Wheelchair Seating & Positioning

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Wheelchair Seating & Positioning Coverage Criteria

 

 

 

    Ohio Medicaid:

 

  • A CMN must be completed to document the need for seating and positioning.

  • For custom seating, the beneficiary must have a moderate to severe impairment of strength and tone which result in an inability to maintain functional or symmetrical postures; and/or flexible scoliosis; and/or flexible kyphosis; and/or dislocated hip with leg length discrepancy of less than two inches; and/or fixed contractures of the hips/knees that cannot be accommodated by standard components (e.g., footrests, leg rests). A severe impairment means the individual has severely abnormal (hyper or hypo) tone that prevents him or her from obtaining or maintaining symmetrical postures, or abnormally fixed curvature of the spine.

    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.

 

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