E0955 Wheelchair Headrest HCPCS: Reimbursement | OpenPayer

Summary & Overview

HCPCS E0955: Wheelchair Cushioned Headrest, Including Mounting Hardware

HCPCS Level II code E0955 covers a cushioned headrest for wheelchairs, including fixed mounting hardware. As a durable medical equipment accessory for seating and positioning, this code supports mobility and postural stability for patients with neurological or musculoskeletal conditions that impair head control. Nationally, accurate coding for accessories like E0955 affects access to appropriate durable medical equipment and impacts durable medical equipment benefit management and claims processing.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations and common billing practices for E0955, benchmarks for utilization and reimbursement where available, and the clinical context that supports medical necessity for a wheelchair headrest. The publication highlights typical sites of service—durable medical equipment suppliers, home settings, outpatient clinics, and rehabilitation facilities—and notes common documentation elements relied upon by payers.

This summary equips providers, billers, and policy analysts with a national perspective on billing and coverage for E0955, clarifying where to look for payer-specific policies and what clinical factors commonly underpin coverage decisions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareE0955HCPCS Level IIwheelchair accessorydurable medical equipmentseating and positioningheadrestmedical billingDME accessoriesrehabilitation

Billing Code Overview

HCPCS Level II code E0955 describes a wheelchair accessory: cushioned headrest, any type, including fixed mounting hardware, each. This item is classified as a durable medical equipment accessory intended to provide head support and positioning for wheelchair users.

Service type: Durable medical equipment accessory; seating and positioning aid
Typical site of service: Durable medical equipment suppliers, home setting, outpatient clinics, and rehabilitation facilities

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A patient who uses a manual or power wheelchair requires a cushioned headrest accessory to provide head and neck support due to limited trunk control and impaired head control. Typical patients include individuals with spinal cord injury, cerebral palsy, amyotrophic lateral sclerosis, stroke with hemiparesis and poor head control, or advanced neuromuscular disease. The durable medical equipment (DME) supplier or wheelchair technician evaluates the wheelchair, documents the need for a headrest (E0955) including measurements and mounting requirements, and coordinates with the prescribing clinician (physiatrist, neurologist, or physical medicine and rehabilitation specialist) who documents the medical necessity in the face-to-face or telehealth visit. The accessory is ordered, fitted, and installed by the supplier or ATP (Assistive Technology Professional). Post-installation, the clinician documents functional improvement, skin inspection, and safety for payment and durable medical equipment records. Typical site of service is durable medical equipment supplier, outpatient clinic, home, or skilled nursing facility where the wheelchair is used and fitted.

Coding Specifications

Modifier	Description	When to Use
`TC`	Technical component	Used when billing only the technical component supplied by the durable medical equipment supplier for the headrest accessory.

HCPCS E0461: Volume Control Ventilator, Non-Invasive

HCPCS-E0969-WHEELCHAIR-NARROWING-DEVICE

HCPCS Level II E0969: Narrowing Device for Wheelchair

HCPCS-E1110-SEMI-RECLINING-WHEELCHAIR-DETACHABLE-ARMS-ELEVATING-LEG-REST

HCPCS E1110: Semi-Reclining Wheelchair with Detachable Arms and Elevating Leg Rest

HCPCS-E1222-WHEELCHAIR-FIXED-ARM-ELEVATING-LEGRESTS

HCPCS E1222: Wheelchair with Fixed Arm, Elevating Legrests

HCPCS-E0732-CRANIAL-ELECTROTHERAPY-STIMULATION-SYSTEM

HCPCS E0732: Cranial Electrotherapy Stimulation System

HCPCS-E0616-IMPLANTABLE-CARDIAC-EVENT-RECORDER

HCPCS E0616: Implantable Cardiac Event Recorder with Memory, Activator and Programmer

HCPCS-E2228-WHEEL-BRAKING-SYSTEM-LOCK-MANUAL-WHEELCHAIR-ACCESSORY

HCPCS Level II E2228: Manual Wheelchair Wheel Braking System and Lock

HCPCS-E0791-STATIONARY-PARENTERAL-INFUSION-PUMP

HCPCS E0791: Parenteral Infusion Pump, Stationary, Single or Multi-Channel

HCPCS-E1224-WHEELCHAIR-DETACHABLE-ARMS-ELEVATING-LEGRESTS

HCPCS E1224: Wheelchair with Detachable Arms, Elevating Legrests

HCPCS-E1160-WHEELCHAIR-FIXED-FULL-LENGTH-ARMS-ELEVATING-LEGRESTS

HCPCS Level II E1160: Wheelchair with Fixed Full-Length Arms, Elevating Legrests

Showing 1–10 of 670

Taxonomy Code	Specialty	Notes
`207V00000X`	Physical Medicine & Rehabilitation	Clinicians who commonly prescribe wheelchair accessories and document medical necessity.
`2084P0800X`	Neurology	Neurologists who manage progressive neuromuscular conditions requiring head support.
`2086S0105X`	Occupational Therapy	Occupational therapists who perform seating and positioning evaluations and make accessory recommendations.
`226E00000X`	Durable Medical Equipment Supplier	Suppliers and ATPs who measure, fit, and install the headrest accessory.
`251B00000X`	Assistive Technology Provider (ATP)	Professionals who assess, specify, and fit wheelchair accessories.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G82.20`	Paraplegia, unspecified	Loss of trunk control and lower extremity function often requires head and trunk support in a wheelchair.
`G82.50`	Quadriplegia, unspecified	Severe trunk and head control impairment making a cushioned headrest necessary for positioning and airway support.
`G12.21`	Amyotrophic lateral sclerosis	Progressive neuromuscular weakness often results in poor head control; headrests improve comfort and function.
`I69.991`	Hemiplegia, unspecified affecting unspecified side following cerebral infarction	Post-stroke patients with weakened neck and trunk muscles may require head support during seating.
`Q07.0`	Spina bifida with hydrocephalus	Congenital conditions with trunk instability and head positioning needs for wheelchair users.
`G80.0`	Spastic quadriplegic cerebral palsy	Children and adults with poor head control commonly require cushioned headrests for safe positioning.
`M62.81`	Muscle weakness (generalized)	Generalized weakness affecting head control supports the need for a supportive headrest.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97530`	Therapeutic activities, direct (one-on-one) patient contact by the provider, each 15 minutes	Used in clinic or home during a seating/positioning session to train the patient or caregiver on headrest positioning and functional use.
`97760`	Orthotic(s) and/or prosthetic(s) fitting, initial encounter, upper extremity or lower extremity, lower complexity	Used when fitting and adjusting seating accessories as part of a broader orthotic/prosthetic or seating intervention.
`92618`	Evaluation of patient for prescription of non-speech generating augmentative and alternative communication device; complex	Data not applicable; not related to headrest fitting.
`99401`	Data not available in the input.	Data not available in the input.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder	Not related; retained for completeness but not typically used with `E0955`.

Note: If a CPT code above appears not directly relevant, the clinical workflow may include therapy evaluations, seating evaluations, and orthotic/prosthetic fittings often billed separately from the DME headrest accessory.

OpenPayer