Wheelchair Seating

Medicare covers wheelchair seating cushions, backs, accessories, and headrests only when the beneficiary has a covered manual wheelchair or a covered power wheelchair with a sling/solid seat/back and when specific clinical criteria are met (e.g., pressure ulcer history, impaired sensation, inability to perform weight shift, or significant postural asymmetry). Custom fabricated cushions require a comprehensive PT/OT evaluation documenting why prefabricated options are insufficient, PDAC coding verification is required for certain items, and claims lacking required documentation (SWO/WOPD, POD, PDAC verification, or correct coding) will be denied.

"A general use seat cushion (E2601, E2602) or general use back cushion (E2611, E2612) is covered only when the beneficiary has a covered manual wheelchair or a covered power wheelchair with a sling/..."

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