Power Wheelchair Prior Authorization Requirements
Need to know if a power wheelchair or accessory requires prior authorization? This quick reference guide breaks down what you need to get approved before delivery.
Required Prior Authorization
CMS requires prior authorization for the following power wheelchair base codes before delivery and claim submission:
Power Wheelchair Bases
- K0800-K0802 (Group 1 standard)
- K0806-K0808 (Group 1 heavy duty)
- K0813-K0816 (Group 1 standard and heavy duty variants)
- K0820-K0829 (Group 2 standard and heavy duty)
- K0835-K0843 (Group 3 standard and heavy duty)
- K0848-K0864 (Group 4 and Group 5)
Voluntary Prior Authorization
The following accessory codes are available for voluntary prior authorization—you can request approval, but it’s not required:
Power Seating Systems
- E0950 - Wheelchair accessory, tray
- E0955 - Wheelchair accessory, headrest extension
- E1002-E1010 - Power seating systems (tilt, recline, combinations)
- E1012 - Center mount power elevating leg rest
- E1029 - Wheelchair accessory, ventilator tray
- E1030 - Wheelchair accessory, ventilator tray, gimbaled
Positioning and Support
- E2310-E2313 - Power wheelchair accessories for power seating
- E2321-E2330 - Power wheelchair accessories
- E2351 - Power wheelchair accessory, electronic interface
- E2373 - Power wheelchair accessory, hand or chin control interface
- E2377 - Power wheelchair accessory, expandable controller
Seating Components
- E2601-E2608 - Wheelchair back cushion systems
- E2611-E2616 - Wheelchair seat cushion systems
- E2620-E2625 - Wheelchair skin protection and positioning accessories
Other Accessories
- K0020 - Standard wheelchair cushion
- K0195 - Elevating leg rests
Important Reminders
Six-Month Validity
Prior authorization decisions remain valid for six months after approval. If you don’t deliver the equipment within six months, you’ll need to submit a new prior authorization request.
Fastest Submission Method
Submit prior authorization requests through the myCGS DME Web Portal for the quickest processing times.
Additional Resources
For complete prior authorization instructions and to submit requests, visit the CGS Medicare PMD Prior Authorization page.