Source: U.S. Rehab / Dan Fedor, VGM — January 18, 2023
Power Wheelchairs
CRT Power Bases (K0835–K0864)
- Capped rental category, but have a first month purchase option
- All accessories used on these bases also have a first month purchase option
- A signed/dated purchase option letter is required
Standard Power Bases (K0813–K0831)
- Capped rental only — no first month purchase option; must rent for 13 months
- Capped rental accessories (e.g., E1028) used on these bases are also rental-only
Manual Wheelchairs
- All manual chairs are capped rental (13-month rental) except K0005
- K0005 (ultra-lightweight) is IRP — can be purchased in the first month
- Capped rental accessories used on any manual chair (including K0005) cannot be purchased
Scooters
- All scooters are IRP — first month purchase option available
Inexpensive/Routinely Purchased (IRP) Items
- Always have a first month purchase option regardless of base code
- Examples: E2363 (batteries), E2603 (skin protection cushion), E0973 (detachable arms)
- If rented instead of purchased: 10 equal monthly payments at the RR rate
Repair Parts
- All repair parts pay as a lump sum (since Oct. 2016)
- No purchase option letter needed — use RB modifier
Calculating Allowables
IRP Items
| Modifier | Meaning | Allowable |
|---|---|---|
| NU | New purchase | Full fee schedule rate |
| UE | Used purchase | 75% of NU |
| RR | Rental | NU ÷ 10 (per month) |
Power Bases
| Scenario | Formula |
|---|---|
| CRT base purchase allowable (K0835–K0864) | RR ÷ 0.15 |
| Standard base total after 13 months (K0813–K0831) | (RR ÷ 0.15) × 1.05 |
Capped Rental Accessories & Manual Bases
| Scenario | Formula |
|---|---|
| Accessory on CRT base — purchase allowable | RR × 10 |
| Accessory/manual base — total after 13 months | RR × 10.5 |
Monthly Payment Structure (Capped Rental)
| Period | Power Bases | Accessories & Manual Bases |
|---|---|---|
| Months 1–3 | RR | RR |
| Months 4–13 | RR × 40% | RR × 75% |
Note
Renting a capped rental item to completion costs 5% more than the purchase allowable — this is by design.
Tags
billing complex-rehab reimbursement wheelchair capped-rental IRP
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).