Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA05.026a


Attachment:A

Policy #:MA05.026a

Description:HCPCS Codes for Manual Wheelchairs

Title:Manual Wheelchairs


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.



TO REPORT MANUAL WHEELCHAIRS, USE THE FOLLOWING CODES

E1031 Rollabout chair, any and all types with castors 5 in or greater

E1037 Transport chair, pediatric size

E1038 Transport chair, adult size, patient weight capacity up to and including 300 pounds

E1039 Transport chair, adult size, heavy-duty, patient weight capacity greater than 300 pounds

E1050 Fully-reclining wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1060 Fully-reclining wheelchair, detachable arms, desk or full-length, swing-away detachable elevating legrests

E1070 Fully-reclining wheelchair, detachable arms (desk or full-length) swing-away detachable footrest

E1083 Hemi-wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests

E1084 Hemi-wheelchair, detachable arms, desk or full-length arms, swing-away detachable elevating legrests

E1085 Hemi-wheelchair, fixed full-length arms, swing-away detachable footrests

E1086 Hemi-wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1087 High strength lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1088 High strength lightweight wheelchair, detachable arms desk or full-length, swing-away detachable elevating legrests

E1089 High-strength lightweight wheelchair, fixed-length arms, swing-away detachable footrest

E1090 High-strength lightweight wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1092 Wide heavy-duty wheel chair, detachable arms (desk or full-length), swing-away detachable elevating legrests

E1093 Wide heavy-duty wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1100 Semi-reclining wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1110 Semi-reclining wheelchair, detachable arms (desk or full-length) elevating legrest

E1130 Standard wheelchair, fixed full-length arms, fixed or swing-away detachable footrests

E1140 Wheelchair, detachable arms, desk or full-length, swing-away detachable footrests

E1150 Wheelchair, detachable arms, desk or full-length swing-away detachable elevating legrests

E1160 Wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1161 Manual adult size wheelchair, includes tilt in space

E1170 Amputee wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1171 Amputee wheelchair, fixed full-length arms, without footrests or legrest

E1172 Amputee wheelchair, detachable arms (desk or full-length) without footrests or legrest

E1180 Amputee wheelchair, detachable arms (desk or full-length) swing-away detachable footrests

E1190 Amputee wheelchair, detachable arms (desk or full-length) swing-away detachable elevating legrests

E1195 Heavy-duty wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1200 Amputee wheelchair, fixed full-length arms, swing-away detachable footrest

E1220 Wheelchair, specially sized or constructed (indicate brand name, model number, if any, and justification)

E1221 Wheelchair with fixed arm, footrests

E1222 Wheelchair with fixed arm, elevating legrests

E1223 Wheelchair with detachable arms, footrests

E1224 Wheelchair with detachable arms, elevating legrests

E1229 Wheelchair, pediatric size, not otherwise specified

E1231 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system

E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system

E1233 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system

E1234 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system

E1235 Wheelchair, pediatric size, rigid, adjustable, with seating system

E1236 Wheelchair, pediatric size, folding, adjustable, with seating system

E1237 Wheelchair, pediatric size, rigid, adjustable, without seating system

E1238 Wheelchair, pediatric size, folding, adjustable, without seating system

E1240 Lightweight wheelchair, detachable arms, (desk or full-length) swing-away detachable, elevating legrest

E1250 Lightweight wheelchair, fixed full-length arms, swing-away detachable footrest

E1260 Lightweight wheelchair, detachable arms (desk or full-length) swing-away detachable footrest

E1270 Lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests

E1280 Heavy-duty wheelchair, detachable arms (desk or full-length) elevating legrests

E1285 Heavy-duty wheelchair, fixed full-length arms, swing-away detachable footrest

E1290 Heavy-duty wheelchair, detachable arms (desk or full-length) swing-away detachable footrest

E1295 Heavy-duty wheelchair, fixed full-length arms, elevating legrest

K0001 Standard wheelchair

K0002 Standard hemi (low seat) wheelchair

K0003 Lightweight wheelchair

K0004 High strength, lightweight wheelchair

K0005 Ultralightweight wheelchair

K0006 Heavy-duty wheelchair

K0007 Extra heavy-duty wheelchair

K0008 Custom manual wheelchair Base

K0009 Other manual wheelchair/base

Version Effective Date: 12/27/2017
Version Issued Date: 12/27/2017
Version Reissued Date: 06/05/2019

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