Does A9900 require prior authorization?

Yes, A9900 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9900?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9900`, Miscellaneous dme supply, accessory, and/or service component of another hcpcs

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; for DMEPOS base items requiring a Written Order Prior to Delivery (WOPD) the supplier must have a signed SWO/WOPD before delivery.

For DMEPOS base items that require a WOPD and have separately billed options/accessories/supplies, the WOPD must list the base item and may list the associated items prior to delivery.

A comprehensive written evaluation by a licensed/certified physical therapist or occupational therapist is required for custom fabricated cushions and must clearly explain why a prefabricated seating system is insufficient; the PT/OT may have no financial relationship with the supplier.

Prefabricated or brand-name custom cushions require written coding verification from the PDAC contractor and must meet the Coding Guidelines stated in the Policy Article; absence of PDAC verification or nonconformance will result in denial.

Suppliers must follow the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, the Supplier Manual, and relevant DME MAC bulletins for additional documentation and payment rules.

Key Coverage Criteria

A general use seat cushion (E2601, E2602) or general use back cushion (E2611, E2612) is covered only when the beneficiary has a covered manual wheelchair or a covered power wheelchair with a sling/solid seat and back that meets Medicare coverage criteria.
A power wheelchair (with sling/solid seat/back) provided with a general use cushion will be covered instead of a Captain's Chair when the cushion is provided with a covered power wheelchair base that is not available in a Captain's Chair model (K0839,K0840,K0843,K0860,K0861,K0862,K0863,K0864,K0890,K0891).
A power wheelchair (with sling/solid seat/back) provided with a general use cushion will be covered instead of a Captain's Chair when a skin protection and/or positioning seat or back cushion that meets coverage criteria is also provided.
A prefabricated skin protection seat cushion (E2603, E2604, E2622, E2623) is covered when the beneficiary has a covered manual wheelchair or power wheelchair with a sling/solid seat/back and has a current pressure ulcer or past history of a pressure ulcer on the area of contact with the seating surface, or has absent/impaired sensation in the contact area or inability to perform a functional weight shift.
A prefabricated positioning seat cushion (E2605, E2606), positioning back cushion (E2613, E2614, E2615, E2616, E2620, E2621), or positioning accessory (E0953, E0955, E0956, E0957, E0960) is covered when the beneficiary has a covered manual wheelchair or power wheelchair with a sling/solid seat/back and has any significant postural asymmetries.
A combination skin protection and positioning seat cushion (E2607, E2608, E2624, E2625) is covered when the beneficiary meets the coverage criteria for both a skin protection seat cushion and a positioning seat cushion.

8 Active Policies

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33312, Wheelchair Seating

L33791, Walkers

L33792, Wheelchair Options/Accessories

L33797, Oxygen and Oxygen Equipment

AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines

AMBETTER-CP.MP.99, Wheelchair Seating

REGENCE-DME83.07, Interferential Current Stimulation

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A9900, Miscellaneous dme supply, accessory, and/or service component of another hcpcs