From outside the Durable Medical Equipment Industry, there is little understanding on how many different categories of wheelchairs exist.
Wheelchair technology has come a long way, and the fit of a wheelchair is much more important than the brand or weight of the equipment.This article is to help understand the differences between them.
Wheelchairs by definition are a wheeled mobility device that assists or replaces mobility for individuals with a ambulatory deficit. Medicare, the largest funder of medical equipment, has a department called SADMERC that reviews all Durable Medical Equipment and codes it within their utilization system.
Insurance coverage criteria for wheelchairs require that the Individual must have limitation that impairs ability to participate in MRADL’s (Mobility Related Activities of Daily Living), or within reasonable time frame or affect safety. The wheelchair must be used with in the home. The mobility deficit cannot be resolved using a cane or walker.The individual is capable and willing to consistently use this technology or has caregiver willing to assist.
For the purposes of this article, there are Eight (8) categories of Manual Wheelchairs;
K0001- StandardManual Wheelchair
A Standard Manual Wheelchair is available for anyone who has a ambulatory limitation where they need a wheelchair for some distance, to extend mobility and safety.These chairs are configured with larger rear wheels and handrims forself propulsion, have smaller casters, and may be configured with fixed or removable armrests, and fixed or removable footrests/legrests. The seating on these chairs are sling upholstery allowing the chairs to be folded for transportation.
These chairs are >40 pounds in weight, have limited seating options, and are offered in 16” or 18” in width and 16” in depth.
The appropriate individual for this equipment; sits with good postural control, has minimal or no postural deformities, sits in standard sized chairs without compromise, has no discomfort/sitting pain with prolonged sitting, can functionally propel the weight of the standard wheelchair to complete all required daily activities, and uses this chair for short time periods for short distances.
PROS/CONS- these chairs are typically inexpensive / these chairs offer little options, and typically do not fit the individual properly. The rear propelling wheels are set to the backof the chair to reduce potential for chair tipping backwards, which makes independent propulsion more difficult.
K0002- Hemi StandardWheelchair
A Hemi Chair, is a chair that is designed for an individual with a hemisphere impairment that notonly affects ambulation.Individuals who have suffered a CVA/Stroke or other medical complication causing the reduced orlack function of one side of the body, would benefit from this type of wheelchair. Hemi Chairs are lower to the ground allowing easier transfers in/out of the chair, but also allows the user to use one arm to push thewheel(s) and one leg to foot propel on the ground.
These chairs follow the same guidelines of the K0001-Standard Wheelchair. These chairs are >40 pounds in weight, have limited seating options, and are offered in16” or 18” in width and 16” in depth.
These chairs are designed for individuals who meet the K0001 Criteria, and also require a lower seat height (17-18”) due to the shortstature or to enable the patient to place feet on the ground for propulsion.
PROS/CONS- these chairs are typically inexpensive / these chairs offer little options, and typically do not fit the individual properly. Posture can be a concern with these chairs, when a foot propeller is pulling with their feet, many times they are sliding forward. Any wheelchair user utilizing this type of chair, should consider a more custom configured chair ifthey are sitting in the chair most or all of the day. The rear propelling wheels are set to the back of the chair to reduce potential for chair tipping backwards, which makes independent propulsion more difficult.
K0003- Light Weight Wheelchair
Light Weight Chairs are lighter than the K0001/K0002 chair types, weighing less than 40 pounds, and are offered in more
dimensional sizes, with optionaldifferent wheel sizes.These chairs have better quality frame and bearing options making them more durable and easier to propel.These chairs are designed for the individual independently propelling these chairs for their primary mobility.These chairs are folding for transportation and have sling upholstery to sit on.
Light Weight Wheelchairs come in 16” wide or 18” and 16” or 18” in seat depth.They have more adjustable options that the previous category of wheelchair frames.
The appropriate user of this equipment is one that sits in standard size chair without compromise, who has good postural control, who has minimal or no postural deformities, who has no sitting pain/discomfort forprolonged sitting times, who has mild activity level, who can propel primarilyon flat, level surfaces indoors, who lacks the physical ability to propel the weight of a standard chair but demonstrates the ability to propel the lightweight wheelchair. Uses the wheelchair part of the time.
The Justification of moving into a K0003- Light Weight Wheelchair is decreased upper extremity muscle strength, poor endurance, functionally limiting fatigue due to disability, de-conditioning, age or other impairment. Impaired coordination, increased or decreased tone, functionally limiting pain from joint dysfunction, cardiac and or pulmonary compromise.
PROS/CONS- these chairs, being lighter are easier to propel,and easier to transport into a vehicle.These chairs still offer limited options and have the rear wheels positioned for stability and safety not effective reach on the push wheels.
The K0004 is the next progression of wheelchairs and wheelchair technology.These chairs offer more options, and configurations making them a much better fit, andoption for users who are physically using the wheelchair for self propulsion.
Anyone who is non-ambulatory and using their wheelchair most/all day should be using the minimum of a K0004 wheelchair frame. Under the guidance of an expert, these chairs have the ability to be minimally configured to improve access and ability to self propel, as well as configured to improve sitting stability and posture.
These frames are offered in more seat widths/depths, and seat heights. For shorter users, or those using their feet for self propulsion, these frames can be configured down to 13” off the ground (ultra hemi). These frames have small amount of fixed tilt adjustability, which makes it easier to sit upright against gravity, with reduces postural slumping posture, and are more comfortable. Many of these have an option that allows the back to be adjustable which can accommodate for postural deviations or sittinglimitations, as well as improve posture for better feeding, and communication.
The coverage criteria for these chairs are that the individual meets the criteria for any manual wheelchair, that the user self-propels the wheelchair while engaging in frequent activites in the home that cannot be performed in a standard or light weight wheelchair and/or requires a seat width, depth or height that cannot be accommodated in astandard, light weight or hemi wheelchair. This user spends a minimum of 2 hoursper day in the wheelchair.
PROS/CONS- these chairs are more adjustable than the standard wheelchairs making them a better option / these chairs are more expensive and still do not offer the rear wheels to be moved forward for increased access,and reduced strain on the shoulder.
Ultra Lightweight Wheelchairs are chair that are custom configurable to fit the wheelchair user, who is not ambulatory, and who requires this chair to support the
ability to get out of bed, and perform activities of living.These chairs require a seating/mobility specialist to ensure the chair is properly and optimally fit to the wheelchair user.
These chairs are typically under 30 pounds in weight, have a partially or fully adjustable axle plate (allowing rear wheel adjustability), has multiple seat and back sizes,is offered with adjustable back angle, squeeze frame, suspension, footrest, armrest, rear wheel, caster and tire options; and other options not available on K0001-K0004 frames.
These chairs have many benefits to the wheelchair userincluding;
- Less Rolling Resistance
- Fewer Strokes of Pushing the Wheels to get from A to B
- Less Force per stroke
- Less Stress / Strain to the Upper Extremities
- Less risk of repetitive strain injury from long term propulsion of a wheelchair
- Decreased Fatigue
- Improved Maneuverability
- Increased Independence
- More Seating Sizes
- Improved Posture/Support/Stability
- Improved Function
- Improved Sitting Tollerance/Comfort
- Horizontal Rear Wheel Adjustments
- Improve Access to Handrim to push the wheelchair
- Better/More Efficient stroke pushing the wheel
- Vertical Rear Wheel Adjustment
- Provide multiple degrees of fixed tilt for posture and balance
- Camber Option
- Increased wheel access, efficiency of propulsionand Turning
- Reduces Wheel Surface area to ground, making iteasier to propel
- Suspension Option
- Reduce Shock and Vibration
- Decrease Back and Overall Pain/Fatigue
- Reduce Spasticity
- Back Angle Adjustability
- Closed seat to back angle (“Sqeeze”) to secure pelvis, encourage upright posture, reduce spasticity.
- Open Back Angle to accommodate postural imitation
- Tighter Frame/ Hanger Angles
- -Shorter overall length for accessibility and manverability
- For wheelchair users to accommodate tighter knee angles
Coverage Criteria for this equipment includes ruling out K0001-K0004 chairs for functional use within the home, however for these K0005 chairs use outside the home is considered as these chairs are designed for moreactive users. Medical documentation (F2F) that supports physical limitations, functional limitations, and a list ofrelevant daily activities of living would be required.Since these chairs are more complicated, a clinician may be required to document and explain why the specific features ofa K0005 are needed to overcome these limitations.
PROS/CONS- these chairs are very adjustability, and custom fit to the user improving mobility, function and access/ these chairs are much more expensive and take more involvement to justify them to insurance.
K0009- Custom Configured (not already specified) Wheelchair
Custom Configured Wheelchair (K0009) was a code used to explain equipment that was not already categorized under the other wheelchair codes.In 2013, Medicare re-classified many chairs that did not fit within the other wheelchair categories, and where the K0009 is no longer a functional code to provide technology. Much of these advanced technology is now aprivate pay upgrade to the patient.
Companion or Transport Wheelchairs are very light weight, portable,and typically are void from
having a larger push wheel in the rear. These chairs are designed for a companion to push the wheelchair user.The coverage criteriafor these chairs are the same for any basic wheelchair (see above under K0001).
The appropriate userfor this type of wheelchair, is someone who is still ambulatory and how needs this equipment for distances.
PROS/CONS- these chairs are very light weight, and compact making them a great option for travel / these chairs offer very few options,and offer poor seating options.
E1161-Tilt in Space Wheelchair
Tilt in Space Wheelchairs use gravity’s assistance to help with postural limitations, and to provide a way to change posture and pressure to avoid skin breakdown.These chairs are very
configurable as they are typically used by individuals who are no longer ambulatory, and who are unable to self propel in any type of wheelchair.
The coverage criteria for this equipment includes the inability to ambulate, the inability to perform a pressure shift, postural deviations/deformity that affect the wheelchair user’s ability to sit upright.These chairs require a Face toFace visit, Specialty Evaluation from a clinician, and a Seating/MobilitySpecialist to ensure the wheelchair and seating is optimally configured to the wheelchair user.
PROS/CONS- these chairs offer assistance to wheelchair users who have poor posture, or the history/concern for skin breakdown / these chairs heavy, and are more difficult to propel and transport.
This article was provided for reference on the complexity of wheelchairs, and to help guide you through the differences. A Wheelchair is not just a wheelchair, and there are many considerations that need to occur to ensure that the Equipment User is properly fit, properly supported, has increased mobility, and had reduced complications as a result of using this technology.To learn more, or to speak to a Seating and Mobility Expert, contact Active Mobility Center at (954) 946-5793 or at firstname.lastname@example.org.