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Positioning Equipment

Revised: 08-01-2011

  • Overview
  • Eligible Providers
  • TPL and Medicare
  • Eligible Recipients
  • Covered Services
  • Reflux Wedges
  • Positioning Cushions/Pillows/Wedges
  • Positioning Seats for Use in Vehicles
  • Positioning Seats for Use in Homes
  • Noncovered Services
  • Authorization
  • Billing
  • Legal References
  • Overview

    Positioning cushions, positioning car seats and positioning feeding chairs are used by individuals who require significant postural support. Reflux wedges are used by infants with severe gastroesophageal reflux.

    Eligible Providers

    The following providers may provide positioning equipment:

  • • Federally Qualified Health Centers
  • • Home health agencies
  • • Hospitals
  • • Indian Health Services
  • • Medical suppliers
  • • Pharmacies
  • • Rural Health Clinics
  • TPL and Medicare

  • • Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer
  • • MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested
  • Eligible Recipients

    Positioning equipment is covered for eligible MHCP recipients who meet medical necessity criteria. Some specific products are not covered in long term care facilities.

    Covered Services

    Use the most appropriate one of these HCPCS codes for the services described below:

  • • E0190 (positioning cushion/pillow/wedge, any shape or size, includes all components and accessories)
  • • T5001 (positioning seat for persons with special orthopedic needs)
  • Reflux Wedges

    Covered for infants with severe gastroesphageal reflux which has been diagnosed by a physician, when other methods of positioning have been tried and failed, or when the physician’s order states that other methods of positioning are contraindicated for the infant. Documentation must specify the medical condition that requires the reflux wedge, as well as other methods of positioning that have been tried.

    Positioning Cushions/Pillows/Wedges

  • • Covered for recipients who need significant postural support when other methods of positioning have been tried and failed or when the physician’s order states that other methods of positioning are contraindicated for the recipient due to the recipient’s medical condition. Positioning cushions/pillows must be manufactured to meet positioning needs rather than for general use, and may include items such as Versa Form® Positioning Pillows.
  • • Documentation must specify the medical condition that requires postural support, as well as other methods of positioning that have been tried. Authorization is required when the submitted charge is over $400. Authorization requests must include documentation that the positioning cushion/pillow/wedge has been prescribed and fitted by a medical professional with experience, and that caregivers have been trained in the use and care of the equipment.
  • • E0190 includes all components and accessories including pillow covers and vacuum pumps. When requesting authorization and billing for positioning pillows, needed accessories may not be separately billed. Accessories dispensed to replace lost or damaged accessories for a patient owned positioning pillow should be billed with E0190 and modifier RB unless a more specific HCPCS code is available for the accessory.
  • Positioning Seats for Use in Vehicles

    Covered with prior authorization for recipients with special orthopedic/medical needs that cannot be met using conventional car seats or with needs that make conventional car seats medically inappropriate. A positioning seat may be medically necessary for a recipient with an inability to maintain an unsupported sitting position independently which is caused by a medical condition such as any of the following (list is not all-inclusive):

  • • Severe head and trunk instability
  • • Severe hypotonicity, hypertonicity, spasticity or muscle spasm which result in uncontrollable movement and position changes
  • • Severe seizure activity that results in uncontrollable movement and position changes
  • • Orthopedic disease processes resulting in significant bony fragility
  • • Significant contractures that would result in an inability to perform postural corrections due to vehicle motion
  • • Orthopedic condition, such as a curvature of the spine, which interferes with proper positioning
  • Documentation for the authorization request for a positioning seat for use in vehicles must include an evaluation by a physical therapist or occupational therapist, the medical condition that causes the need for the positioning seat, other interventions that have been tried to meet the recipient’s needs, and less costly positioning seats that have been considered and rejected. Document the recipient’s current height and weight, and the weight capacity and growth potential for the requested seat.

    Positioning Seats for Use in Homes

    Covered with prior authorization for recipients with special orthopedic/medical needs during essential activities of daily living that cannot be met using conventional chairs or with needs that make conventional chairs medically inappropriate. A positioning seat may be medically necessary for a recipient with an inability to maintain an unsupported sitting position independently which is caused by a medical condition such as any of the following (list is not all-inclusive):

  • • Severe head and trunk instability
  • • Severe hypotonicity, hypertonicity, spasticity or muscle spasm which result in uncontrollable movement and position changes
  • • Severe seizure activity that results in uncontrollable movement and position changes
  • • Orthopedic condition, such as curvature of the spine, which interferes with proper positioning
  • Documentation for the authorization request for a positioning seat for use in homes must include the medical condition that causes the need for the positioning seat, the specific activities of daily living for which the seat is requested, other interventions that have been tried to meet the recipient’s needs, and less costly positioning seats that have been considered and rejected. Document the recipient’s current height and weight, and the weight capacity for the requested seat.

    Noncovered Services

  • • Car seats when used simply to prevent injury to a child as required by law and community practice are not medically necessary
  • • Car seats for recipients who use mobility devices with positioning/support attachments, and whose primary caregiver has a van equipped for wheelchair transportation are a duplication of service
  • • Car seats for children who do not require positioning assistance
  • • Cervical rolls or pillows are not medically necessary
  • • Feeding chairs/high chairs for recipients without significant positioning needs due to a medical condition are not medically necessary
  • • Positioning seats, including feeding chairs/high chairs, for home use for recipients who use mobility devices with positioning/support attachments are a duplication of service
  • • Furniture that is marketed to or useful to the general population, such as recliners, is not medically necessary and is not durable medical equipment
  • • Heat and massage cushion pads/recliners are not medically necessary and are not durable medical equipment
  • • Pillows designed to reduce allergens are not medically necessary and are not durable medical equipment
  • • Vehicle restraint belts or harnesses except where part of a covered positioning seat are a duplication of services
  • Authorization

  • • Authorization is required for purchase of E0190 when the submitted charge is over $400
  • • Authorization is required for repair of, including replacement accessories for, E0190 when the submitted charge is over $400
  • • Authorization is always required for T5001
  • Submit authorization request and required documentation to the authorization medical review agent.

    Billing

  • • Use X12 Batch or MN–ITS Interactive 837P Professional electronic claim. Refer to the MN–ITS User Guide for DME/Med Supply/Prosthetics/Orthotics (PDF) for billing instructions
  • • Bill purchase of all reflux wedges and positioning cushions/pillows/wedges using E0190 and modifier NU unless a more specific code has been assigned by the Medicare Pricing, Data Analysis and Coding contractor (PDAC)
  • • Bill replacement of accessories for a patient owned positioning pillow using E0190 and modifier RB unless a more specific code has been assigned by the PDAC
  • • Bill purchase of all positioning seats for home or vehicle use using T5001 and modifier NU unless a more specific code has been assigned by the PDAC
  • • Positioning equipment that requires an authorization must be billed on a separate claim from equipment/supplies that do not require authorization
  • • The HCPCS code and modifiers must match the authorization
  • • If authorization is not required, the electronic claim must include the manufacturer’s invoice or price list as an attachment as described in the MHCP Claim Attachment Criteria (PDF)
  • Legal References

    MS 256B.0625 subd. 31 Covered Services
    Minnesota Rules 9505.0310

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