[lucky]

when billing power wheelchair can we bill for battery E2365 and charger E2366

[HEATHER]

PWC Basic Equipment Package - Each power wheelchair code is required to include all these items on initial issue (i.e., no separate billing/payment at the time of initial issue, unless otherwise noted). The statement that an item may be separately billed does not necessarily indicate coverage.


•Lap belt or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately.

•Battery charger, single mode

•Complete set of tires and casters, any type

•Legrests. There is no separate billing/payment if fixed, swingaway, or detachable non-elevating legrests with or without calf pad are provided. Elevating legrests may be billed separately.

•Footrests/foot platform. There is no separate billing/payment if fixed, swingaway, or detachable footrests or a foot platform without angle adjustment are provided. There is no separate billing for angle adjustable footplates with Group 1 or 2 PWCs. Angle adjustable footplates may be billed separately with Group 3, 4 and 5 PWCs.

•Armrests. There is no separate billing/ payment if fixed, swingaway, or detachable non-adjustable height armrests with arm pad are provided. Adjustable height armrests may be billed separately.

•Any weight specific components (braces, bars, upholstery, brackets, motors, gears, etc.) as required by patient weight capacity.

•Any seat width and depth. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed separately:

◦For Standard Duty, seat width and/or depth greater than 20 inches;

◦For Heavy Duty, seat width and/or depth greater than 22 inches;

◦For Very Heavy Duty, seat width and/or depth greater than 24 inches;

◦For Extra Heavy Duty, no separate billing
•Any back width. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed separately:

◦For Standard Duty, back width greater than 20 inches;

◦For Heavy Duty, back width greater than 22 inches;

◦For Very Heavy Duty, back width greater than 24 inches;

◦For Extra Heavy Duty, no separate billing
•Controller and Input Device.
There is no separate billing/payment if a non-expandable controller and a standard proportional joystick (integrated or remote) is provided. An expandable controller, a nonstandard joystick (i.e., nonproportional or mini, compact or short throw proportional), or other alternative control device may be billed separately.

[lucky]

I am looking for modifier for e2365
I am trying to bill with E2365 RR KE KH KX WITH 2 UNITES CLAIM DOESN'T PROCESS THROUGH SOFTWARE.
I am getting error
ERROR: LOOP: LX_2400 SEGMENT: MPR_ENTRY FIELD: FILLER_009 SEQ: 111
CODE: C111 VALUE: E2365RR
DESC: INVALID SERVICE COUNT - RR MODIFIER

[HEATHER]

It's not a capped rental. It is Inexpensive or Routinely purchased. Lose the KH. And since it is being used with a K0823, you shouldn't be using the KE either.

[lucky]

so you have to bill k0823 RR MODIFIER
BUT FOR BATTERY YOU HAVE TO BILL E2365 NU MODIFIER.

[HEATHER]

The K0823 has to be a rental. The batteries - just like all Inex/Rout Purchased items, can be done several ways:

Rental = RR
New Sale = NU
Used Sale = UE

However, at this point you cannot just choose one. It must match your Detailed Product Description and your delivery ticket. (Since you are getting rejections, I assume you already delivered the equipment and have these on file) You need to reference the above documents and bill accordingly.

[btrevolution4]

This is how we always billed for an initial Power Wheelchair delivery on the first month.

K0823 - RRKHKX (Just using this code as an example, billing depends on what you delivered)
E2365 - NUKX (2 units, billed as purchased on first month)

NOTE: Heather, you mentioned the E2365 can be billed with the NU and leave out the KX modifier? I haven't tried billing with just the NU; afraid that Medicare will kick it back and deny it. If I can get it paid without the KX, I would be glad to leave it off!

** Also, I was told that you can also bill for the E0973, 2 units and get paid too? Is this true or is this person talking out of their you know what? Thanks in advance!

[TLAT1270]

K0823-RRKHKX Rental item
E2365-NUKX- Purchased item
E0973- ADJ ARM REST- Medicare will not reimburse for this until the chair is at least 2 yrs old. it is billed for repair NU KX RB

Medicare will not pay for any chair related items without the kx modifier

[HEATHER]

Just to clarify, my original answer just pointed out that batteries are not capped rentals and therefore do not require KH. They also would not require the KE because they ARE being used with a PMD. You would still need the KX modifier. And because batteries are Inexpensive or Routinely Purchased, you can do them as a rental, new sale or used sale (RR, NU or UE.)

HOWEVER, the real point is that when you provide the Detailed Product Description to the ordering physician, you have to include your price and Medicare's price. THIS dictates which modifier (besides the KX) you are required to use. This should also match the information provided to the patient on the delivery ticket regarding whether items are rentals or purchases and pricing. This is not a back end, arbitrary decision.

As for the Adjustable Ht Arms (E0973), Medicare WILL pay for them with the initial claim for the power wheelchair. They are also Inexpensive or Routinely Purchased, so follows same modifier protocol as batteries listed above. You DO need to have all pertinent documentation on why they are necessary for that patient and they must be included on Detailed Product Description.