Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

E1220 - E1228  Wheelchair - Other and Accessories

E1220
Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification
shortWhlchr special size/constrc
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1221
Wheelchair with fixed arm, footrests
shortWheelchair spec size w foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1222
Wheelchair with fixed arm, elevating legrests
shortWheelchair spec size w/ leg
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1223
Wheelchair with detachable arms, footrests
shortWheelchair spec size w foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1224
Wheelchair with detachable arms, elevating legrests
shortWheelchair spec size w/ leg
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1225
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each
shortManual semi-reclining back
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1226
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each
shortManual fully reclining back
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH1.02 Date of Service Edit: PolicyNature of Equipment
DME1.02 Date of Service Edit: PolicyNature of Equipment
E1227
Special height arms for wheelchair
shortWheelchair spec sz spec ht a
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME0.03 Date of Service Edit: ClinicalPublished Contractor Policy
E1228
Special back height for wheelchair
shortWheelchair spec sz spec ht b
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.02 Date of Service Edit: PolicyNature of Equipment