Local Coverage Determination · DME MAC
L33792
Wheelchair Options/Accessories
Version 43. CMS effective date 10/01/2025. CMS updated 10/23/2025. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. Pub. 100-03 (Medicare National Coverage Determinations Manual), Chapter 1, Sections 280.1, 280.3, 280.16
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. Options and accessories for wheelchairs are covered if the beneficiary has a wheelchair that meets Medicare coverage criteria and the option/accessory itself is medically necessary. Coverage criteria for specific items are described below. If these criteria are not met, the item will be denied as not reasonable and necessary. Adjustable arm height option (E0973, K0017, K0018, K0020) is covered if the beneficiary requires an arm height that is different from that available using nonadjustable arms and the beneficiary spends at least 2 hours per day in the wheelchair. An arm trough (E2209) is covered if the beneficiary has quadriplegia, hemiplegia, or uncontrolled arm movements.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A52504 · Wheelchair Options/Accessories - Policy Article
Related NCDs
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
- NCD 280.3 · Mobility Assistive Equipment (MAE) (version 2)
- NCD 280.16 · Seat Elevation Equipment (Power Operated) on Power Wheelchairs (version 1)
HCPCS codes on this LCD
158 other Level II codes are on the LCD and are not given a page in this set: E0973, E2209, K0018, K0019, K0020, E0951, E0952, E0954, E0990, E0995, E1020, K0037, K0038, K0039, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0195, E1011, E2201, E2202, E2203, E2204, K0056, E0961, E0967, E0988, E2205, E2206, E2211, E2212….
Questions
What does LCD L33792 cover?
L33792 is Wheelchair Options/Accessories. It is a current final DME MAC local coverage determination, version 43.
Where is the CMS source for L33792?
The Medicare Coverage Database page for LCD L33792 version 43.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=K0015&as_of=2024-01-15&npi=1234567890&state=UT"