• All Power Wheelchairs are in the Capped Rental Fee Schedule Category

• K0835-K0843 and K0848-K0864 (complex rehab) have First Month Purchase Option

  • ALL Capped Rental Accessories used on these bases have a First Month Purchase Option

• Inexpensive/Routinely Purchased Accessories ALWAYS have a Purchase Option (batteries, cushions, backs, detachable height adjustable arms etc.)

• BP Modifier MUST be used on Capped Rental items selected for purchase

• NO KH Modifier when a Capped Rental item is purchased

• K0813-K0931 and K0898 must be rented following standard capped rental rules

Chapter 5 of Medicare Manual

Complex Rehabilitative Power Wheelchairs (HCPCS codes K0835-K0843 andK0848-K0864) and Wheelchair Options/Accessories Furnished for Use with aComplex Rehabilitative Power Wheelchair

Complex rehabilitative power wheelchairs (HCPCS codes K0835-K0843 and K0848-K0864) and options/ accessories furnished for use with a complex rehabilitative power wheelchair can be either rented or purchased. You must give beneficiaries entitled to these power wheelchairs and options/accessories the option of purchasing at the time you first furnish the item. No rental payment will be made for the first month until you notify the DME MAC that the beneficiary has been given the option to either purchase or rent. If the beneficiary chooses to purchase, payment will be made on a lump sum purchase basis. In this case, the modifiers billed on the claim for purchase must be NU (or UE, if used), KH, and BP (in addition to any modifiers required by the Local Coverage Determination). If the beneficiary declines the purchase in the first month, payment will be made on a rental basis. Effective for dates of service on and after October 1, 2018, the KH modifier is no longer required for purchased (NU or UE) wheelchairs and accessories. For power wheelchair rentals beginning on or after January 1, 2011, monthly rental payment amounts under the DMEPOS fee schedule are calculated using a different percentage of the purchase price than the percentage used for regular capped rental items. Payment for the first three months of rental is 15 percent (instead of 10 percent) of the purchase price of the power wheelchair, and payment for months 4 through 13 is 6 percent (instead of 7.5 percent). The purchase fee schedule amount for complex rehabilitative power wheelchairs is equal to the monthly rental fee schedule amount divided by 0.15.

Standard Power Wheelchairs

For power wheelchair rentals beginning on or after January 1, 2011, monthly rental payment amounts under the DMEPOS fee schedule are calculated using a different percentage of the purchase price than the percentage used for regular capped rental items. Payment for the first three months of rental is 15 percent (instead of 10 percent) of the purchase price of the power wheelchair, and payment for months 4 through 13 is 6 percent (instead of 7.5 percent).