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June 13, 2024

Wheelchair Replacements When the Manufacturer Exits Wheelchair Business – Effective July 8

CMS issued instructions for replacement power or manual wheelchairs. These instructions apply to dates of service on or after July 8, 2024, when:

  1. The manufacturer exits the wheelchair business resulting in the wheelchair ceasing to exist on the market, and
  2. There is no availability of aftermarket repair or replacement parts to make the manufacturer’s equipment operable.

The beneficiary may no longer have wheelchair mobility when the wheelchair stops working due to the need for repairs that can no longer be made. In this scenario, Medicare may consider the wheelchair equipment as lost so the beneficiary can get new equipment. Suppliers should follow current instructions for replacement when equipment is lost, stolen, or irreparably damaged.

This does not apply to situations where a manufacturer stops manufacturing or no longer supports a wheelchair product line, but repair parts to make the manufacturer’s equipment operable for the reasonable useful lifetime of the equipment remain available. This replacement scenario applies when there are no repair parts to make the manufacturer’s equipment operable.

See Supplier Manual Chapter Five – DMEPOS Fee Schedule CategoriesPDF for more information about repairs and replacement.

Follow the prior authorization process when replacing a power mobility device.

Claim instructions for Dates of service on or after July 8, 2024:

  • Use the RA on the first month.
  • For capped rental payment, use the KH modifier (DMEPOS Item, Initial Claim, Purchase or First Month Rental), except for purchased complex rehabilitation power mobility devices (PMDs).
  • Add a claim narrative “Replacement due to manufacturer exiting wheelchair business” or a similar statement.
  • For PMDs: the unique tracking number (UTN) from the prior authorization decision

View the entire CMS instruction hereExternal PDF.


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