Quickie QRi User Manual download pdf (Page 5)

Seating Selection

Basic

E2611

™

E2611, E2612

Care

™

E2615

™

E2613

™

Deep Contour

E2620

Focus Point

™

E2620

™

Posterior

E2613

™

Posterior

(over 22" wide)

E2614

™

Posterior

& Lateral

E2615

™

Posterior

Deep

E2620

JAY

Backs

120695 Rev. B

Customer Service: 800.333.4000

www.SunriseMedical.com

Ultra Lightweight Wheelchair Justification

K0005

• Per Medicare policy, "coverage of an ultra-lightweight wheelchair

(K0005) is determined on an individual consideration basis." The

primary objective is to rule out all lower level equipment.

• Include a list of indoor and outdoor Activities of Daily Living (ADLs)

and document what specific features the wheelchair base has that

are medically needed by the end user.

• Although not required, a seating evaluation conducted by a clinician

experienced in seating & positioning is strongly recommended.

• Documentation "must include a description of the patient's

routine activities. This may include the types of activities the

patient frequently encounters and whether the patient is fully in-

pendent in the use of the wheelchair. Describe the features of

the K0005 base which are needed compared to the K0004 base."

K0009

• Medicare does not have a stated medical policy for the K0009

code, therefore if billed, it must be clinically documented as

to why a lower level wheelchair cannot meet their medical

needs within the home.

Basic

E2601, E2602

™

E2603, E2604

Soft Combi

™

E2605, E2606

JAY

Cushions

Easy

™

E2607, E2608

Ion

™

E2607, E2608

Union

™

E2607, E2608

™

Deep Contour

E2622, E2623,

E2624, E2625

™

E2622, E2623

E2624, E2625

Zip

™

E2607

™

E2622, E2623,

E2624, E2625

Lite

E2603, E2604,

E2607, E2608

To learn more about customizing JAY seating products, visit the JAY Your Way product page on www.sunrisemedical.com.

Fusion

™

E2622, E2623

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Quickie QRi User Manual Page 5

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