Coding Corner: CMS Drops ICD-10 Requirement for Cushions, Backs

Published in Complex Rehab on December 03, 2025

This article was originally written by Liz Beaulieu, Editor of HME News. View original article here.

Complex rehab technology (CRT) stakeholders were pleasantly surprised when CMS recently removed the ICD-10 requirements for skin protection and positioning cushions and backs.

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) removed the requirements from both the wheelchair seating local coverage determination (LCD) and policy article effective Oct. 1.

“It’s a good thing – and I think all would agree it’s a good thing,” said Dan Fedor, director of reimbursement and education for U.S. Rehab, part of VGM & Associates. “Prior to this change, the patient had to have a specific ICD-10 code and then the condition – it was both.”

The DME MACs still require that conditions are documented in the medical record – either in the chart note from the ordering practitioner, or in the wheelchair evaluation from the physical or occupational therapist.

But the change means that CMS is no longer tying a Medicare patient’s ability to get a skin protection and/or positioning cushion and back to a specific diagnosis code, Fedor says.

“There were situations when a patient would have the condition but not the ICD-10, and the MACs would add the ICD-10 to the policy or a medical reviewer would use clinical judgment and approve without a valid ICD-10, which was great, but then the claim would deny as a qualifying ICD-10 wasn't present,” he said.

“That’s been happening over the last year, and this removes that obstacle,” he said. “We all thank the MACs for this policy change, which will allow those that need these items to receive them.”

Despite the change to not require a specific ICD-10, Fedor reminds providers that the coverage criteria remain the same. To qualify for a skin protection cushion, the Medicare patient must still have:

A past history of, or current, pressure ulcer in the area of contact with the seating surface;
Absent or impaired sensation in the area of contact with the seating surface; or
An inability to carry out a functional weight shift.

To qualify for a positioning cushion/back, the Medicare patient must have significant postural asymmetries.

Ultimately, the removal of ICD-10 requirements aligns with emerging assistive technology trends in which healthcare providers can continue to deliver tailored support that meets the individual needs of those requiring these essential complex rehab solutions.

TAGS