How To Use HCPCS Code E0995

HCPCS code E0995 describes a wheelchair accessory known as a calf rest/pad. This code is used specifically for replacement purposes, indicating that it is used when the existing calf rest or pad on a wheelchair needs to be replaced. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for the services provided.

1. What is HCPCS E0995?

HCPCS code E0995 is used to identify a wheelchair accessory, specifically a calf rest/pad, that requires replacement. This code is used when the existing calf rest or pad on a wheelchair is damaged, worn out, or no longer functional, and needs to be replaced with a new one. It is important to note that this code is only applicable for replacement purposes and should not be used for initial installation or addition of a calf rest/pad to a wheelchair.

2. Official Description

The official description of HCPCS code E0995 is “Wheelchair accessory, calf rest/pad, replacement only, each.” This description clearly indicates that this code is used specifically for replacement purposes of the calf rest or pad on a wheelchair. The short description for this code is “Enteral supp not otherwise c,” which provides a brief summary of the code’s purpose.

3. Procedure

1. To replace the calf rest/pad on a wheelchair, the healthcare provider or authorized personnel should first assess the condition of the existing calf rest/pad to determine if replacement is necessary.
2. If replacement is deemed necessary, the provider should remove the old calf rest/pad from the wheelchair by following the manufacturer’s instructions or guidelines.
3. Next, the provider should select a suitable replacement calf rest/pad that is compatible with the specific wheelchair model.
4. The replacement calf rest/pad should be securely attached to the wheelchair according to the manufacturer’s instructions, ensuring proper alignment and functionality.
5. Finally, the provider should test the newly replaced calf rest/pad to ensure that it is functioning correctly and providing the necessary support and comfort to the wheelchair user.

4. When to use HCPCS code E0995

HCPCS code E0995 should be used when the existing calf rest or pad on a wheelchair needs to be replaced. This code is not applicable for initial installation or addition of a calf rest/pad to a wheelchair. It is important to accurately document the need for replacement and ensure that the replacement is medically necessary.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E0995, healthcare providers should ensure that the replacement of the calf rest/pad is properly documented in the patient’s medical record. The documentation should include the reason for replacement, such as damage or wear, as well as any relevant supporting information. Additionally, the provider should include the date of replacement and the specific wheelchair model for which the replacement was performed.

6. Historical Information and Code Maintenance

HCPCS code E0995 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996, indicating that it has been in use for a considerable period of time. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code E0995 is covered by Medicare and other insurance carriers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers using their own methodology. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. Providers should verify coverage and reimbursement policies with the respective payers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code E0995 should be billed:

1. A patient’s wheelchair calf rest/pad is damaged due to wear and tear, and a replacement is necessary to ensure the patient’s comfort and support.
2. A wheelchair user’s calf rest/pad becomes detached from the wheelchair, rendering it unusable, and a replacement is required.
3. A wheelchair calf rest/pad is found to be defective during routine maintenance, and a replacement is needed to ensure the wheelchair’s functionality.
4. A patient’s wheelchair calf rest/pad is lost or misplaced, and a replacement is necessary to provide the patient with the necessary support.
5. A wheelchair user’s calf rest/pad is no longer providing adequate support, causing discomfort, and a replacement is required to address the issue.