Transcription of ROHO Products, HCPCS Codes and Allowables
1 ROHO Products, HCPCS Codes and Allowables 1/3/2011. 2011 Medicare B Allowables *. With KE Without KE. HCPCS product Modifier** Modifier**. Codes Descriptors ROHO product HCPCS code Assignments Category (manual chairs) (power chairs). Wheelchair Seat Cushions: General Use Wheelchair Seat Cushion, E2601 MOSAIC Cushion Cushion $ $ width less than 22 inches, any depth General Use Wheelchair Seat Cushion, E2602 Cushion $ $ width 22 inches or greater, any depth Skin Protection Wheelchair Cushion, E2603 Triumph Cushion - Discontinued Cushion $ $ width less than 22 inches, any depth Skin Protection Wheelchair Cushion, E2604 Cushion $ $ width 22 inches or greater, any depth Positioning Wheelchair Seat Cushion, E2605 AirLITE Cushion Cushion $ $ width less than 22 inches, any depth Positioning Wheelchair Seat Cushion.
2 E2606 Cushion $ $ width 22 inches or greater, any depth Skin Protection and Positioning HARMONY Cushion E2607 Wheelchair Cushion, width less than 22 Cushion $ $ Triumph Contour Cushion - Discontinued inches, any depth Skin Protection and Positioning E2608 Wheelchair Cushion, width 22 inches or Cushion $ $ greater, any depth Custom Fabricated Wheelchair Seat ROHO Custom Seat Cushions (Based on unique, individual E2609 Cushion Individual Consideration Cushion, Any Size design): CUSTC, ENHCUSTC, QSCUSTC & CSCUSTC. HIGH PROFILE Single Compartment Cushion < 22". Hybrid ELITE Single Valve Cushion < 22".
3 Adjustable Skin Protection Wheelchair K0734 Hybrid ELITE Dual Valve Cushion < 22". Cushion, width less than 22 inches, any Cushion $ $ E2622 LOW PROFILE Single Compartment Cushion < 22". depth MID PROFILE Single Compartment Cushion < 22". nexus SPIRIT Cushion HIGH PROFILE Single Compartment Cushion 22". Adjustable Skin Protection Wheelchair K0735 Hybrid ELITE Single Valve Cushion 22". Cushion, width 22 inches or greater, any Cushion $ $ E2623 Hybrid ELITE Dual Valve Cushion 22". depth LOW PROFILE Single Compartment Cushion 22". C:\Documents and Settings\davem\My Documents\Dave M\Medicare & PAOC\ Allowables & Products\2011 ROHO Seating Products and Allowables - Seating Page 1 of 3.
4 ROHO Products, HCPCS Codes and Allowables 1/3/2011. 2011 Medicare B Allowables *. With KE Without KE. HCPCS product Modifier** Modifier**. Codes Descriptors ROHO product HCPCS code Assignments Category (manual chairs) (power chairs). CONTOUR SELECT Cushion < 22". ENHANCER Cushion < 22". Adjustable Skin Protection and HIGH PROFILE Dual Compartment Cushion < 22". K0736. Positioning Wheelchair Cushion, width LOW PROFILE Dual Compartment Cushion < 22" Cushion $ $ E2624. less than 22 inches, any depth LOW PROFILE QUADTRO SELECT Cushion < 22". MID PROFILE QUADTRO SELECT Cushion < 22". QUADTRO SELECT Cushion < 22".
5 CONTOUR SELECT Cushion 22". ENHANCER Cushion 22". Adjustable Skin Protection and K0737 HIGH PROFILE Dual Compartment Cushion 22". Positioning Wheelchair Cushion, width Cushion $ $ E2625 LOW PROFILE Dual Compartment Cushion 22". 22 inches or greater, any depth MID PROFILE QUADTRO SELECT Cushion 22". QUADTRO SELECT Cushion 22". Wheelchair Back Cushion Descriptor JetStream Pro Standard & Low Back System - Fixed General use wheelchair back cushion, E2611 JetStream Pro Standard & Low Back System - Adjustable Back $ $ width less than 22 inches, any depth RETROBACK Back Support System General use wheelchair back cushion, E2612 Back $ $ width 22 inches or greater, any depth Positioning wheelchair back cushion, E2613 posterior, width less than 22 inches, any Back $ $ height Positioning wheelchair back cushion, E2614 posterior, width 22 inches or greater, any Back $ $ height Positioning wheelchair back cushion.
6 E2615 posterior-lateral, width less than 22 Back $ $ inches, any height Positioning wheelchair back cushion, E2616 posterior-lateral, width 22 inches or Back $ $ greater, any height Custom fabricated wheelchair back ROHO Custom Back Cushions (Based on unique, individual E2617 cushion, any size, including any thpe Back Individual Consideration design): CUSTBKC ** code Verification Pending**. mounting hardware C:\Documents and Settings\davem\My Documents\Dave M\Medicare & PAOC\ Allowables & Products\2011 ROHO Seating Products and Allowables - Seating Page 2 of 3. ROHO Products, HCPCS Codes and Allowables 1/3/2011.
7 2011 Medicare B Allowables *. With KE Without KE. HCPCS product Modifier** Modifier**. Codes Descriptors ROHO product HCPCS code Assignments Category (manual chairs) (power chairs). Positioning wheelchair back cushion, E2620 planar back with lateral suppots, width Back $ $ less than 22 inches, any height Positioning wheelchair back cushion, E2621 planar back with lateral suppots, width 22 Back $ $ inches or greater, any height Accessories and Misc. Items Replacement cover for wheelchair seat Cushion /. E2619 Applicable for all replacement seat cushion and back covers $ $ cushion or back cushion, each Back Cover This code could be recommended for ROHO products that are Wheelchair Component or Accessory, K0108 used with a wheelchair and are not otherwise coded, however misc Individual Consideration Not Otherwise Covered there is no assurance of coverage or payment This code could be recommended for ROHO products that are Durable Medical Equipment, E1399 not used with a wheelchair and are not otherwise coded.
8 Misc Individual Consideration Miscellaneous however there is no assurance of coverage or payment * Puerto Rico Allowables are unique, and not included on this spreadsheet ** NEW KE Modifier required for use when claim is associated with manual wheelchairs * Suppliers are encouraged to make sure that their information matches the information included on the PDAC. product Classification List: * If a nonpowered, prefabricated seat cushion, a prefabricated back cushion, or a brand name custom fabricated seat or back cushion has not received a written coding verification from the SADMERC / PDAC or if it is determined that the cushion does not meet the criteria for the code , it must be billed with code K0669.
9 * Medicare Coding and Allowables are subject to change. Consult the PDAC and your local DMERC for the most current information C:\Documents and Settings\davem\My Documents\Dave M\Medicare & PAOC\ Allowables & Products\2011 ROHO Seating Products and Allowables - Seating Page 3 of 3.
