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Billing Reminders for K0195 and E0988 with Manual or Power Wheelchairs

National Government Services, the Jurisdiction B DME MAC has noticed an increase in the number of claims denying with ANSI denial code CO-4 for leg rests, HCPCS code K0195 and lever-activated wheel drive, HCPCS E0988. Suppliers are attempting to start a new rental period because the beneficiary’s condition has changed and now requires a different wheelchair.

When suppliers bill for either of these items for the first rental month (KH modifier) the base equipment for the new manual or power wheelchair must be billed on the same claim if the existing leg rests cannot be attached to the new manual or power wheelchair. Suppliers should report the base equipment on the first line and the leg rests or lever-activated wheel drive on any of the subsequent claim lines. If suppliers fail to follow this billing practice, the leg rests or lever-activated wheel drive could deny ANSI CO-4 (procedure code is inconsistent with the modifier used, or a required modifier is missing).

When suppliers receive the ANSI denial of CO-4, this is considered an unprocessable claim. Suppliers are not afforded appeal rights and may not request a reopening on this denial. If ANSI denial CO-4 is received for the leg rests or lever-activated wheel drive, suppliers should utilize the variety of self-service tools National Government Services offers in order to determine the appropriate monthly capped rental modifier (KH, KI, KJ) that should be appended when resubmitting their claim.

By using the IVR system, suppliers would select option 3 which is for CMN status. Suppliers will need to check for HCPCS codes K0195 and/or E0988. By using this option, suppliers will be able to determine how many rental payments are on file for the item.

Suppliers who have access to NGSConnex will need to select the “My Claims Tab.” Suppliers will need to select “Same or Similar” from the “Claim Type” drop down menu. Suppliers will be able to review total rental payments made on the particular item.

Claim Status Inquiry allows suppliers to review same or similar and CMN status for beneficiaries. Once logged into CSI, suppliers will need to select the “CMN Status” option to review previous rental payments on a particular item.

Suppliers are reminded when billing for rental items, the appropriate monthly modifier is required and all other applicable modifiers per the medical policy:

  • KH modifier for the first month of billing
  • KI modifier for the second and third month of billing
  • KJ modifier for the fourth through thirteenth month of billing

Suppliers who have additional questions may contact the PCC at 866-590-6727. The PCC is available Monday–Friday: 8:30 a.m.–5:30 p.m. ET. The PCC is closed on Fridays from 2:30–4:30 p.m. ET for training.

Billing Reminders for K0195 and E0988 with Manual or Power Wheelchairs
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