Power Wheelchair Reference Guide - Sunrise Medical
Power Wheelchair Reference Guide - Sunrise Medical
Power Wheelchair Reference Guide - Sunrise Medical
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Power</strong> <strong>Wheelchair</strong> <strong>Reference</strong> <strong>Guide</strong><br />
MEDICÅRE– UNLOCK THE MYSTERY<br />
– New Codes<br />
– The LCD - local coverage determination criteria<br />
– ABN - advanced beneficiary notice
Local Coverage Determination Algorithm<br />
To determine the appropriate group and code a patient will qualify for.<br />
(Chart continued on following page)<br />
A) The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility related activities of daily living<br />
(MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home. A mobility limitation is one that:<br />
- Prevents the patient from accomplishing an MRADL entirely, or<br />
- Places the patient at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or<br />
- Prevents the patient from completing an MRADL within a reasonable time frame.<br />
B) The patient’s mobility limitation cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker.<br />
C) The patient does not have sufficient upper extremity function to self-propel an optimally-configured manual wheelchair in the home<br />
to perform MRADLs during a typical day.<br />
- Limitations of strength, endurance, range of motion, or coordination, presence of pain, or deformity or absence of one or both upper extremities<br />
are relevant to the assessment of upper extremity function.<br />
- An optimally-configured manual wheelchair is one with an appropriate wheelbase, device weight, seating options,<br />
and other appropriate non-powered accessories.<br />
D) The patient is able to:<br />
- Safely transfer to and from a POV, and<br />
- Operate the tiller steering system, and<br />
- Maintain postural stability and position while operating the POV in the home.<br />
E) The patient’s mental capabilities (e.g., cognition, judgment) and physical capabilities (e.g., vision) are sufficient for safe mobility using a POV in the home.<br />
F) The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV that is provided.<br />
G) The patient’s weight is less than or equal to the weight capacity of the POV that is provided.<br />
H) Use of a POV will significantly improve the patient’s ability to participate in MRADLs and the patient will use it in the home.<br />
I) The patient has not expressed an unwillingness to use a POV in the home.<br />
Trek<br />
THIS STOPS AT A POV OR SCOOTER.<br />
J) The patient has the mental and physical capabilities to safely operate the power wheelchair that is provided; or<br />
K) If the patient is unable to safely operate the power wheelchair, the patient has a caregiver who is unable to adequately propel an optimally<br />
configured manual wheelchair, but is available, willing, and able to safely operate the power wheelchair that is provided; and<br />
L) The patient’s weight is less than or equal to the weight capacity of the power wheelchair that is provided.<br />
M) The patient’s home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the power wheelchair that is provided.<br />
N) Use of a power wheelchair will significantly improve the patient’s ability to participate in MRADLs and the patient will use it in the home.<br />
For patients with severe cognitive and/or physical impairments, participation in MRADLs may require the assistance of a caregiver.<br />
O) The patient has not expressed an unwillingness to use a power wheelchair in the home.<br />
ADDITIONAL CRITERIA GROUP 2 AND ABOVE SLING SEAT<br />
The patient is using a skin protection and/or positioning seat and/or back cushion that meets the coverage criteria defined in the <strong>Wheelchair</strong> Seating policy.<br />
THIS STOPS AT A GROUP 1 OR 2– NO POWER OPTION.<br />
ADDITIONAL CRITERIA SINGLE POWER OPTION<br />
1. The patient requires a drive control interface other than a hand or chin operated standard proportional joystick<br />
(examples include but are not limited to head control, sip and puff, switch control) OR<br />
2. The patient meets coverage criteria for a power tilt or recline seating system (see <strong>Wheelchair</strong> Options and Accessories policy for coverage criteria)<br />
and the system is being used on the wheelchair AND<br />
3. The patient has had a specialty evaluation that was performed by a licensed/certified medical professional, such as a physical therapist (PT) or occupational<br />
therapist (OT), or physician who has specific training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for<br />
the wheelchair and its special features. The PT, OT, or physician may have no financial relationship with the supplier.<br />
THIS STOPS AT A GROUP 2 OR 3– SINGLE POWER OPTION.<br />
ADDITIONAL CRITERIA MULTIPLE POWER OPTION<br />
1. The patient meets coverage criteria for a power tilt and/or recline seating system with three or more actuators OR<br />
2. The patient uses a ventilator which is mounted on the wheelchair. AND<br />
3. The patient has had a specialty evaluation that was performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific<br />
training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for the wheelchair and its special features. The PT,<br />
OT, or physician may have no financial relationship with the supplier.<br />
STOP 2<br />
STOP 3<br />
Rhapsody<br />
Melody CB<br />
Freestyle-<br />
F11HD<br />
Freestyle-<br />
M11<br />
RhapsodyBB Freestyle /tilt<br />
FreestyleM11<br />
➧<br />
ADDITIONAL CRITERIA TO MOVE UP TO A GROUP 3 DEVICE<br />
The patient’s mobility limitation is due to a neurological condition, myopathy or congenital skeletal deformity.<br />
FreestyleF11<br />
Rhythm<br />
Groove<br />
➧<br />
➧<br />
➧<br />
➧<br />
(Chart continued on following page)<br />
For the most current Local Coverage Determination Algorithm<br />
visit our website: www.sunrisemedical.com
POV’S<br />
(SCOOTERS)<br />
K0800,K0801,K0802<br />
GROUP 1 GROUP 2 GROUP 3<br />
PWC<br />
K0813-K0816<br />
PWC<br />
K0823-K0829<br />
PWC<br />
Sling/Solid Seat<br />
K0820-K0822<br />
PWC<br />
Single <strong>Power</strong><br />
K0835-K0840<br />
PWC<br />
Multi <strong>Power</strong><br />
K0841-K0843<br />
PWC<br />
No <strong>Power</strong> Opt.<br />
K0848-K0855<br />
PWC<br />
Single <strong>Power</strong><br />
K0856-K0860<br />
PWC<br />
Multi <strong>Power</strong><br />
K0861-K0864<br />
YES YES YES YES YES YES YES YES YES<br />
YES YES YES YES YES YES YES YES YES<br />
YES YES YES YES YES YES YES YES YES<br />
YES<br />
NO ON ONE<br />
OF THESE<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
YES<br />
YES<br />
YES NA NA NA NA NA NA NA NA<br />
YES NA NA NA NA NA NA NA NA<br />
YES NA NA NA NA NA NA NA NA<br />
STOP<br />
ONE OF THESE<br />
IS MET<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
NO ON ONE<br />
OF THESE<br />
and<br />
ONE OF THESE<br />
IS MET<br />
and<br />
YES YES YES YES YES YES YES YES<br />
YES YES YES YES YES YES YES YES<br />
YES YES YES YES YES YES YES YES<br />
YES YES YES YES YES YES YES YES<br />
NO NO YES Not Required Not Required Not Required Not Required Not Required<br />
STOP 1 STOP 2 STOP 3<br />
ONE OF THESE<br />
IS MET<br />
and<br />
NA NA ONE OF THESE NA<br />
IS MET<br />
NA NA and<br />
NA<br />
YES NA NA YES NA<br />
STOP<br />
ONE OF THESE<br />
IS MET<br />
and<br />
NA NA ONE OF THESE<br />
IS MET<br />
NA<br />
NA<br />
and<br />
YES NA NA YES<br />
STOP<br />
YES YES YES<br />
STOP STOP STOP
K-Code<br />
Allowable<br />
Product<br />
GROUP 1<br />
K0800<br />
$1292.77<br />
POV<br />
Trek 3<br />
Trek 4<br />
BEST PICK BEST PICK BEST PICK<br />
Quickie<br />
Rhapsody<br />
K0822<br />
$4008.10<br />
Rehab Seat, Std Weight Cap.<br />
Quickie<br />
Freestyle<br />
Quickie<br />
V-121<br />
GROUP 2 - (Continued on next page)<br />
Quickie<br />
V-521<br />
Quickie<br />
Freestyle<br />
K0823<br />
$4023.70<br />
Captains Seat, Std. Weight Cap.<br />
Quickie<br />
Melody<br />
Quickie<br />
Prelude<br />
Quickie<br />
Rhapsody<br />
Model<br />
Drive Wheel<br />
Position<br />
Max. Speed<br />
User Weight<br />
Capacity<br />
Electronics<br />
Trek 3/4 BB M11 BB V-121 V-521 M11 CB Melody CB CB CB<br />
Scooter Mid Mid Rear Rear Mid Rear Mid Mid<br />
4.0 mph 4.0 mph 4.0 mph 4.5 mph 4.5 mph 4.0 mph 4.0 mph 4.0 mph 4.0 mph 4<br />
250 lbs 300 lbs 300 lbs 250 lbs 300 lbs 300 lbs 250 lbs 300 lbs 300 lbs<br />
P&G P&G P&G P&G P&G P&G P&G P&G P&G<br />
Suspension<br />
Turning Radius<br />
Seat Selection<br />
Drive Wheels<br />
Overall<br />
Base Width<br />
Overall Length<br />
Transit Tested<br />
Warranty<br />
Dynamic<br />
Dynamic<br />
N/A<br />
Overland N/A N/A Overland N/A Dynamic SFS<br />
Suspension<br />
Suspension<br />
T3: 32" T4: 44.5" 20" 20.5" 33.5" 33.5" 20.5" 24.5" 21" 20"<br />
Stadium Rehab Rehab Rehab Rehab Captains<br />
Captain's<br />
Lo Back<br />
Captain's<br />
Lo Back/High Back<br />
18-20<br />
Width 16" 16", 18" 16", 18", 20" 14-20 14-20 18", 20", 22" 18" 18" 16", 18", 20"<br />
*1"<br />
Depth<br />
Back Angle<br />
Seat-to-Floor<br />
Height<br />
<strong>Power</strong>ed Seating<br />
Tilt<br />
Recline<br />
Lift<br />
ELR<br />
<strong>Power</strong> Center Mt. ALR<br />
Vent Tray<br />
Batteries<br />
N/A<br />
N/A<br />
16.5"-20.5"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
12V, 12Ah, x 2<br />
16", 18"<br />
15°<br />
16.5"-20.5"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1 or 50Ahr<br />
16", 18", 20"<br />
30°<br />
15.5"-19.5"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1 or 50Ahr<br />
14-18<br />
30°<br />
18.5"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1, Group 22NF<br />
14-18<br />
30°<br />
18.5"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1, Group 22NF<br />
16", 18", 20"<br />
30°<br />
17" - 21"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1 or 50 Ahr<br />
17"<br />
7°<br />
21"-22"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
2 - 12 amp/hr<br />
LoBack: 17"<br />
HighBack: 17"-19"<br />
LoBack: 7°<br />
HighBack: upto 30°<br />
18" & 19.5"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1<br />
16" - 20"<br />
up to 40°<br />
17" - 21"<br />
No <strong>Power</strong> Options<br />
--<br />
--<br />
--<br />
--<br />
--<br />
N/A<br />
U1 or 50Ahr<br />
18"<br />
17.<br />
No Po<br />
Grou<br />
G<br />
7.5" 10" 10" 12" 12" 10" 8" 10" 10"<br />
20" 23.5" 22.5" 19.5" - 25.5" 19.5" - 25.5" 22.5" 22.5" 23.5" 23.5"<br />
38" 38" w/ footplate<br />
38.5" w/footplate 31" - 33" 30" - 34" 38.5" w/footplate<br />
36.5" w/footplate<br />
32"<br />
32" w/out footplate w/o hangers w/o hangers 32" w/out footplate<br />
33" w/out footplate<br />
38" w/footplate<br />
N/A N/A N/A N/A N/A N/A N/A N/A N/A<br />
BRONZE SILVER SILVER SILVER SILVER SILVER SILVER SILVER SILVER<br />
Captains<br />
O<br />
39"<br />
33" w<br />
Key of Quickie Suffixes<br />
1st Letter<br />
2nd Letter<br />
B= Basic Rehab Seat A= Group 1<br />
C= Captain’s Seat B= Group 2<br />
S= Single <strong>Power</strong> Option C= Group 3<br />
MP= Multiple <strong>Power</strong> Option D= Group 4<br />
Examples: CB=Captain’s Seat, Group 2<br />
SC=Single <strong>Power</strong> Option, Group 3<br />
Medicare<br />
Best Picks<br />
Warranty:<br />
For detailed warranty information<br />
visit our website:<br />
www.sunrisemedical.com
K-Code<br />
Allowable<br />
Product<br />
BEST PICK BEST PICK BEST PICK BEST PICK BEST PICK<br />
K0824<br />
$4842.70<br />
Rehab Seat, HD<br />
Quickie<br />
Freestyle<br />
K0825<br />
$4229.60<br />
Captains Seat, HD<br />
Quickie<br />
Freestyle<br />
Quickie<br />
Freestyle<br />
GROUP 2 - Continued<br />
K0835<br />
$4132.30<br />
Rehab Seat, Single <strong>Power</strong> Option<br />
Quickie<br />
Rhapsody<br />
Quickie<br />
P-220<br />
Quickie<br />
S-525<br />
K0841<br />
$4318.60<br />
Multi <strong>Power</strong><br />
Option<br />
Quickie<br />
Freestyle<br />
Coming Soon!<br />
Model F11 BB HD F11 CB HD M11 SB SB P-220 S-525 M11 MPB<br />
Drive<br />
Mid<br />
Wheel<br />
Position<br />
Mid Mid Mid Mid Rear Rear Mid Mid Mid<br />
4.0 Max. mphSpeed<br />
4.0 mph 4.0 mph 4.0 mph 4.0 mph 6.5 mph 4.5 / 6.5 mph 4.0 mph 6.0 mph 5.5 mph<br />
300<br />
User<br />
lbs<br />
Weight<br />
Capacity<br />
400 lbs 400 lbs 300 lbs 300 lbs 300 lbs 300 lbs 300 lbs 300 lbs 165 lbs<br />
P&G Electronics P&G P&G P&G** P&G** P&G** P&G** P&G* P&G**<br />
Suspension Overland Overland Overland<br />
Dynamic<br />
Suspension<br />
Rear Stabilizers N/A Overland Overland Overland<br />
Turning 20" Radius 22.5" 22.5" 20.5" 20" 25" 32" 20.5" 22.5" 20.5"<br />
Seat Captains Selection Rehab Captains Rehab Rehab Rehab Rehab Perfect Fit Rehab Rehab<br />
18-20"*, 22", 24"<br />
12" - 20"<br />
16", 18", Width 20"<br />
22" 16", 18", 20" 16" & 18" 14" - 24" 14" - 20"<br />
*1" increments<br />
in 1" increments<br />
16", 18", 20"<br />
16" - 20" Depth<br />
up Back to 40° Angle<br />
17"<br />
Seat-to-Floor<br />
- 21"<br />
Height<br />
18", 19", 20"<br />
30°<br />
17.5" - 21.5"<br />
20"<br />
30°<br />
19" - 23"<br />
16", 18", 20"<br />
30°<br />
15.5"-19.5"<br />
16" & 18"<br />
15°<br />
16.5"-20.5"<br />
14" - 26"<br />
30°<br />
18"<br />
14" - 20"<br />
30°<br />
18"<br />
12" - 18"<br />
in 1" increments<br />
30°<br />
17.5"-21.5"<br />
16", 18", 20"<br />
30°<br />
17.5"<br />
25°<br />
15.5"-19.5"<br />
ons<br />
Select two or more<br />
No <strong>Power</strong>ed Options Seating No <strong>Power</strong> Options No <strong>Power</strong> Options Choose One Choose One Choose One Choose One<br />
options<br />
No <strong>Power</strong> Options No <strong>Power</strong> Options<br />
-- Tilt -- -- • • • • • -- --<br />
-- Recline -- -- -- -- -- -- • -- --<br />
--<br />
--<br />
Lift<br />
ELR<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
•<br />
--<br />
--<br />
--<br />
--<br />
<strong>Power</strong> Center -- Mt. ALR<br />
N/A Vent Tray<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
N/A<br />
U1 or Batteries 50Ahr<br />
Group 22NF or<br />
Group 22NF or<br />
Group 24 U1 or 50Ahr U1 or 50Ahr<br />
Group 24<br />
Group 24<br />
Group 22NF U1 or 50Ahr U1 or 50Ahr<br />
Drive 10" Wheels<br />
Overall<br />
23.5"<br />
Base Width<br />
14"<br />
24.5"<br />
14"<br />
24.5"<br />
10"<br />
22.5"<br />
10"<br />
23.5"<br />
12"<br />
24.5"<br />
12"<br />
22.25" - 26.25"<br />
10"<br />
22.5"<br />
14"<br />
24.5"<br />
10"<br />
22.5"<br />
39" w/footplate 39" w/footplate 38.5" w/footplate<br />
31.5" 27" w/o footrest 38.5" w/footplate<br />
38" Overall w/footplate Length<br />
38" w/footplate<br />
33" w/out footplate 33" w/out footplate 32" w/out footplate<br />
w/o footplates or ant-tips 32" w/out footplate<br />
Transit N/A Tested<br />
SILVER Warranty<br />
N/A<br />
SILVER<br />
N/A<br />
SILVER<br />
N/A<br />
SILVER<br />
N/A<br />
SILVER<br />
Yes<br />
SILVER<br />
Yes<br />
SILVER<br />
N/A<br />
SILVER<br />
N/A<br />
GOLD<br />
Yes<br />
GOLD
K-Code<br />
Allowable<br />
Product<br />
BEST PICK BEST PICK BEST PICK BEST PICK BEST PICK BEST PICK<br />
Quickie<br />
Freestyle<br />
K0848<br />
$5433.60<br />
Rehab Seat, Std. Weight Cap.<br />
Zippie<br />
Z-Bop<br />
Quickie<br />
Rhythm<br />
GROUP 3 - (Continued on next page)<br />
Quickie<br />
Groove<br />
Quickie<br />
Rhythm<br />
K0850<br />
$6139.90<br />
Rehab Seat, HD<br />
Quickie<br />
Groove<br />
Quickie<br />
Freestyle<br />
K0856<br />
$5672.30<br />
Single <strong>Power</strong> Option<br />
Quickie<br />
Rhythm<br />
Quickie<br />
Groove<br />
Model F11 BC Z-Bop BC BC BC HD BC HD F11 SC SC SC<br />
Drive<br />
Mid<br />
Wheel<br />
Position<br />
Mid Mid Mid Front/Rear Mid Front/Rear Mid Mid Front/Rear<br />
h 4.0 Max. mphSpeed<br />
300<br />
User<br />
lbs<br />
Weight<br />
Capacity<br />
6.0 mph<br />
300 lbs<br />
5.5 mph<br />
165 lbs<br />
Quickie<br />
6.5 mph<br />
300 lbs<br />
Quickie<br />
5.0 mph / 6.5 mph<br />
300 lbs<br />
Quickie<br />
5.0 mph<br />
400 lbs<br />
Quickie<br />
5.0 mph<br />
400 lbs<br />
Quickie<br />
6.0 mph<br />
300 lbs<br />
6.5 mph<br />
300 lbs<br />
Quickie<br />
5.0 mph / 6.5 mph<br />
300 lbs<br />
Quickie<br />
P&G* Electronics P&G** Electronics** Electronics** Electronics** Electronics Electronics P&G** Electronics** Electronics**<br />
<strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi<br />
<strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi<br />
Overland Suspension<br />
Turning 20.5" Radius<br />
Overland<br />
22.5"<br />
Overland<br />
20.5"<br />
6-Form Suspension<br />
21"<br />
2-Form Suspension<br />
28"<br />
6-Form Suspension<br />
21"<br />
2-Form Suspension<br />
28"<br />
Overland<br />
22.5"<br />
6-Form Suspension<br />
21"<br />
2-Form Suspension<br />
28"<br />
6-For<br />
Perfect Seat Selection Fit Rehab Rehab<br />
Rehab & Rehab & Rehab & Rehab &<br />
Rehab & Rehab &<br />
Rehab<br />
Perfect Fit Perfect Fit Perfect Fit Perfect Fit<br />
Perfect Fit Perfect Fit<br />
10" - 18"<br />
Width 16", 18", 20"<br />
in 1" increments<br />
14" - 24" 14" - 24" 14" - 24" 15" - 24" 16", 18", 20" 14" - 24" 14" - 24" 1<br />
Depth 16", 18", 20"<br />
13" - 20"<br />
in 1" increments<br />
12" - 24" 12" - 24" 12" - 24" 12" - 24" 16", 18", 20" 12" - 24" 12" - 24" 1<br />
Back 30° Angle<br />
17.5"-21.5"<br />
Seat-to-Floor<br />
Height<br />
<strong>Power</strong>ed Seating<br />
30°<br />
17.5"<br />
No <strong>Power</strong> Options<br />
25°<br />
15.5"-19.5"<br />
No <strong>Power</strong> Options<br />
30°<br />
16.8"-20.1"<br />
No <strong>Power</strong> Options<br />
30°<br />
17.3"-20.6"<br />
No <strong>Power</strong> Options<br />
30°<br />
16.8"-20.1"<br />
No <strong>Power</strong> Options<br />
30°<br />
17.3"-20.6"<br />
No <strong>Power</strong> Options<br />
30°<br />
19"-23"<br />
Choose One<br />
30°<br />
16.8"-20.1"<br />
Choose One<br />
30°<br />
17.3"-20.6"<br />
Choose One<br />
16<br />
Ch<br />
•<br />
•<br />
--<br />
•<br />
Tilt<br />
Recline<br />
Lift<br />
ELR<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
•<br />
--<br />
--<br />
--<br />
•<br />
•<br />
•<br />
--<br />
•<br />
•<br />
•<br />
--<br />
<strong>Power</strong> Center -- Mt. ALR<br />
N/A Vent Tray<br />
--<br />
N/A<br />
--<br />
N/A<br />
--<br />
•<br />
--<br />
•<br />
--<br />
•<br />
--<br />
•<br />
--<br />
N/A<br />
•<br />
•<br />
•<br />
•<br />
U1 or 50Ahr Batteries<br />
Group 22NF or<br />
Group 24 or Group 24 or Group 24 or Group 24 or Group 24 or Group 24 or Group 24 or<br />
U1 or 50Ahr<br />
Group 24<br />
Group 22 NF Group 22 NF Group 22 NF Group 22 NF Group 22 NF Group 22 NF Group 22 NF<br />
5"<br />
Drive 10" Wheels<br />
Overall<br />
22.5"<br />
Base Width<br />
14"<br />
24.5"<br />
10"<br />
22.5"<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
14"<br />
24.5"<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
39" w/footplate 38.5" w/footplate<br />
39" w/footplate<br />
Overall Length<br />
39" 39" 39" 39"<br />
33" w/out footplate 32" w/out footplate<br />
33" w/out footplate<br />
39" 39"<br />
Transit N/A Tested<br />
SILVER Warranty<br />
N/A<br />
GOLD<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD<br />
N/A<br />
GOLD<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD
GROUP 3 - Continued<br />
GROUP 4 - (Continued on next page)<br />
BEST PICK BEST PICK BEST PICK<br />
K-Code<br />
Allowable<br />
K0858<br />
$7037.60<br />
HD Single <strong>Power</strong> Option<br />
K0861<br />
$5681.40<br />
Multi <strong>Power</strong> Option<br />
K0868***<br />
High Activity, No <strong>Power</strong> Option<br />
Product<br />
Quickie<br />
Rhythm<br />
Quickie<br />
Groove<br />
Quickie<br />
Freestyle<br />
Quickie<br />
Rhythm<br />
Quickie<br />
Groove<br />
Quickie<br />
P-222 SE<br />
Quickie<br />
S-646 / S-646 SE<br />
Quickie<br />
Rhythm<br />
Quickie<br />
Groove<br />
Model SC HD SC HD F11 MPC MPC MPC P-222 SE BD S-646/S-646 SE BD BD BD<br />
Front/Rear<br />
Drive Wheel<br />
Position<br />
Mid Front/Rear Mid Mid Front/Rear Rear Rear Mid Rear<br />
5.0 mph Max. / 6.5 Speed mph<br />
300<br />
User<br />
lbs<br />
Weight<br />
Capacity<br />
5.0 mph<br />
400 lbs<br />
Quickie<br />
5.0 mph<br />
400 lbs<br />
Quickie<br />
6.0 mph<br />
300 lbs<br />
6.5 mph<br />
300 lbs<br />
Quickie<br />
5.0 mph<br />
300 lbs<br />
Quickie<br />
7.0 mph<br />
300 lbs<br />
6.0 mph<br />
300 lbs<br />
8.5 mph<br />
300 lbs<br />
Quickie<br />
8.5 mph<br />
300 lbs<br />
Quickie<br />
8<br />
Electronics Electronics** Electronics** P&G* Electronics* Electronics* P&G** P&G** Electronics** Electronics**<br />
<strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi<br />
<strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi<br />
<strong>Power</strong>ed by Delphi <strong>Power</strong>ed by Delphi<br />
ion 2-Form Suspension<br />
Turning 28" Radius<br />
6-Form Suspension<br />
21"<br />
2-Form Suspension<br />
28"<br />
Overland<br />
22.5"<br />
6-Form Suspension<br />
21"<br />
2-Form Suspension<br />
28"<br />
Rear Stabilizers<br />
25"<br />
Fox-Shocks<br />
34"<br />
6-Form Suspension<br />
21"<br />
2-Form Suspension<br />
28"<br />
6-Form<br />
Seat Selection<br />
Rehab & Rehab &<br />
Rehab &<br />
Perfect Fit Perfect Fit Perfect Fit Rehab Rehab<br />
Perfect Fit Perfect Fit<br />
Perfect Fit<br />
Rehab<br />
12" - 20"<br />
14" - 24" Width 14" - 24" 14" - 24"<br />
in 1" increments<br />
14" - 24" 14" - 24" 14" - 24" 14" - 24" 14" - 24" 14" - 24" 14<br />
12" - 24" Depth 12" - 24" 12" - 24"<br />
12" - 18"<br />
in 1" increments<br />
12" - 24" 12" - 24" 14" - 24" 14" - 22" 12" - 24" 12" - 24" 12<br />
30° Back Angle<br />
17.3"-20.6"<br />
Seat-to-Floor<br />
Height<br />
30°<br />
16.8"-20.1"<br />
30°<br />
17.3"-20.6"<br />
30°<br />
17.5" - 21.5"<br />
30°<br />
17.1"-20.1"<br />
30°<br />
17.6"-20.6"<br />
30°<br />
18"<br />
30°<br />
18"-21"<br />
30°<br />
16.8"-20.1"<br />
30°<br />
17.3"-20.6" 16<br />
Select two or more More than one More than one<br />
<strong>Power</strong>ed Choose One Seating Choose One Choose One<br />
options option option<br />
No <strong>Power</strong> Options No <strong>Power</strong> Options No <strong>Power</strong> Options No <strong>Power</strong> Options Ch<br />
•<br />
•<br />
•<br />
--<br />
Tilt<br />
Recline<br />
Lift<br />
ELR<br />
•<br />
--<br />
--<br />
--<br />
•<br />
--<br />
--<br />
--<br />
•<br />
•<br />
--<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
--<br />
<strong>Power</strong> Center • Mt. ALR<br />
• Vent Tray<br />
--<br />
•<br />
--<br />
•<br />
•<br />
N/A<br />
•<br />
•<br />
•<br />
•<br />
--<br />
N/A<br />
--<br />
•<br />
--<br />
•<br />
--<br />
•<br />
Batteries<br />
Group 24 or Group 24 or Group 24 or Group 24 or Group 24 or<br />
Group 24 or Group 24 or Group 24 or<br />
Group 24<br />
Group 22 NF Group 22 NF Group 22 NF Group 22 NF Group 22 NF<br />
Group 22 NF Group 22 NF Group 22 NF<br />
Drive 14" Wheels<br />
Overall<br />
25.5"<br />
Base Width<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
14"<br />
24.5"<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
12"<br />
24.5"<br />
14"<br />
25.75"<br />
14"<br />
25.5"<br />
14"<br />
25.5"<br />
39" w/footplate<br />
31.5"<br />
Overall 39" Length 39" 39"<br />
39" 39"<br />
33" w/out footplate<br />
w/o footplates<br />
29.5" 39" 39"<br />
Transit Yes Tested<br />
GOLD Warranty<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD<br />
N/A<br />
GOLD<br />
Yes<br />
GOLD<br />
Yes<br />
GOLD<br />
No<br />
PLATINUM<br />
No<br />
PLATINUM<br />
Yes<br />
PLATINUM<br />
Yes<br />
PLATINUM P
K-Code<br />
Allowable<br />
Product<br />
BEST PICK<br />
K0877***<br />
High Activity, Single <strong>Power</strong> Option<br />
Quickie<br />
Rhythm<br />
Quickie<br />
P-222 SE<br />
GROUP 4 - Continued<br />
BEST PICK<br />
Quickie<br />
Rhythm<br />
K0884***<br />
High Activity, Multi <strong>Power</strong> Option<br />
Quickie<br />
S-646 / S-646 SE<br />
Quickie<br />
Groove<br />
GROUP 1<br />
Standard PWC Captains Chair and weight<br />
capacity up to and including 300 lbs<br />
• K0800 Portable PWC<br />
• K0816 non-portable PWC<br />
Model SD P-222 SE SD MPD S-646/S-646 SE MPD MPD<br />
Drive<br />
Rear<br />
Wheel<br />
Position<br />
Mid Rear Mid Rear Rear<br />
8.5 Max. mphSpeed<br />
300<br />
User<br />
lbs<br />
Weight<br />
Capacity<br />
8.5 mph<br />
300 lbs<br />
Quickie<br />
7.0 mph<br />
300 lbs<br />
8.5 mph<br />
300 lbs<br />
Quickie<br />
6.0 mph<br />
300 lbs<br />
8.5 mph<br />
300 lbs<br />
Quickie<br />
Electronics Electronics**<br />
<strong>Power</strong>ed by Delphi<br />
P&G** Electronics*<br />
<strong>Power</strong>ed by Delphi<br />
P&G* Electronics*<br />
<strong>Power</strong>ed by Delphi<br />
ion 2-Form Suspension<br />
Turning 28" Radius<br />
Seat Rehab Selection<br />
6-Form Suspension<br />
21"<br />
Rehab<br />
Rear Stabilizers<br />
25"<br />
Rehab<br />
6-Form Suspension<br />
21"<br />
Rehab<br />
Fox-Shocks<br />
34"<br />
Rehab<br />
2-Form Suspension<br />
28"<br />
Rehab<br />
14" - 24" Width 14" - 24" 14" - 24" 14" - 24" 14" - 24" 14" - 24"<br />
12" - 24" Depth 12" - 24" 14" - 24" 12" - 24" 14" - 22" 12" - 24"<br />
Back 30° Angle<br />
17.3"-20.6"<br />
Seat-to-Floor<br />
Height<br />
30°<br />
16.8"-20.1"<br />
30°<br />
18"-20"<br />
30°<br />
17.1"-20.1"<br />
30°<br />
18"-21"<br />
30°<br />
17.6"-20.6"<br />
ns<br />
More than one More than one More than one<br />
No <strong>Power</strong>ed Options Seating Choose One Choose One<br />
option option option<br />
-- Tilt • • • • •<br />
-- Recline • -- • • •<br />
--<br />
--<br />
Lift<br />
ELR<br />
•<br />
--<br />
--<br />
--<br />
•<br />
•<br />
--<br />
•<br />
•<br />
•<br />
<strong>Power</strong> Center -- Mt. ALR<br />
• Vent Tray<br />
•<br />
•<br />
--<br />
N/A<br />
•<br />
•<br />
•<br />
•<br />
•<br />
•<br />
Batteries<br />
Group 24 or Group 24 or Group 24 or Group 24 or Group 24 or<br />
Group 22 NF Group 22 NF Group 22 NF Group 22 NF Group 22 NF<br />
Drive 14" Wheels<br />
Overall<br />
25.5"<br />
Base Width<br />
14"<br />
25.5"<br />
12"<br />
24.5"<br />
14"<br />
25.5"<br />
14"<br />
25.75"<br />
14"<br />
25.5"<br />
31.5"<br />
Overall 39" Length 39"<br />
w/o footplates<br />
39" 29.5" 39"<br />
Transit Yes Tested<br />
PLATINUM Warranty<br />
Yes<br />
PLATINUM<br />
No<br />
PLATINUM<br />
Yes<br />
PLATINUM<br />
No<br />
PLATINUM<br />
Yes<br />
PLATINUM<br />
GROUP 2<br />
Standard PWC with weight capacity up to and<br />
including 300 lbs<br />
• K0822 Rehab Seat<br />
• K0823 Captains Seat<br />
• K0824 Rehab Seat, HD<br />
• K0825 Captains Seat, HD<br />
• K0835 Rehab Seat, Single <strong>Power</strong> Option<br />
• K0841 Multiple <strong>Power</strong> Option<br />
GROUP 3<br />
Standard PWC with weight capacity up to and<br />
including 300 lbs<br />
• K0848 Rehab Seat<br />
• K0850 Rehab Seat, HD<br />
• K0856 Single <strong>Power</strong> Option<br />
• K0858 Single <strong>Power</strong> Option, HD<br />
• K0861 Multiple <strong>Power</strong> Option<br />
GROUP 4<br />
High Activity<br />
• K0868 No <strong>Power</strong> Option<br />
• K0877 Single <strong>Power</strong> Option<br />
• K0884 Multiple <strong>Power</strong> Option<br />
*Ships standard with expandable electronics.<br />
* *Expandable electronics available as an option.<br />
***No allowable assigned.
Driving Controls and Electronic Components<br />
Non Expandable<br />
Electronics<br />
Can the consumer manage a<br />
standard proportional joystick?<br />
Does consumer need to operate 1 power<br />
actuator (tilt or recline) thru the joystick?<br />
Does consumer sometimes require driving assistance<br />
in small spaces (van entry/bed transfers) or management<br />
of power seat functions in time of medical<br />
emergency (hypotension, autonomic dysreflexia)?<br />
Joystick (no additional billable code)<br />
• Needs 0 or 1 power seat function<br />
• Seat function (tilt) doesn’t have to be operated using joystick<br />
• No need for upgrade to specialty controls<br />
E2310<br />
• Thru drive power seat function<br />
• E2310 – Operation of one seat function<br />
thru input device<br />
Attendant control<br />
E2331 – Attendant control<br />
Does consumer need to operate 2 actuators<br />
(tilt and recline) thru the joystick?<br />
E2311<br />
• Thru drive power seat functions<br />
• E2311 – Operation of > 2 seat functions thru input device<br />
• E2377 – Expandable electronics<br />
Is consumer able to manage standard joystick but requires<br />
multiple drive profiles with individualized programming for<br />
safe driving in customarily encountered environments such<br />
as van entry, home environments, community mobility?<br />
E2377<br />
• Joystick control<br />
• E2377 – Expandable electronics<br />
Expandable Electronics<br />
Is consumer unable to manage standard joystick but<br />
can manage a mini, compact or short throw joystick<br />
or other specialty control device?<br />
Mechanical Switches<br />
E2377 – Expandable electronics<br />
E2322 – Mechanical switches<br />
E2310 – Thru input device control of 1 power seat function or<br />
E2311 – Thru input device control of > 2 power seat functions<br />
Non Proportional Head Array<br />
E2377 – Expandable electronics<br />
E2329 – Non proportional head array<br />
E2310 – Thru input device control of 1 power seat function or<br />
E2311 – Thru input device control of > 2 power seat functions<br />
Does consumer sometimes require driving assistance in<br />
small spaces (van entry/bed transfers) or management of<br />
power seat functions in time of medical emergency<br />
(hypotension, autonomic dysreflexia)?<br />
Mini/compact joystick<br />
E2377 – Expandable electronics<br />
E2373 – Mini proportional joystick<br />
E2310 / E2311 – Thru input device control of<br />
1 or > 2 power seat functions<br />
Sip and Puff Interface<br />
E2377 – Expandable electronics<br />
E2325 – Sip and puff interface<br />
E2326 – Breath tube kit<br />
E2310 – Thru input device control of 1 power seat function or<br />
E2311 – Thru input device control of > 2 power seat functions<br />
Proportional Head Array<br />
E2377 – Expandable electronics<br />
E2328 – Proportional head array<br />
E2310 – Thru input device control of 1 power seat function or<br />
E2311 – Thru input device control of > 2 power seat functions<br />
Attendant control<br />
E2377 – Expandable electronics<br />
E2331 – Attendant control<br />
© 2006 <strong>Sunrise</strong> <strong>Medical</strong> Inc. <strong>Sunrise</strong> <strong>Medical</strong>, Quickie and Nothing Beats A Quickie are registered trademarks of <strong>Sunrise</strong> <strong>Medical</strong>.<br />
102277 Rev. D
Change language