Wheelchair Seating - Policy Article

Medicare covers wheelchair seat and back cushions, positioning accessories, and custom fabricated cushions only when specific clinical criteria are met (e.g., pressure ulcer history, impaired sensation, inability to weight shift, or significant postural asymmetry) and when used with a wheelchair that meets Manual Wheelchair Bases or Power Mobility Devices LCD coverage criteria. Required documentation includes a specialty (comprehensive) evaluation, face-to-face encounter and Written Order Prior to Delivery for specified codes per Final Rule 1713, and model/manufacturer details for custom cushions; claims missing required modifiers or prior orders will be denied or rejected.

"A skin protection seat cushion (HCPCS E2603, E2604, E2622, E2623) is covered when the beneficiary has a past or current pressure ulcer in the seating contact area, or has absent/impaired sensation ..."