Medicare Reimbursement Schedule
Wheelchair Cushions | |||||
| HCPCS Codes | Wheelchair Product Description | Product Link | New Purchase Allowable w/ KE Modifier (Manual Chair) | New Purchase Allowable w/o KE Modifier (Power Chair) | Retail |
|---|---|---|---|---|---|
| E2601 | General Use Wheelchair Seat Cushion, width less than 22 inches, any depth | Curve | $67.89 | $58.51 | $88.00 |
| Elements with Gel | $109.00 | ||||
| E2602 | General Use Wheelchair Seat Cushion, width 22 inches or greater, any depth | Curve | $132.53 | $114.23 | $185.00 |
| Elements with Gel | $195.00 | ||||
| E2603 | Skin Protection Wheelchair Seat Cushion, width less than 22 inches, any depth | Ascent | $168.26 | $145.02 | $245.00 |
| Hyalite | $237.00 | ||||
| E2604 | Skin Protection Wheelchair Seat Cushion, width 22 inches or greater, any depth | Ascent | $209.12 | $180.25 | $306.00 |
| Hyalite | $309.00 | ||||
| E2605 | Positioning Wheelchair Seat Cushion, width less than 22 inches, any depth | Ridge | $294.36 | $253.71 | $394.00 |
| E2606 | Positioning Wheelchair Seat Cushion, width 22 inches or greater, any depth | Ridge | $459.22 | $395.80 | $498.00 |
| E2607 | Skin Protection and Positioning Wheelchair Seat Cushion, width less than 22 inches, any depth | M2 | $321.72 | $277.29 | $390.00 |
| Maxx | $372.00 | ||||
| Acta-Embrace | $352.00 | ||||
| E2608 | Skin Protection and Positioning Wheelchair Seat Cushion, width 22 inches or greater, any depth | M2 | $386.35 | $333.00 | $418.00 |
| Maxx | $448.00 | ||||
| Acta-Embrace | $428.00 | ||||
| Saddle 7 Series | $473.00 | ||||
| E2609 | Custom fabricated wheelchair seat cushion, any size | Inception | Varies | Varies | Varies |
| E2622 | Adjustable Skin Protection Wheelchair Seat Cushion, width less than 22 inches, any depth | Adjuster | $367.90 | $317.10 | $441.00 |
| Adjuster X | $441.00 | ||||
| Liberty X | $462.19 | ||||
| E2623 | Adjustable Skin Protection Wheelchair Seat Cushion, width 22 inches or greater, any depth | Adjuster | $468.16 | $403.50 | $488.00 |
| Adjuster X | $488.00 | ||||
| Liberty X | $462.19 | ||||
| E2624 | Adjustable Skin Protection and Positioning Wheelchair Seat Cushion, width less than 22 inches, any depth | Vector | $370.93 | $319.71 | $462.00 |
| Vector X | $462.00 | ||||
| Versa X | $462.00 | ||||
| M2 ATI | $524.00 | ||||
| Acta-Embrace ATI | $352.00 | ||||
| E2625 | Adjustable Skin Protection and Positioning Wheelchair Seat Cushion, width 22 inches or greater, any depth | Vector | $469.58 | $404.73 | $509.00 |
| Vector X | $509.00 | ||||
| Versa X | $509.00 | ||||
| M2 ATI | $552.00 | ||||
| Acta-Embrace ATI | $428.00 | ||||
*Reimbursements may vary slightly by state. Retail prices vary slightly by product size.
Back Supports | |||||
| HCPCS Codes | Wheelchair Product Description | Product Link | New Purchase Allowable w/ KE Modifier (Manual Chair) | New Purchase Allowable w/o KE Modifier (Power Chair) | Retail |
|---|---|---|---|---|---|
| E2611 | General Use Wheelchair Back Support, width less than 22 inches, any height, including any type mounting hardware | Elements Back | $346.69 | $298.82 | $354.00 |
| Radius Back | $481.00 | ||||
| Visco Back | $439.00 | ||||
| E2612 | General Use Wheelchair Back Support, width 22 inches or greater, any height, including any type mounting hardware | Elements Back | $469.01 | $404.24 | $482.00 |
| Radius Back | $534.00 | ||||
| Visco Back | $514.00 | ||||
| E2613 | Positioning Wheelchair Back Support, Posterior, width less than 22 inches, any height, including any type mounting hardware | Acta-Back | $436.25 | $376.01 | $507.00 |
| IncrediBack | $435.00 | ||||
| Acta-Embrace Back | $530.00 | ||||
| Acta-Embrace LTS | $696.52 | ||||
| E2614 | Positioning Wheelchair Back Support, Posterior, width 22 inches or greater, any height, including any type mounting hardware | Acta-Back | $603.74 | $520.37 | $596.00 |
| IncrediBack | $536.00 | ||||
| Acta-Embrace Back | $678.00 | ||||
| Acta-Embrace LTS | $786.07 | ||||
| E2615 | Positioning Wheelchair Back Support, Posterior Lateral, width less than 22 inches, any height, including any type mounting hardware | Acta-Back Deep | $502.06 | $432.72 | $601.00 |
| IncrediBack | $493.00 | ||||
| Acta-Relief | $684.08 | ||||
| E2616 | Positioning Wheelchair Back Support, Posterior Lateral, width 22 inches or greater, any height, including any type mounting hardware | Acta-Back Deep | $675.49 | $582.21 | $677.00 |
| IncrediBack | $621.00 | ||||
| E2617 | Custom Fabricated Wheelchair Back Support | Custom Acta-Back | Varies | Varies | Varies |
| Custom Acta-Back Deep | Varies | ||||
| Custom Acta-Embrace | Varies | ||||
| E2620 | Positioning Wheelchair Back Support, Planar with Lateral Supports, width less than 22 inches, any height, including any type mounting hardware | Acta-Back Contour | $607.92 | $637.96 | $605.00 |
| Acta-Back LTS | $671.00 | ||||
| Acta-Relief LTS | $870.65 | ||||
| E2621 | Positioning Wheelchair Back Support, Planar with Lateral Supports, width 22 inches or greater, any height, including any type mounting hardware | Acta-Back Contour | $637.96 | $549.86 | $679.00 |
| Acta-Back LTS | $744.00 | ||||
| Acta-Relief LTS | $870.65 | ||||
*Reimbursements may vary slightly by state. Retail prices vary slightly by product size.
Accessories | |||||
| HCPCS Codes | Wheelchair Product Description | Product Link | New Purchase Allowable w/ KE Modifier (Manual Chair) | New Purchase Allowable w/o KE Modifier (Power Chair) | Retail |
|---|---|---|---|---|---|
| E1020 | Residual Limb Support for a wheelchair | Quick-Release Amp | $266.18 | $229.42 | $338.00 |
| Swing-Away Amp | $348.00 | ||||
| E1028 | Manual swing-away, retractable or removable mounting hardware | Swing Away Arm Hardware | $229.25 | $197.59 | $263.00 |
| EAD Arm Hardware | $322.00 | ||||
| Durasoft Half Lap Tray Hardware | $243.00 | ||||
| Swing Away Lateral Hardware | $263.00 | ||||
| Head Support Hardware | $211.00 | ||||
| E2209 | Arm trough with or without hand support | Comfort Arm | $118.95 | $102.52 | $138.00 |
| Molded Arm | $73.00 | ||||
| E0956 | Lateral trunk or hip support, any type including fixed mounting hardware | Flat Top Lateral Roll | $109.42 | $94.30 | $72.00 |
| Lateral Pads | $79.00 | ||||
| E0955 | Cushioned head support, any type including fixed mounting hardware | BodiLink Head Support | $224.42 | $196.93 | $230.00 |
| E0995 | Calf rest/pad | Calf Protector | $33.75 | $29.08 | $55.00 |
| E2619 | Replacement cushion cover | Cushion Cover | $55.57 | $47.88 | $60.00 |
| E0992 | Solid seat insert | Rigid Insert | N/A | $105.62 | $63.00 |
| K0108 | Wheelchair accessory, not otherwise specified | Comfort Foot Single | Varies | Varies | -------- |
| Comfort Foot Double | -------- | ||||
*Reimbursements may vary slightly by state. Retail prices vary slightly by product size.
Medicare Resources
Helpful Medicare WebsitesCenters for Medicare and Medicaid Services
Search for HCPCS Codes or Fees
Seating Code Coverage Determinations:
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Region D
Medicare Seating Code Explanations