.
The list, published March 11, includes updates on codes and modifiers that are new, revised or discontinued for the second biannual 2024 HCPCS coding cycle.
Wheelchair transit accessories: Two new codes
CMS reported that Palmetto GBA, which describes itself as “one of the nation’s largest providers of high-volume claims and transaction processing … to the federal government and other commercial customers,” asked for two new HCPCS codes for wheelchair transit accessories, which have been billed using the miscellaneous K0108 component/accessory code.
“We believe there is a claims processing need on behalf of Medicare to help reduce the manual adjudication process for existing HCPCS Level II code K0108 for wheelchair tiedowns and occupant restraint systems,” CMS said in its second biannual coding cycle report.
While CMS does not recognize wheelchair transit accessories as durable medical equipment (DME) and therefore does not offer Medicare reimbursement, the agency did establish two new HCPCS codes in acknowledgement of “a claims processing need.”
E1022 is the code for “Wheelchair transportation securement system, any type, includes all components and accessories.” E1023 is the code for “Wheelchair transit securement system, includes all components and accessories.”
CMS makes changes to hardware codes
Palmetto GBA also requested three new HCPCS codes “to further identify wheelchair mounting hardware accessories,” the biannual report said, and further asked E1028 “be revised to account for any type of mounting hardware that does not fall into the three requested new HCPCS Level II codes … An individual will often need multiple accessories to be mounted, and this will require multiple billings of E1028, each needing a narrative description to identify the type of accessory being mounted.”
CMS responded in its biannual report, “We believe there is a claims processing need on behalf of Medicare to address issues related to multiple billings of existing HCPCS Level II code E1028, such as review the narrative description, manual tracking of the rental months, and the correction of inappropriate MUE [medically unlikely edits].”
In its biannual report, CMS finalized its decision to do the following:
— Revise E1028 (Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory” to “Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other.”
— Establish new code E1032: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface.
— Establish new code E1033: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type.
— Establish new code 1034: Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type.
“CMS determined that HCPCS Level II code E0953, ‘Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each’ includes fixed mounting hardware as described in the applicant’s proposed HCPCS Level II code EXXX4, ‘Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral thigh or knee support, any type,’” the decision said. “The HCPCS modifier KU can be included when billing certain wheelchair accessories furnished in connection with Group 3 power wheelchairs for complex rehabilitative individuals to receive the unadjusted fee schedule amount. Also, the HCPCS modifier BP can be included when certain CRT wheelchairs are purchased in the first month. The wheelchair mounting hardware items of this application are applicable.”
CMS declines to identify seat elevation as power seating system
CMS said in its report that the National Coalition for Assistive and Rehab Technology (NCART), representing power seat elevation manufacturers and other stakeholders, “submitted a request to revise existing HCPCS Level II code E2298 to identify the advanced technology of Complex Rehabilitative Technology (CRT) power seat elevation (PSE) systems and to recalculate its fee schedule amount.”
The agency said NCART contended that the current definition for E2298 — Complex rehabilitative power wheelchair accessory, power seat elevation system, any type — “does not differentiate CRT PSE systems from a basic PSE accessory and will have long-term unintended consequences if it is not changed.”
NCART, CMS added, had asked the agency to “adopt characteristics to define CRT PSE that included at least 10 inches of elevation; being capable of elevating/descending while the power wheelchair (PWC) moves and of moving on a horizontal surface while fully elevated; and compatible with other power seating options (power tilt and/or power recline).”
NCART and manufacturers had additionally argued that CRT PSE is comparable to a power tilt seating system.
CMS countered that adding specifications to a code — for example, defining CRT seat elevation as rising at least 10 inches — “was addressed during the NCD [national coverage determination] process and is outside the scope of the HCPCS Level II coding process.”
The agency finalized its preliminary coding decision, asserting that the current E2298 code “describes power seat elevation that may be covered for use on a complex rehabilitative power-driven wheelchair in accordance with the Medicare national coverage determination for power wheelchair seat elevation equipment.”
