How To Use HCPCS Code E1235

HCPCS code E1235 describes a pediatric size rigid wheelchair with an adjustable seating system. This code is used to identify a specific type of wheelchair that is designed for children and has a rigid frame. The wheelchair also includes a seating system that can be adjusted to accommodate the individual needs of the child. In this article, we will explore the details of HCPCS code E1235, 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 E1235?

HCPCS code E1235 is used to identify a pediatric size rigid wheelchair with an adjustable seating system. This code is specific to wheelchairs designed for children and has a rigid frame, which provides stability and support. The wheelchair also includes a seating system that can be adjusted to meet the individual needs of the child, ensuring proper positioning and comfort.

2. Official Description

The official description of HCPCS code E1235 is “Wheelchair, pediatric size, rigid, adjustable, with seating system.” The short description for this code is “Enteral supp not otherwise c.” This description accurately reflects the nature of the product and its purpose in providing mobility and support for pediatric patients.

3. Procedure

1. Measure the child’s body dimensions to determine the appropriate size of the wheelchair.
2. Select a pediatric size rigid wheelchair with an adjustable seating system.

4. When to use HCPCS code E1235

HCPCS code E1235 should be used when a pediatric patient requires a rigid wheelchair with an adjustable seating system. This code is specific to wheelchairs designed for children and should not be used for adult-sized wheelchairs or other types of mobility devices. It is important to ensure that the patient meets the eligibility criteria for this specific type of wheelchair before using this code for billing purposes.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1235, healthcare providers should ensure that the necessary documentation is in place to support the medical necessity of the wheelchair for the pediatric patient. This may include medical records, prescriptions, and any other relevant documentation. It is also important to follow the specific billing guidelines set forth by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code E1235 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions to the code since its addition to the system.

7. Medicare and Insurance Coverage

HCPCS code E1235 is covered by Medicare and other insurance carriers. The pricing indicator code 57 indicates that the service or supply is priced by other carriers. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. It is important to verify coverage and reimbursement policies with the specific insurance carrier to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code E1235 should be billed:

1. A 6-year-old child with a mobility impairment requires a pediatric size rigid wheelchair with an adjustable seating system for daily use.
2. A 4-year-old child with a spinal cord injury needs a wheelchair that provides stability and support, and can be adjusted to accommodate their growth.
3. A 10-year-old child with a neuromuscular disorder requires a wheelchair with an adjustable seating system to maintain proper positioning and comfort.
4. A 7-year-old child with a congenital disability needs a rigid wheelchair that can be adjusted to meet their specific postural needs.
5. A 5-year-old child with a musculoskeletal condition requires a pediatric size rigid wheelchair with an adjustable seating system to improve their mobility and independence.