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ManualsBrandsMedline ManualsMobilityExcel Deluxe Basic Aluminum Transport Chair

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HCPCS Disclaimer: HCPCS codes and Home Health Consolidated Billing codes provided by Medline are intended as general guidelines only. Medline does not guarantee coverage or reimbursement of

any products. You must address all coverage and reimbursement issues (including the correctness and accuracy of codes) with you r individual payers. It is your responsibility to ensure the accuracy and

appropriateness of each claim you submit, in accordance with all applicable payer requirements. Rev 09092010

Basic coverage criteria met

Patient requires lower seat height

(17" to 18") because of short stature, or

To enable patient to place feet on ground

for propulsion

Basic coverage criteria met

Patient cannot self-propel in standard

wheelchair in home

Patient can and does self-propel in

lightweight wheelchair

Basic coverage criteria met

Self-propels wheelchair while engaging

in frequent activities in home that cannot

be performed in standard or lightweight

wheelchair

Requires seat width, depth, or height that

cannot be accommodated in standard,

lightweight or hemi-wheelchair (spends

at least two hours per day in wheelchair)

Basic coverage criteria met

Coverage determined on individual

consideration basis based on supporting

medical documentation

Basic coverage criteria met

Patient weighs more than 250 lbs or

Patient has severe spasticity

Basic coverage criteria met

Patient weighs more than 300 lbs

Basic coverage criteria met

Basic coverage criteria me

Basic coverage criteria met

Wheelchair weight: Greater than 36 lbs

Seat height: 19" or greater