Wheelchair Seating and Positioning
Wheelchair Seating & Positioning Coverage Criteria
Medicare:
Pressure Relieving Cushion
- Client must meet 1 or 2 or 3:
1) If there is a past history of, or current pressure ulcer in the area of contact with seating surface; or
2) If there is absent or impaired sensation in the area of contact with the seating surface due to one of the diagnoses listed below; or
3) If there is an inability to carry out a functional weight shift due to one of the diagnoses listed below
- Covered Diagnoses
- Spinal cord injury resulting in quadriplegia or paraplegia
- Other spinal cord disease
- Multiple sclerosis (340)
- Other demyelinating disease
- Cerebral Palsy
- Anterior horn cell disease including ALS (335.23-335.9)
- Post polio paralysis
- Traumatic brain injury resulting in quadriplegia
- Spina Bifida (741.00-741.93)
- Childhood cerebral degeneration
- Alzheimer’s disease (331.0)
- Parkinson’s disease (332.0)
Positioning Cushion
- Client must meet both criteria:
1) The patient has a wheelchair and the patient meets Medicare coverage criteria for it; and
2) The patient has any significant postural asymmetries that are due to one of the diagnoses listed under Pressure Relieving Cushion or to one of the following diagnoses:
- Covered Diagnoses
- Monoplegia of the lower limb (344.30-344.32, 438.40-438.42)
- Hemiplegia (342.00-342.92,438.20-438.22) due to strong, traumatic brain injury, or other etiology
- Muscular Dystrophy (359.0-359.1)
- Torsion dystonias (333.4,333.6,333.7)
- Spinocerebellar disease 334.0-334.9)
Pressure Relieving and Positioning Cushion
- Client must meet the criteria for the pressure relieving cushion and positioning cushion.