Manual Wheelchair Bases

 

Definitions

 

A standard wheelchair (K0001) is characterized by:

 

Weight                               > 36 lbs.

Seat Width             16” (narrow), 18” (adult)

Seat Depth             16”

Seat Height             >19” and <21”

Back Height                       Non-adjustable 16” or 17”

Arm Style               Fixed or detachable

Footplate Extension            16” – 21”

Footrests                Fixed or swingaway detachable

 

A standard hemi (low seat) wheelchair (K0002) is characterized by:

 

Weight                               > 36 lbs.

Seat Width             16” (narrow), 18” (adult)

Seat Depth             16”

Seat Height             17” - 18”

Back Height                       Non-adjustable 16” - 17”

Arm Style               Fixed or detachable

Footplate Extension            14” – 17½”

Footrests                Fixed or swingaway detachable

 

A standard hemi-wheelchair (K0002) is covered when the patient requires a lower seat height (17”to 18”) because of short stature or to enable the IW to place his/her feet on the ground for propulsion.

 

A lightweight wheelchair (K0003) is characterized by:

 

Weight                   < 36 lbs.

Seat Width             16” or 18”

Seat Depth             16”

Seat Height             > 17” - < 21”

Back Height                       Non-adjustable 16” - 17”

Arm Style               Fixed height, detachable

Footplate Extension            16” – 21”

Footrests                Fixed or swingaway detachable

 

A lightweight wheelchair (K0003) is covered when the IW:

·         Cannot self-propel in a standard wheelchair using arms and/or legs; and

·         The IW can and does self-propel in a light weight wheelchair.

 

 

A high strength, lightweight wheelchair (K0004) is characterized by:

 

Lifetime Warranty   On side frames and crossbraces

Weight                               < 34 lbs.

Seat Width             14, 16” or 18”

Seat Depth             14” (child), 16” (adult)

Seat Height             > 17” and < 21”

Back Height                       Sectional or adjustable 15” - 19”

Arm Style               Fixed or detachable

Footplate Extension            16” – 21”

Footrests                Fixed or swing-away detachable

 

      A high strength lightweight wheelchair (K0004) is covered when an IW meets the criteria in (1) and/or (2):

      1)   The IW self-propels the wheelchair while engaging in frequent activities that cannot be performed in a standard or lightweight wheelchair.

      2)  The patient requires a seat width, depth, or height that cannot be accommodated in a standard, lightweight or hemi-wheelchair, and spends at least two hours per day in the wheelchair.

 

An ultra-lightweight wheelchair (K0005) is characterized by:

 

Lifetime Warranty   On side frames and crossbraces

Weight                               < 30 lbs.

Adjustable rear axle position

Seat Width             14, 16” or 18”

Seat Depth             14” (child), 16” (adult)

Seat Height             > 17” and < 21”

Arm Style               Fixed or detachable

Footplate Extension            16” – 21”

Footrests                Fixed or swingaway detachable

 

Coverage of a K0005 lightweight wheelchair is determined on an individual consideration basis and must include a description of the injured worker’s routine activities.  This may include what types of activities the IW  frequently encounters, and whether the IW if fully independent in the use of the wheelchair.

A heavy duty wheelchair (K0006) is characterized by:

 

Seat Width             18”

Seat Depth             16” or 17”

Seat Height             > 19” - < 21”

Back Height                       Non-adjustable 16” - 17”

Arm Style               Fixed height, detachable

Footplate Extension            16” – 21”

Footrests                Fixed or swingaway detachable

Reinforced back and seat upholstery

Can support patient weighing > 250 pounds

 

An extra heavy duty wheelchair (K0007) is characterized by:

 

Seat Width             18”

Seat Depth             16” or 17”

Seat Height             > 19” - < 21”

Back Height                       Non-adjustable 16” - 17”

Arm Style               Fixed height, detachable

Footplate Extension            16” – 21”

Footrests                Fixed or swingaway detachable

Reinforced back and seat upholstery

Can support patient weighing > 300 pounds

 

Wheelchair “poundage” (lbs.) represents the weight of the usual configuration of the wheelchair without front riggings.

 

Adult tilt-in-space wheelchair (E1161)  is characterized by an ability to tilt the frame of the wheelchair greater than or equal to 45 degrees from horizontal while maintaining the same back to seat angle. Includes lifetime warranty and side frames        and cross braces

 

Other manual wheelchair base (K0009)

 

Other manual wheelchairs and accessories include:

·        E1050 Fully-reclining wheelchair, fixed full-length arms, swing away, detachable, elevating leg rests

·        E1060 Fully reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating leg rests

·        E1065  Power attachment (to convert any wheelchair to motorized wheelchair, e.g., solo)

·        E1070 Fully-reclining wheelchair, detachable arms (desk or full-length) swing-away, detachable footrest

·        E1083 Hemi-wheelchair, fixed full-length arms, swing-away, detachable, elevating leg rest

·        E1084 Hemi-wheelchair, detachable arms desk or full-length arms, swing-away, detachable, elevating leg rests

·        E1087  High-strength lightweight wheelchair, fixed full-length arms, swing-away, detachable footrests

·        E1088 High-strength lightweight wheelchair, detachable arms desk or full-length, swing-away detachable arms desk or full-length, swing-away, detachable, elevating leg rests

·        E1092 Wide, heavy-duty wheelchair, detachable arms (desk or full-length, swing-away, detachable, elevating leg rests

·        E1240 Lightweight wheelchair; detachable arms, (desk or full-length) swing away, detachable, elevating leg rest

·        E1270 Lightweight wheelchair, fixed full length arms, swing-away, detachable, elevating legrests

·        E1280 Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests

·        E1295 Heavy duty wheelchair, fixed full-lengthy arms, elevating legrest