[morkin5000]

Hi, I am a new biller and I have an order for a patient transport chair HCPCS code E1038. Will Medicare cover? I looked on the cignagovernmentservices.com website and found nothing! Please advise if you know.

Thank you!

[DMEisgoodfun]

I've gotten them covered in Region D. They are a capped rental item. Same
criteria as wheelchair. Can't get paid for a cushion w/ transport chair.

[morkin5000]

So when generating paperwork for doctor to sign you just use std wheelchair LCD??

[Regina]

I was under the impression that a transport chair was for someone who cannot self propel in a wheelchair. They have small front wheels and can only be propelled with the feet.
I usually get something from the doctor stating that the patient cannot self propel due to upper body weakness.

[HEATHER]

Medicare will pay for a transport chair in lieu of a regular wheelchair. Yes follow lcd for manual wheelchair. The reimbursement is poor. In region C they only allow $18.91/mo for the 1st 3 months and $14.18/mo after that. Which is why we ONLY do them unassigned. Once upon a time they allowed almost $40/mo for them - but turned out that price mistakenly included allowance for ELR's. Which just to point out - has a higher allowable amount that the E1038! The only accessory you can bill with an E1038 is a pair elevating leg rests (K0195). Any other accessory is non-covered. You don't have to show that a patient cannot self propel - they just have to meet the coverage criteria for a K0001. And earlier poster was correct, it is a capped rental.

[morkin5000]

Thank you so much everyone!! I am so glad I stumbled upon this HME TALK site!

[nps7vc]

Where can I find documentation that the requirements for the e1038 are the same as those for the k0001? I have looked all over the lcd's and the only mention I can find of e1038 is the one in the wheelchair seating lcd, saying that you can't bill for cushions with an e1038. Thanks in advance