Wheelchair Seating

This policy covers wheelchair seating—including prefabricated and custom seat and back cushions (skin‑protection, positioning, and combination), headrests, and positioning accessories—for approved manual or power wheelchairs and select power‑operated vehicles (captain’s chair seats) to prevent or manage pressure ulcers and address postural needs. Coverage applies to patients with current or prior pressure ulcers, impaired or absent sensation, inability to perform functional weight shifts due to conditions such as spinal cord injury, multiple sclerosis, cerebral palsy, ALS, TBI, spina bifida and other listed neurologic/musculoskeletal diagnoses, as well as children, patients with progressive disease, incontinence, or significant postural asymmetries. Major limitations require a comprehensive PT/OT evaluation to justify custom items when prefabricated devices are insufficient, exclude powered seat cushions (E2610) and certain accessory codes for non‑captain‑chair bases, prohibit prescribing/reusing components that caused prior skin breakdown, and restrict coverage to the specific HCPCS/ICD‑10 codes and LCD L33312.