Documentation for Power Tilt/Recline Seating Systems for Wheelchairs

by  Medicare Learning Network
March 8th, 2018

The Medicare Learning Network provides coverage guidance for Power Tilt and/or Recline Seating Systems that must be documented:

POWER TILT AND/OR RECLINE SEATING SYSTEMS (E1002-E1012)

A power seating system – tilt only, recline only, or combination tilt and recline – with or without power elevating legrestsis covered if criteria 1, 2, and 3 are met and if criterion 4, 5, or 6 is met:

1. The beneficiary meets all the coverage criteria for a power wheelchair described in the Power Mobility Devices Local Coverage Determination (LCD); and
2. A specialty evaluation that was performed by a licensed/certified medical professional, such as a PT or OT or physician who has specific training and experience in rehabilitation wheelchair evaluations, of the beneficiary’s seating and positioning needs. The PT, OT, or physician may have no financial relationship with the supplier; and
3. The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the beneficiary; and

One of the following items must be met:

4. The beneficiary is at high risk for development of a pressure ulcer and is unable to perform a functional weight shift; or
5. The beneficiary uses intermittent catheterization for bladder management and is unable to independently transfer from the wheelchair to bed; or
6. The power seating system is needed to manage increased tone or spasticity.

* If these criteria are not met, the power seating component(s) will be denied as not reasonable and necessary.

References:

• MLN Fact Sheet: Provider Compliance Tips for Wheelchair Options/Accessories
• Medicare LCD (L33792)
• Medicare Article (A52504)