Manual Tilt

Manual Tilting Wheelchair

Tilt-in-space wheelchairs are often used by patients who have progressive medical conditions, moderate to severe motor involvement, poor head and trunk control and limitations in range of motion, especially in the hips. In addition, patients require contoured seating like back and seat cushions that relieve pressure when the chair is tilted. Tilting wheelchairs are able to be modified to "grow" with the patient and the seat and back angle remain constant at up to 45 degrees tilt.

HCPCS Code:

E1161 Manual Tilt-in-space

Category:

Purchased

Common Diagnosis:

(check for current coding)

343.9 Cerebral Palsy
359.1 Muscular Dystrophy (MD)
344.1 Paraplegia
340.0 Multiple Sclerosis (MS)

Coverage Information

Requires a Detailed Written Order

Covered if the following criteria are met:

The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home; AND

The patient’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker; AND

The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for use of the manual wheelchair that is provided; AND

Use of a manual wheelchair will significantly improve the patient’s ability to participate in MRADLs and the patient will use it on a regular basis in the home; AND

The patient has not expressed an unwillingness to use the manual wheelchair that is provided in the home; AND

The patient has sufficient upper extremity function and other physical and mental capabilities needed to safely self-propel the manual wheelchair that is provided in the home during a typical day; OR

The patient has a caregiver who is available, willing, and able to provide assistance with the wheelchair; AND

The patient is at high risk for development of a pressure ulcer and is unable to perform a functional weight shift; OR

The patient utilizes intermittent catheterization for bladder management and is unable to independently transfer from the wheelchair to bed.

Note 1: Tilt-in-Space wheelchair is eligible for Advance Determination of Medicare Coverage (ADMC). Refer to the Medicare or MAC Supplier Manual for details concerning the ADMC process and ADMC form.

Note 2: You must use KX modifier to denote that patient meets the coverage criteria and that any required documentation is file.

Documentation Requirements: in addition to the basic Medicare documentation (proof of delivery, AOB, etc.) the detailed written order form must contain the patient’s name, the start date of the order, and a description of the item.

Medicare requires that the ordering physician’s chart notes or other physician documentation support the coverage criteria listed above. Oftentimes the most recent history and physical (a common document in most medical records) will include information that supports the need described in the coverage criteria.

At a minimum, you should obtain documentation to document that the patient is at high risk for pressure ulcers and is unable to weight shift, or that the patient catheterizes for bladder management and is unable to independently transfer from the wheelchair to bed.

The detailed written order form must contain the patient’s name, the start date of the order, a description of the item, and a length of need if the product provided is a rental item or recurring supply.

A home mobility evaluation is required to be completed by the supplier and placed in the patient file that documents that the home will accommodate the wheelchair provided. This evaluation can be done at the patient’s home or through an interview with the patient/caregiver if the DME supplier does not deliver the product directly to the patient’s home.