How To Use HCPCS Code E1226

HCPCS code E1226 describes a wheelchair accessory that consists of a manual fully reclining back, with a recline greater than 80 degrees. This code is used to identify and bill for the provision of this specific wheelchair accessory. In this article, we will explore the details of HCPCS code E1226, 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 E1226?

HCPCS code E1226 is used to identify a manual fully reclining back wheelchair accessory. This accessory allows the wheelchair user to recline the backrest to a greater extent, exceeding 80 degrees. It provides enhanced comfort and support for individuals who require a more reclined seating position. The code E1226 is specific to this particular wheelchair accessory and should be used when billing for its provision.

2. Official Description

The official description of HCPCS code E1226 is “Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each.” This description accurately represents the nature and purpose of the wheelchair accessory. The short description for this code is “Enteral supp not otherwise c,” which indicates that this code is not related to enteral supplies.

3. Procedure

1. Position the wheelchair user in a suitable location for the installation of the manual fully reclining back accessory.
2. Ensure that the wheelchair is stable and secure to prevent any accidents or injuries during the procedure.
3. Attach the manual fully reclining back accessory to the wheelchair frame according to the manufacturer’s instructions.
4. Adjust the accessory to the desired recline angle, ensuring that it exceeds 80 degrees.
5. Verify that the accessory is securely attached and functioning properly.
6. Instruct the wheelchair user on how to operate and adjust the reclining back for their comfort.
7. Provide any necessary education or training on the proper use and maintenance of the accessory.

4. When to use HCPCS code E1226

HCPCS code E1226 should be used when providing a manual fully reclining back wheelchair accessory with a recline greater than 80 degrees. It is important to ensure that the accessory meets the specific criteria outlined in the code description. This code is typically used for individuals who require a more reclined seating position due to medical or comfort reasons.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1226, healthcare providers should ensure that the following documentation requirements are met:

• A detailed description of the wheelchair accessory provided, including the brand, model, and specifications.
• Documentation supporting the medical necessity of the accessory, such as physician orders or clinical notes.
• Proof of delivery or installation of the accessory.
• Any additional documentation required by the payer or insurer.

6. Historical Information and Code Maintenance

HCPCS code E1226 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. The code has remained unchanged since its addition to the system.

7. Medicare and Insurance Coverage

HCPCS code E1226 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. Medicare and other insurers may have specific coverage guidelines and reimbursement rates for this code, so it is important to verify with the payer for accurate billing and reimbursement information.

8. Examples

Here are five examples of scenarios where HCPCS code E1226 should be billed:

1. A patient with a spinal cord injury requires a wheelchair with a fully reclining back to alleviate pressure and prevent skin breakdown.
2. An individual with a degenerative condition needs a wheelchair with a reclining back to manage pain and maintain a comfortable position.
3. A healthcare facility provides a manual fully reclining back wheelchair accessory to a patient recovering from a surgical procedure, allowing them to rest in a reclined position.
4. A wheelchair user with a respiratory condition requires a reclining back to improve breathing and lung function.
5. An elderly individual with limited mobility needs a wheelchair with a fully reclining back to facilitate transfers and provide support during extended periods of sitting.