Summary & Overview
HCPCS Level II E1031: Rollabout Chair with Casters 5" or Greater
HCPCS Level II code E1031 represents a rollabout chair with casters 5 inches or greater, classified as durable medical equipment for mobility and seating support. Nationally, this code matters because it standardizes billing for commonly prescribed wheeled seating used in home, long-term care, and outpatient DME settings, affecting coverage determinations and supplier reimbursement across major payers. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what E1031 covers clinically and operationally, how major payers approach coverage and claims processing, and where common billing issues arise. The publication summarizes benchmark pricing patterns, reimbursement considerations, and documentation expectations relevant to suppliers and billing professionals. It also provides context on typical sites of service and the clinical rationale for prescribing larger-caster rollabout chairs. Data limitations: Data not available in the input where payer-specific rates, taxonomies, and ICD-10 linkage would normally appear.
Billing Code Overview
HCPCS Level II code E1031 describes a rollabout chair of any type equipped with casters 5 inches or greater. This item is a durable medical equipment seating device intended to provide mobility and support for patients who require a wheeled chair with larger casters for ease of movement over varied surfaces.
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Service type: Durable Medical Equipment (DME) seating/mobility device
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Typical site of service: Outpatient durable medical equipment suppliers, home, long-term care facilities, and other non-acute care settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with limited mobility due to neuromuscular disease, arthritis, obesity, recent lower-extremity fracture, or postoperative weakness who requires a rollabout chair with 5" or larger casters to improve indoor mobility and reduce fall risk. The item is ordered by a physician or qualified practitioner in an outpatient durable medical equipment (DME) setting, home health program, inpatient rehab unit, or skilled nursing facility after assessment by physical or occupational therapy. Documentation includes the patient’s functional mobility limitations, home environment assessment showing the need for large casters for threshold and carpet clearance, measurements for seat width and height, and a plan of use (daily indoor ambulation, transfers, and positioning). The DME supplier verifies patient eligibility, obtains prior authorization if required by payor policy, delivers and fits the chair in the patient’s home or facility, provides instruction on safe transfers and braking, and documents delivery, medical necessity, and supplier details for billing with HCPCS code E1031.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Data not available in the input. | Data not available in the input. |