How To Use HCPCS Code E1280

HCPCS code E1280 describes a heavy-duty wheelchair with detachable arms (desk or full length) and elevating legrests. This code is used to identify the specific type of wheelchair that is being provided to a patient. In this article, we will explore the details of HCPCS code E1280, 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 E1280?

HCPCS code E1280 is used to identify a heavy-duty wheelchair with detachable arms (desk or full length) and elevating legrests. This code is specific to this type of wheelchair and is used to ensure accurate billing and reimbursement for the equipment provided.

2. Official Description

The official description of HCPCS code E1280 is “Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. When providing a heavy-duty wheelchair with detachable arms (desk or full length) and elevating legrests, the healthcare provider must ensure that the wheelchair meets the specifications outlined in HCPCS code E1280.
2. The provider should assess the patient’s needs and determine if a heavy-duty wheelchair is necessary.
3. The provider should then select a wheelchair that has detachable arms, either desk or full length, and elevating legrests.
4. The wheelchair should be properly fitted to the patient to ensure comfort and functionality.
5. Once the wheelchair is provided to the patient, the provider should document the details of the equipment and the patient’s specific needs in the medical record.

4. When to use HCPCS code E1280

HCPCS code E1280 should be used when providing a heavy-duty wheelchair with detachable arms (desk or full length) and elevating legrests to a patient. This code is specific to this type of wheelchair and should not be used for other types of wheelchairs or equipment.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code E1280, healthcare providers should ensure that the documentation supports the medical necessity of the heavy-duty wheelchair with detachable arms (desk or full length) and elevating legrests. This may include documentation of the patient’s condition, mobility limitations, and the need for a heavy-duty wheelchair. Providers should also include detailed information about the specific wheelchair provided, including the brand, model, and any additional features or modifications.

6. Historical Information and Code Maintenance

HCPCS code E1280 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.

7. Medicare and Insurance Coverage

HCPCS code E1280 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 it is not applicable as HCPCS priced under one methodology. Providers should check with individual payers to determine the specific coverage and reimbursement policies for HCPCS code E1280.

8. Examples

Here are five examples of when HCPCS code E1280 should be billed:

1. A patient with a documented medical condition that requires a heavy-duty wheelchair with detachable arms (desk or full length) and elevating legrests.
2. A patient who has limited mobility and requires a wheelchair that can support their weight and provide the necessary comfort and functionality.
3. A patient who has undergone a surgical procedure and requires a heavy-duty wheelchair during their recovery period.
4. A patient with a chronic illness or disability that affects their mobility and requires a heavy-duty wheelchair for daily use.
5. A patient who has experienced a recent injury or accident that has resulted in temporary or permanent mobility limitations and requires a heavy-duty wheelchair for rehabilitation or long-term use.