E1060 Fully-Reclining Wheelchair HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS E1060: Fully-Reclining Wheelchair with Elevating Legrests

HCPCS Level II code E1060 represents a fully-reclining durable medical wheelchair with detachable arms, desk or full-length seating, and swing-away detachable elevating legrests. This equipment supports patients with complex mobility and positioning needs who require both reclining capability and leg elevation for pressure management, postural support, or edema control. Nationally, durable medical equipment codes like E1060 matter because they guide coverage determinations, prior authorization processes, and supplier billing for high-cost mobility devices.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for use, typical sites of service where this equipment is provided, and the common billing considerations associated with supplying a fully-reclining wheelchair. The publication outlines expected benchmarks for coding and reimbursement practices, highlights policy drivers that affect coverage decisions for complex wheelchairs, and summarizes documentation elements that commonly factor into payer reviews.

Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, or related codes is noted where applicable. The content is intended for national audiences involved in durable medical equipment provision, billing, and policy oversight.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareE1060HCPCS Level IIdurable medical equipmentwheelchairmobility aidereclining wheelchairelevating legrestsmedical billingDME policy

Billing Code Overview

HCPCS Level II code E1060 describes a fully-reclining wheelchair with detachable arms, suitable for desk or full-length use, and equipped with swing-away detachable elevating legrests.

Service type: Durable Medical Equipment (wheelchair)

Typical site of service: Home, long-term care facility, or other outpatient/home-based settings where durable medical equipment is used

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with advanced Parkinson disease and severe postural instability is evaluated by a durable medical equipment (DME) supplier following an outpatient physician visit. The physician documents progressive motor dysfunction, recurrent falls, and inability to safely propel a standard wheelchair due to poor trunk control and frequent need to lie flat for orthostatic symptoms. The physician certifies medical necessity for a fully reclining wheelchair with detachable arms and swing-away detachable elevating legrests to provide pressure relief, facilitate transfers, and allow supine positioning during long-distance transport. The clinical workflow includes physician documentation of diagnosis and functional deficits, a detailed mobility assessment by a physical or occupational therapist, prior authorization submission to the payor, delivery and fit-check by the DME supplier, and training for the patient and caregivers on safe operation and transfer techniques.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when complexity of delivery, customization, or time for seating evaluation and customization significantly exceeds usual for the wheelchair supply.
`26`

HCPCS Level II E2300: Wheelchair Power Seat Elevation System

HCPCS-E0373-NONPOWERED-ADVANCED-PRESSURE-REDUCING-MATTRESS

HCPCS E0373: Nonpowered Advanced Pressure Reducing Mattress

HCPCS-E0310-BED-SIDE-RAILS-FULL-LENGTH

HCPCS E0310: Bed Side Rails, Full Length

HCPCS-E1807-DYNAMIC-WRIST-EXTENSION-DEVICE

HCPCS E1807: Dynamic Adjustable Wrist Extension Device

HCPCS-E2508-SPEECH-GENERATING-DEVICE-SPELLING-PHYSICAL-CONTACT

HCPCS E2508: Speech-Generating Device, Synthesized Speech, Spelling Access

HCPCS-E2504-SPEECH-GENERATING-DEVICE-DIGITIZED-SPEECH-20-40MIN

HCPCS E2504: Speech-Generating Device, Digitized Speech (20–40 min)

HCPCS-E0610-PACEMAKER-MONITOR-SELF-CONTAINED-BATTERY-CHECK

HCPCS Level II E0610: Pacemaker Monitor, Self-Contained (Battery Check)

HCPCS-E1050-FULLY-RECLINING-WHEELCHAIR-FIXED-FULL-LENGTH-ARMS

HCPCS Level II E1050: Fully-Reclining Wheelchair, Full-Length Arms

HCPCS-E2613-WHEELCHAIR-BACK-CUSHION-POSTERIOR-WIDTH-UNDER-22IN

HCPCS Level II E2613: Posterior Wheelchair Back Cushion, <22"

HCPCS-E0245-TUB-STOOL-BENCH-BATHING-AID-HOME

HCPCS E0245: Tub Stool or Bench for Bathing

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Taxonomy Code	Specialty	Notes
`225100000X`	Physical Therapist	Performs seating/mobility assessment, documents functional limitations and recommendations for wheelchair configuration.
`225200000X`	Occupational Therapist	Conducts ADL-focused seating assessment and documents transfer needs and environmental adaptations.
`207Q00000X`	DME Supplier (Prosthetics/Orthotics)	Responsible for fabrication, fitting, delivery, and patient/caregiver training for the wheelchair.
`208D00000X`	Surgeon	Manages patients with surgical needs who may require specialized transport or positioning; documents related surgical implications.
`207L00000X`	Durable Medical Equipment and Supplies Retail	Supplier taxonomy for billing and supply coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G20`	Parkinson disease	Progressive motor dysfunction and postural instability may necessitate a fully reclining wheelchair for safety and positioning.
`G82.50`	Paraplegia, unspecified	Loss of lower limb function with need for specialized seating, pressure relief, and leg elevation.
`M62.81`	Muscle weakness (generalized)	Significant weakness affecting mobility and ability to maintain upright posture, indicating need for reclining support.
`R26.89`	Other abnormalities of gait and mobility	Gait dysfunction that impairs safe ambulation, supporting wheelchair provision.
`I69.391`	Hemiplegia and hemiparesis following cerebral infarction, affecting unspecified side	Neurologic deficits requiring adaptive seating and elevating legrests for spasticity management and positioning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical therapy evaluation, low complexity	Performed prior to DME order to document functional deficits and support medical necessity for the fully reclining wheelchair.
`97162`	Physical therapy evaluation, moderate complexity	Used when a more detailed mobility and seating assessment is required to justify complex wheelchair features.
`97530`	Therapeutic activities, direct (one-on-one)	May be billed for functional mobility training and transfer training after wheelchair delivery.
`99456`	Work-related or medical disability evaluation (impairment rating)	Occasionally used when documentation of long-term mobility impairment is needed for durable equipment justification or vocational determinations.
`99070`	Supplies and materials (DME supplier)	Used by suppliers for non-covered items or additional supplies not included in the base HCPCS pricing when permitted by payor policy.

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