Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

E0950 - E1030  Wheelchair Accessories

E0950
Wheelchair accessory, tray, each
shortTray
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
E0951
Heel loop/holder, any type, with or without ankle strap, each
shortLoop heel
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E0952
Toe loop/holder, any type, each
shortToe loop/holder, each
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyNature of Equipment
E0953
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each
shortW/c lateral thigh/knee sup
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME4.03 Date of Service Edit: ClinicalNature of Equipment
E0954
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot
shortFoot box, any type each foot
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E0955
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each
shortCushioned headrest
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
E0956
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each
shortW/c lateral trunk/hip suppor
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME4.03 Date of Service Edit: ClinicalNature of Equipment
E0957
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each
shortW/c medial thigh support
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.03 Date of Service Edit: ClinicalAnatomic Consideration
E0958
Manual wheelchair accessory, one-arm drive attachment, each
shortWhlchr att- conv 1 arm drive
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.03 Date of Service Edit: ClinicalNature of Equipment
E0959
Manual wheelchair accessory, adapter for amputee, each
shortAmputee adapter
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyNature of Equipment
DME2.02 Date of Service Edit: PolicyNature of Equipment
E0960
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware
shortW/c shoulder harness/straps
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyNature of Equipment
E0961
Manual wheelchair accessory, wheel lock brake extension (handle), each
shortWheelchair brake extension
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyNature of Equipment
DME2.02 Date of Service Edit: PolicyNature of Equipment
E0966
Manual wheelchair accessory, headrest extension, each
shortWheelchair head rest extensi
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
E0967
Manual wheelchair accessory, hand rim with projections, any type, replacement only, each
shortMan wc rim/projection rep ea
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E0968
Commode seat, wheelchair
shortWheelchair commode seat
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
E0969
Narrowing device, wheelchair
shortWheelchair narrowing device
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
E0970
No. 2 footplates, except for elevating leg rest
shortWheelchair no. 2 footplates
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E0971
Manual wheelchair accessory, anti-tipping device, each
shortWheelchair anti-tipping devi
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalNature of Equipment
DME2.03 Date of Service Edit: ClinicalNature of Equipment
E0973
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each
shortW/ch access det adj armrest
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyNature of Equipment
DME2.02 Date of Service Edit: PolicyNature of Equipment
E0974
Manual wheelchair accessory, anti-rollback device, each
shortW/ch access anti-rollback
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyNature of Equipment
DME2.02 Date of Service Edit: PolicyNature of Equipment
E0978
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each
shortW/c acc,saf belt pelv strap
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH1.03 Date of Service Edit: ClinicalNature of Equipment
DME1.03 Date of Service Edit: ClinicalNature of Equipment
E0980
Safety vest, wheelchair
shortWheelchair safety vest
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
E0981
Wheelchair accessory, seat upholstery, replacement only, each
shortSeat upholstery, replacement
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
E0982
Wheelchair accessory, back upholstery, replacement only, each
shortBack upholstery, replacement
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
E0983
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control
shortAdd pwr joystick
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: ClinicalCMS Policy
E0984
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control
shortAdd pwr tiller
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: ClinicalCMS Policy
E0985
Wheelchair accessory, seat lift mechanism
shortW/c seat lift mechanism
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
E0986
Manual wheelchair accessory, push-rim activated power assist system
shortMan w/c push-rim powr system
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
E0988
Manual wheelchair accessory, lever-activated, wheel drive, pair
shortLever-activated wheel drive
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
E0990
Wheelchair accessory, elevating leg rest, complete assembly, each
shortWheelchair elevating leg res
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E0992
Manual wheelchair accessory, solid seat insert
shortWheelchair solid seat insert
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
E0994
Arm rest, each
shortWheelchair arm rest
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E0995
Wheelchair accessory, calf rest/pad, replacement only, each
shortWc calf rest, pad replacemnt
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
E1002
Wheelchair accessory, power seating system, tilt only
shortPwr seat tilt
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
E1003
Wheelchair accessory, power seating system, recline only, without shear reduction
shortPwr seat recline
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
E1004
Wheelchair accessory, power seating system, recline only, with mechanical shear reduction
shortPwr seat recline mech
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
E1005
Wheelchair accessory, power seatng system, recline only, with power shear reduction
shortPwr seat recline pwr
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
E1006
Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction
shortPwr seat combo w/o shear
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
E1007
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction
shortPwr seat combo w/shear
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
E1008
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction
shortPwr seat combo pwr shear
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
E1009
Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each
shortAdd mech leg elevation
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyClinical: Data
E1010
Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair
shortAdd pwr leg elevation
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: PolicyCode Descriptor / CPT Instruction
E1011
Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)
shortPed wc modify width adjustm
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
E1012
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each
shortCtr mount pwr elev leg rest
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME1.03 Date of Service Edit: ClinicalNature of Equipment
E1014
Reclining back, addition to pediatric size wheelchair
shortReclining back add ped w/c
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
E1015
Shock absorber for manual wheelchair, each
shortShock absorber for man w/c
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.03 Date of Service Edit: ClinicalNature of Equipment
E1016
Shock absorber for power wheelchair, each
shortShock absorber for power w/c
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.03 Date of Service Edit: ClinicalNature of Equipment
E1017
Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each
shortHd shck absrbr for hd man wc
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.03 Date of Service Edit: ClinicalNature of Equipment
E1018
Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each
shortHd shck absrber for hd powwc
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.03 Date of Service Edit: ClinicalNature of Equipment
E1020
Residual limb support system for wheelchair, any type
shortResidual limb support system
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME2.02 Date of Service Edit: PolicyNature of Equipment
E1028
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory
shortW/c manual swingaway
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH0.03 Date of Service Edit: ClinicalCMS Policy
DME6.03 Date of Service Edit: ClinicalClinical: Data
E1029
Wheelchair accessory, ventilator tray, fixed
shortW/c vent tray fixed
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
E1030
Wheelchair accessory, ventilator tray, gimbaled
shortW/c vent tray gimbaled
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