How To Use HCPCS Code E1195

HCPCS code E1195 describes a heavy-duty wheelchair with fixed full-length arms and swing-away detachable elevating legrests. This code is used to identify a specific type of wheelchair that is designed to accommodate individuals with special mobility needs. In this article, we will explore the details of HCPCS code E1195, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and other insurance providers.

1. What is HCPCS E1195?

HCPCS code E1195 is used to identify a heavy-duty wheelchair with fixed full-length arms and swing-away detachable elevating legrests. This type of wheelchair is designed to provide enhanced support and comfort for individuals with mobility limitations. It is equipped with sturdy construction and features that allow for easy maneuverability and adjustment to meet the specific needs of the user.

2. Official Description

The official description of HCPCS code E1195 is “Heavy duty wheelchair, fixed full-length arms, swing away detachable elevating legrests.” This description accurately represents the features and characteristics of the wheelchair that this code identifies. The short description for this code is “Parenteral supp not othrws c,” which provides additional information about the specific use of this wheelchair.

3. Procedure

1. Position the wheelchair in a suitable location for the individual to transfer into it.
2. Ensure that the fixed full-length arms are securely attached to the wheelchair frame.
3. Attach the swing-away detachable elevating legrests to the designated mounting points on the wheelchair.
4. Adjust the legrests to the desired height and angle to provide optimal support and comfort for the individual.
5. Assist the individual in transferring into the wheelchair, ensuring proper positioning and alignment.
6. Securely fasten any safety belts or restraints as necessary.
7. Ensure that all adjustments and attachments are properly secured and functioning before moving the wheelchair.

4. When to use HCPCS code E1195

HCPCS code E1195 should be used when billing for the provision of a heavy-duty wheelchair with fixed full-length arms and swing-away detachable elevating legrests. This code is applicable for individuals who require the use of a wheelchair with these specific features to meet their mobility needs. It is important to ensure that the individual meets the eligibility criteria and guidelines for using this code before submitting a claim.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1195, healthcare providers need to document the medical necessity for the wheelchair and the specific features that justify the use of this code. The documentation should include details about the individual’s mobility limitations, the need for fixed full-length arms and swing-away detachable elevating legrests, and any other relevant information. It is also important to follow the billing guidelines provided by the payer and submit the necessary supporting documentation to ensure timely and accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code E1195 was added to the Healthcare Common Procedure Coding System on January 01, 1985. Since its addition, 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 an effective date of January 01, 1996, and has remained unchanged since then.

7. Medicare and Insurance Coverage

HCPCS code E1195 is eligible for coverage by Medicare and other insurance providers. 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 that it is not applicable as HCPCS priced under one methodology. Medicare and other insurance providers may have specific coverage policies and reimbursement rates for this code, so it is important to verify the coverage and reimbursement guidelines with the respective payer.

8. Examples

Here are five examples of when HCPCS code E1195 should be billed:

1. A patient with a spinal cord injury requiring a heavy-duty wheelchair with fixed full-length arms and swing-away detachable elevating legrests for daily mobility.
2. An individual with muscular dystrophy who needs a wheelchair with enhanced support and legrest elevation capabilities.
3. A person with severe arthritis who requires a heavy-duty wheelchair with fixed full-length arms and swing-away detachable elevating legrests to alleviate joint pain and provide stability.
4. A patient recovering from a lower limb amputation who needs a wheelchair with adjustable legrests to support the residual limb and aid in rehabilitation.
5. An individual with a congenital disability that affects lower limb function and requires a wheelchair with fixed full-length arms and swing-away detachable elevating legrests for independent mobility.