Wheelchair Seating & Positioning

Wheelchair Seating & Positioning Coverage Criteria


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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