Retired - Correct Coding – Braces (Orthoses) Attached to Wheelchairs

Joint DME MAC and PDAC Publication

Recently claims for braces attached to wheelchairs have been submitted using HCPCS code K0108 - WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED.  K0108 is not the correct HCPCS code to use for these items.

CMS has clarified the distinction between braces (orthoses) and durable medical equipment (DME) under Medicare Part B. The orthotics benefit in section 1861(s)(9) of the Act, insofar as braces are concerned, is limited to leg, arm, back, and neck braces that are used independently, rather than in conjunction with, or as components of, other medical or non-medical equipment. Accessories used in conjunction with, and necessary for the full functioning of, durable medical equipment fall under the durable medical equipment benefit. Suppliers must not use L-codes or miscellaneous codes such as K0108 to bill for items that are components of, or used in conjunction with, wheelchairs. These items are correctly billed using the appropriate E-codes (E2626-E2633).

E2626 - WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE

E2627 - WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, ADJUSTABLE RANCHO TYPE

E2628 - WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, RECLINING

E2629 - WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, FRICTION ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS)

E2630 - WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT, MONOSUSPENSION ARM AND HAND SUPPORT, OVERHEAD ELBOW FOREARM HAND SLING SUPPORT, YOKE TYPE SUSPENSION SUPPORT

E2631 - WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, ELEVATING PROXIMAL ARM

E2632 - WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, OFFSET OR LATERAL ROCKER ARM WITH ELASTIC BALANCE CONTROL

E2633 - WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, SUPINATOR

This information was previously published by the DME MACs in a December 1996 Newsletter article, “Seating Systems: DME vs. Orthosis”. This article updates the earlier publication.

For questions about correct coding, contact the Pricing, Data Analysis and Coding Contractor (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.