Most people aren't aware that the wheelchair your insurance company is buying for you has a very important code attached to it. These codes are from the Healthcare Common Procedure Coding System which is called HCPCS for short. Most manual wheelchairs belong to special classifications. Each classification also has a code associated with it.
Why are these codes so important? The code the particular chair is assigned affects several important things. First, it affects the qualification criteria. The patient needed a wheelchair must meet important criteria in order to get insurance to pay for the chair. Second, it affects the price the insurance will pay for the chair. So, every wheelchair that has a certain code gets the same payment from the insurance company.
Here is a quick rundown of the HCPCS codes for manual wheelchairs.
These are your everyday wheelchairs that you probably see the most often in hospitals and facilities. These chairs come in very limited sizes (18″wide X 16″ deep), can not be customized, and offer very few options. Most chairs in this category weigh more than 36 lbs without front riggings (closer to 50 lbs with front riggings) and seat to floor heights (how high the seat is off of the ground) of 19″-21″.
Standard wheelchairs are best used with patient who have the strength to propel themselves at home in a standard weight chair. Because there are not many options for these chairs, the patient also should not have any deformities or positioning problems that need to be addressed.
These wheelchairs are basically the same as standard wheelchairs except they are not as high off the ground (17″-18″). They are designed for people who are shorter than the average height or need to be closer to ground to propel the wheelchair with their feet. The footrest assemblies are shorter for these chairs too.
This category of manual chair offers a few more options than the others. You can get seats that are either 16″ or 18″ wide and even 20″ wide in some brands. These chairs are lighter than the standard manual chairs. To be in this classification, the wheelchair must weigh less than 36 pounds without foot riggings. The seat to floor heights in this class are usually 19″ to 21″.
These chairs are used for patient who do not have the strength to propel a standard weight manual wheelchair. Other patients suitable for this chair are patients with heart and lung problems, joint or back pain, or low endurance. Users of these chairs should not have any deformities or positioning challenges either.
You can check out some of my favorite lightweight folding wheelchairs here.
Following our pattern, the chairs in this category offer more options and accommodate a wider range of patients. Seat widths in this category come in 14″, 16″, 18″ and even 20″ with many models. Other options include adjustable height arms, adjustable back heights, and even the axle plate on the wheels can be adjusted to help the patient propel the chair. These chairs must weigh less than 34 lbs and are often in the 26 lb to 29 lb range. Seat to floor height options range from 17″ to 21″ high.
High strength lightweight wheelchairs are used with patients who have difficulty propelling the other classes of chair. The patient must also have a need for one of the adjustable options on the chair like poor posture control requiring a higher back or some other orthopedic issue. However, these patients should not have any significant deformities or positioning problems.
These chairs are known for being extremely light. They are almost always custom built for the users. Check out this article for more details on Ultralightweight chairs.
This classification of manual wheelchair often has additional support structures that make them more durable than a standard manual chair. The strengthened supports are usually in the back hinge than the cross braces under the seat. The added supports though make these chairs heavier than standard chairs with many of them weighing 40 lbs or more. They come in larger widths and depths for heavier patients.
The typical patient for this type of chair is the patient who weighs more than 250 lbs or has high tone or severe spasticity. These patients tend to stiffen up when in pain or excited which puts additional stresses on the wheelchair frame. These chairs are built to withstand those stresses.
These wheelchairs, often called bariatric chairs, are designed for patients who exceed 300 lbs. Many of these chairs support patients of 700 lbs or more. They come in much wider widths to accommodate the patient’s size. These chairs can weigh in excess of 50 lbs or more due to the additional bracing and support required.
It isn't super important for every senior to know and fully understand these codes. But, it is nice to hae a general understanding. For one thing, it's a good idea to understand the qualification criteria and know what type of chair you qualify for.
Let me know in the comments if you have any questions. This is a complicated, technical subject so don't be afraid to ask!
I work daily with seniors and the elderly in my position as a wheelchair specialist at a home medical company. I see the struggle they have maintaining their independence and living their daily lives. Most are completely unaware of the options and products out there that can improve their independence, mobility, and safety in their home. I created this site to help seniors, elders, and their caregivers make smart buying decisions about the many independent living aids on the market.
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