The MACs have just removed all of the ICD-10 Dx codes from the wheelchair seating policy! Here’s what it means.
Medicare Administrative Contractors (MACs) are private health care insurers that have been awarded geographic jurisdictions to process Medicare claims. Specifically, DME MACs (Durable Medical Equipment MACs) handle claims and coverage policies for durable medical equipment, including wheelchair seating systems.
What Changed
- Effective October 1, 2025, MACs revised the Local Coverage Determination (LCD) and Policy Article for wheelchair seating.
- All ICD-10 diagnosis code references were removed from the coverage criteria for:
- Skin protection seat cushions
- Positioning seat cushions and accessories
- Combination and adjustable cushions
- Custom fabricated seating components
- KX modifier guidance was also stripped of diagnosis code references, meaning suppliers no longer need to link specific ICD-10 codes to justify use of the modifier.
What It Means for CRT Suppliers
- No more diagnosis code matching: You’re no longer required to include specific ICD-10 codes to meet coverage criteria for wheelchair seating items.
- Streamlined documentation: This could reduce administrative burden and eliminate confusion over which codes qualify.
- Medical necessity still required: The removal of diagnosis codes doesn’t mean coverage is automatic. You must still document:
- The clinical need for the seating component specific to skin integrity, absence of sensation, inability to perform functional weight shifts, or postural asymmetry
- How it improves function or prevents complications (e.g., pressure injuries)
- Audit implications: Without diagnosis codes as anchors, suppliers may face more subjective scrutiny during audits. Clear, narrative documentation from clinicians becomes even more critical.
- Potential for broader access: This change may help patients who didn’t fit neatly into the previous diagnosis code groups but still need seating support.
What to do
- Review the updated LCD and Policy Article carefully to understand the full scope of changes. You can find the official summary here.
- Educate referral sources: Let clinicians know that ICD-10 codes are no longer required, but strong documentation of medical necessity is.
- Update internal workflows: Adjust intake and documentation templates to reflect the new policy language.
- Stay alert for future guidance: This change was made under the 21st Century Cures Act as a non-substantive update, so it didn’t go through public comment. More clarification may follow.