For Dates of Service Before January 1, 2018

Adaptive Equipment

Covered adaptive equipment is limited to basic items for independence in self-care tasks. Selected adaptive equipment is covered when the equipment is the following:

• Medically necessary.
• Prescribed by a physician.
• Required for a member's independence in self-care tasks.

As stated in DHS 107.24(2)(c), Wis. Admin. Code, adaptive equipment is the category of DME used in the home to assist a person with a disability to achieve independence in performing daily self-care tasks.

ForwardHealth has assigned modifiers "U1"-"U7," "U9," "UA," "UB," and "UD" to HCPCS procedure code A9900 (Miscellaneous DME supply, accessory, and/or service component of another HCPCS code). The "U" modifiers used with procedure code A9900 identify specific pieces of adaptive equipment.

Noncovered Adaptive Equipment

The following adaptive equipment items are not covered:

• Items determined not to be medically necessary. For example:
  • Duplicative adaptive equipment (more than one item per member or items that serve the same purpose).
  • Items or equipment that may be helpful but do not significantly change the member's level of functional independence.
• Adaptive equipment for homemaking, recreation, or other activities, such as adaptive cutting boards, key holders, page turners, book holders, and doorknob extensions.
• Items that are commercially available, such as pencil grips, elastic shoe laces, jar openers, and flexible mounting hardware to hold appliances, telephones, beverages, etc.