July 15, 2004
Mitchell Yaffy
SOS Rehabilitation
St. Laurent, Quebec
H4T-1N3
Pro-Custom (Model SC3022) manufactured by SOS Rehabilitation
Products, Inc.
The SADMERC and the four Durable Medical Equipment Regional Carriers
(DMERCs) have completed the HCPCS Coding Verification Re-Review on July
6, 2004 for the above listed product(s) manufactured by SOS Rehabilitation
Products, Inc. This review resulted in a consensus coding decision.
It is our determination that the Pro-Max Cushion meets the characteristics
and description of the HCPCS code(s) as defined in the DMERC Medical
Policy for Wheelchair Seating. Therefore, the correct Medicare billing
code(s) for the product(s) is/are:
Effective July 1, 2004 use HCPCS code E2607 Skin protection
and positioning wheelchair seat cushion, width less than 22 inches, any
depth, for Model SC3024
This HCPCS coding decision applies to the submitted product(s) as presented
to and reviewed by the SADMERC and four DMERCs. Any modifications to
this product could change the HCPCS code and would need to be reviewed
for coding verification. The assignment of a HCPCS code to this product
should in no way be construed as an approval or endorsement of this product
by SADMERC or Medicare, nor does it imply or guarantee claim reimbursement
or coverage. For questions regarding claim coverage or reimbursement
please contact your regional DMERC.
Should you disagree with this coding decision, a re-review of the product(s) can be initiated. The SADMERC will provide a re-review if the request in made within 45 days of the date of this letter and additional documentation is provided supporting the request. If a request for a re-review is made after 45 days, the request is treated as a new Coding Verification Review and a complete application must be submitted along with the additional documentation supporting the request.
Palmetto GBA
Statistical Analysis Durable Medical Equipment Regional Carrier
Post Office Box 100143. Columbia. South Carolina. 29202-3143
A CMS Contracted Intermediary and Carrier
