CGS Administrators and Noridian Healthcare Solutions, Medicare’s DME MAC contractors, have released new local coverage determinations (LCDs) listing coverage criteria for Group 2 power wheelchairs (HCPCS codes K0830 and K0831) with seat elevation.
The LCDs go into effect Dec. 20, 2026.
The DME MACs said in a Nov. 5 announcement, “The final LCD includes coverage criteria for Group 2 power wheelchairs (PWCs) with seat elevation systems (K0830 and K0831) for beneficiaries whose primary means of mobility within the home is their PWC and who rely upon their upper extremities for transfers or mobility-related activities of daily living (MRADLs) when documentation from a licensed/certified medical professional (LCMP) confirms that the seat elevation system is medically necessary.
“The final LCD is being amended to incorporate stakeholders’ suggestions received during the open comment period.”
Proper documentation for the power chair
The future LCDs impact power mobility devices and wheelchair options/accessories.
For a non-complex Group 2 seat elevator PWC, HCPCS codes K0830 and K0831, to be covered, the following criteria must be met:
— All Medicare coverage criteria for a power wheelchair must be met.
— The power wheelchair is appropriate for the beneficiary’s weight.
— The beneficiary uses a power wheelchair as the primary means of mobility within the home.
Additionally, the beneficiary must rely on upper extremities to perform transfers, OR while in the power chair, the beneficiary must perform reaching actions to perform one or more MRADLs — toileting, bathing, grooming, feeding and dressing — while within customary locations in the home.
The beneficiary must also require “substantial mobility assistance — at least 50% of the effort required” to perform transfers or one or more MRADLs in the home.
A licensed/certified medical professional (LCMP) — such as a physical or occupational therapist or other practitioner experienced in rehab wheelchair evaluations — must perform the specialty evaluation and must document the medical necessity for the wheelchair and special features, including seat elevation.
And the wheelchair provider must employ an Assistive Technology Professional (ATP) “who has direct, in-person involvement in the wheelchair selection for the beneficiary.”
Documentation for the seat elevation system
The second LCD said, “A power seat elevation system (E2298) will be covered if a beneficiary meets the coverage criteria for either a Group 2 single power option or multiple power option power-driven wheelchair, or a Group 3 power-driven wheelchair as described in the power mobility devices LCD and meets the coverage criteria for seat elevation equipment as described in CMS Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03) Chapter 1, Part 4, Section 280.16 Seat Elevation Equipment (Power Operated) on Power Wheelchairs.”
For some other types of power chairs, the miscellaneous K0108 code will be used to designate power seat elevation, the LCD said.
“A power seat elevation system (K0108) is covered if a beneficiary meets the coverage criteria for a non-complex Group 2 no power option, Group 5 single power option, or Group 5 multiple power option power-driven wheelchair (K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0890, K0891), as described in the Power Mobility Devices LCD, and the following criteria (A-D) are met.”
Those four criteria are:
— The beneficiary relies on a power chair as the primary means of mobility in the home.
— Either the beneficiary relies on upper extremities to perform transfers OR the beneficiary uses reaching actions from the power chair to perform MRADLs.
— The beneficiary needs substantial mobility assistance (described as at least 50% of the effort needed) to accomplish those transfers or MRADLs.
— Specialty evaluation must be completed by a clinician or practitioner with rehab wheelchair experience.
In a Nov. 6 bulletin to stakeholders, the American Association for Homecare (AAHomecare) said industry comments impacted the new LCDs.
“A proposed LCD was released indicating the technology was not reasonable or necessary,” the organization said. “AAHomecare participated in the public comment opportunity, encouraging our members to also participate. According to the newly released future LCDs, the DME MACs listened to industry feedback and reconsidered.”
The National Coalition for Assistive & Rehab Technology (NCART) said on Nov. 5 that it is “gathering questions our members may have on this so we can seek clarification from the Medicare medical directors prior to implementation.”
CGS Administrators is the DME MAC for jurisdictions B and C. Noridian Healthcare Solutions is the DME MAC for jurisdictions A and D.
