23 Miss. Code. R. 209-1.46

Current through October 31, 2024

Rule 23-209-1.46 - Wedge Seat Insert, Custom

A. Medicaid defines a custom wedge seat insert as an item that is made of various materials and is inserted into a seating system. It is used either for positioning or pressure reduction and has been uniquely constructed or substantially modified for a specific beneficiary.

B. Medicaid covers custom wedge seat inserts for all beneficiaries with prior authorization for purchase only, when ordered by pediatrician, orthopedist, neurosurgeon, neurologist, or a physiatrist, a physician specializing in physical rehabilitation, and has a stable seating device or a mobility device such as a buggy/stroller, stable seating device, or wheelchair to allow use of the item and is needed to:

1. Decrease posterior pelvic tilt, or

2. Assist with proper positioning for stable seating.

C. Medicaid requires that the assessment or evaluation must be performed by a physical therapist or occupational therapist not employed by the DME supplier or manufacturer.

D. If the beneficiary has an existing wheelchair custom seating system or a custom wheelchair seat that provides similar benefits, Medicaid does not cover this.

23 Miss. Code. R. 209-1.46

Miss. Code Ann. § 43-13-121; 43-13-117(17); Social Security Act § 1834