How To Use HCPCS Code E1031

HCPCS code E1031 describes a rollabout chair with casters 5″ or greater. This code is used to identify a specific type of wheelchair that is designed for individuals who require enteral support. In this article, we will explore the details of HCPCS code E1031, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS E1031?

HCPCS code E1031 is used to identify a rollabout chair with casters 5″ or greater. This type of wheelchair is specifically designed for individuals who require enteral support. It is important to note that this code is not applicable for other types of wheelchairs or medical equipment.

2. Official Description

The official description of HCPCS code E1031 is “Rollabout chair, any and all types with casters 5″ or greater.” The short description for this code is “Enteral supp not otherwise c.” This description accurately reflects the purpose and usage of this specific wheelchair.

3. Procedure

1. When providing a rollabout chair with casters 5″ or greater, ensure that the chair meets the specifications outlined in the HCPCS code E1031.
2. Verify that the individual requires enteral support and that a rollabout chair is medically necessary for their condition.
3. Select a rollabout chair that meets the specific needs of the individual, including the appropriate size, features, and support for enteral feeding.
4. Ensure that the rollabout chair is properly assembled and adjusted to provide optimal comfort and safety for the individual.
5. Provide instructions to the individual or their caregiver on how to use and maintain the rollabout chair.

4. When to use HCPCS code E1031

HCPCS code E1031 should be used when providing a rollabout chair with casters 5″ or greater to an individual who requires enteral support. It is important to ensure that the individual meets the eligibility criteria for this specific type of wheelchair and that it is medically necessary for their condition.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1031, healthcare providers should ensure that the following documentation is included:

• A detailed description of the rollabout chair provided, including the make, model, and specifications.
• Documentation supporting the medical necessity of the rollabout chair for the individual’s enteral support needs.
• Any additional documentation required by the payer, such as prior authorization or supporting medical records.

Providers should follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code E1031 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has remained unchanged since its addition to the HCPCS.

7. Medicare and Insurance Coverage

HCPCS code E1031 is eligible for coverage under Medicare. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for specific coverage and reimbursement guidelines.

8. Examples

Here are five examples of when HCPCS code E1031 should be billed:

1. A patient with a medical condition that requires enteral support and mobility assistance is provided with a rollabout chair with casters 5″ or greater.
2. An individual with a disability that affects their ability to walk independently requires a rollabout chair for daily activities, including enteral support.
3. A healthcare facility provides a rollabout chair to a patient who is recovering from surgery and requires enteral feeding.
4. A home healthcare provider supplies a rollabout chair to a patient with a chronic illness who needs enteral support and mobility assistance.
5. A hospice agency provides a rollabout chair to a terminally ill patient who requires enteral support and wishes to maintain mobility and independence.