Summary & Overview
HCPCS E1086: Hemi-Wheelchair with Detachable Arms and Swing-Away Footrests
HCPCS Level II code E1086 identifies a hemi-wheelchair with detachable arms (desk or full length) and swing-away detachable footrests, a form of durable medical equipment used to improve mobility and access for patients in clinical, outpatient, and home settings. This code matters nationally because it supports billing and coverage for mobility aids that enable functional independence and access to workstations and standard seating.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers coverage parameters and payment benchmarks across major commercial plans and Medicare policies, where available. Readers will find a concise explanation of the device and service context, payer coverage patterns, typical sites of service, and the operational information needed for billing and documentation. The publication also summarizes common modifier usage and where to look for payer-specific prior authorization or medical necessity requirements. Data not available in the input is noted where applicable.
This national summary is intended for billing managers, DME suppliers, compliance officers, and clinicians who need a clear reference on what E1086 represents and which payers are relevant for coverage considerations.
Billing Code Overview
HCPCS Level II code E1086 describes a hemi-wheelchair with detachable arms (desk or full length) and swing-away detachable footrests. The code denotes a mobility assistive device configured as a hemi (side) wheelchair intended to provide seating and mobility for patients who require a compact chair that fits under desks or work surfaces or offers full-length arm support.
Service type: Durable medical equipment (DME) — mobility/assistive device
Typical site of service: Outpatient or community settings, patient residence, or any facility where durable medical equipment is provided or used (e.g., clinics, outpatient DME suppliers, home use).
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with hemiparesis following a left hemispheric ischemic stroke requires mobility assistance for home and community activities. The patient has good trunk control on the right side but limited strength and range of motion of the left upper extremity, and requires a hemi-height wheelchair with detachable arms and swing-away detachable footrests to facilitate safe lateral transfers, positioning at a desk, and easier propulsion with the unaffected limb. A physical or occupational therapist performs a mobility assessment, documents measurements for seat width and height, assesses transfer method and caregiver needs, and the durable medical equipment provider supplies and fits a E1086 hemi-wheelchair with the requested accessories. Clinical documentation includes the mobility evaluation, functional goals, justification for hemi-height configuration (to allow foot propelling or hemi-pelvic positioning), and rationale for detachable arms/footrests to accommodate transfers and desk activity. Delivery, fitting, and patient/caregiver training are documented in the medical record and itemized in the claim submission according to payer requirements.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | Use when a hemi-wheelchair is supplied with fewer components than billed, or service is partially furnished. |