HCPCS Level II E1087: High Strength Lightweight Wheelchair with Elevating Leg Rests - OpenPayer

Summary & Overview

HCPCS Level II E1087: High Strength Lightweight Wheelchair with Elevating Leg Rests

HCPCS Level II code E1087 designates a high strength lightweight manual wheelchair with fixed full-length arms and swing-away detachable elevating leg rests. This equipment code matters nationally because it identifies a specific mobility device with clinical features that affect functional mobility, patient safety, and durable medical equipment (DME) coverage decisions. Accurate coding ensures appropriate provision, billing, and claims adjudication for patients who require elevated leg support and durable armrests in a lightweight frame.

Key payers typically referenced for coverage and billing practice comparisons include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coding implications, typical sites of service, and the clinical context in which E1087 is used. The publication also covers common modifiers and payment considerations, benchmarking approaches, and policy or coverage change signals relevant to DME suppliers, billing staff, and clinical teams.

The content is organized to help readers quickly identify what E1087 represents, how it is used in clinical and billing workflows, and where to look for payer-specific coverage rules and documentation requirements. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareE1087HCPCS Level IIdurable medical equipmentwheelchairmobility aidDME codingmedical billingelevating leg restsfixed full-length arms

Billing Code Overview

HCPCS Level II code E1087 describes a high strength lightweight wheelchair equipped with fixed full-length arms and swing-away detachable elevating leg rests. The description indicates a durable medical equipment mobility device designed for patients who require a robust but lightweight manual wheelchair option.

Service type: Durable medical equipment — manual wheelchair provision and fitting
Typical site of service: Durable medical equipment suppliers, outpatient clinics, long-term care facilities, patient homes

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with progressive lower extremity weakness and degenerative joint disease presents to durable medical equipment (DME) services after repeated falls and increasing difficulty with ambulation. The patient requires a high-strength, lightweight wheelchair with fixed full-length arms and swing-away detachable elevating leg rests to permit safe transfers, optimized seating support, and lower extremity elevation for edema management. The clinical workflow begins with a physician or advanced practice clinician documenting medical necessity and a face-to-face evaluation, including functional mobility assessment and home environment review. A DME supplier obtains a signed prescription and supporting documentation (diagnosis, mobility limitations, measurements, seating needs) and submits prior authorization to the payer when required. Delivery includes wheelchair fitting, instructions for use and safe transfers, and documentation of the beneficiary’s ability to operate or the need for caregiver assistance. Follow-up visits may address modifications, repairs, or replacement over time.

Coding Specifications

Modifier	Description	When to Use
`KS`	Service furnished in a rural area by a nonparticipating supplier	Use when supplier is nonparticipating and service occurs in designated rural areas (note: include only if payer recognizes `KS`).

Related Codes

HCPCS-E0175-FOOT-REST-COMMODE-CHAIR

HCPCS E0175: Foot Rest for Commode Chair, Each

HCPCS-E0486-ORAL-APPLIANCE-UPPER-AIRWAY-COLLAPSE

HCPCS E0486: Custom Oral Appliance to Reduce Upper Airway Collapsibility

HCPCS-E0154-WALKER-PLATFORM-ATTACHMENT

HCPCS E0154: Platform Attachment for Walker, Each

HCPCS-E1234-PEDIATRIC-TILT-IN-SPACE-FOLDING-WHEELCHAIR

HCPCS Level II E1234: Pediatric Tilt-in-Space Folding Wheelchair

HCPCS-E2512-SPEECH-GENERATING-DEVICE-MOUNTING-SYSTEM

HCPCS E2512: Accessory for Speech Generating Device, Mounting System

HCPCS-E1012-POWER-ELEVATING-LEG-REST-CENTER-MOUNT

HCPCS E1012: Center-Mount Power Elevating Leg Rest/Platform

HCPCS-E0172-TOILET-SEAT-LIFT-MECHANISM

HCPCS E0172: Seat Lift Mechanism for Toilet

HCPCS-E0218-FLUID-CIRCULATING-COLD-PAD-PUMP

HCPCS Level II E0218: Fluid Circulating Cold Pad with Pump

HCPCS-E2375-POWER-WHEELCHAIR-CONTROLLER-REPLACEMENT

HCPCS Level II E2375: Power Wheelchair Non-Expandable Controller, Replacement

HCPCS-E0167-COMMODE-PAIL-PAN-REPLACEMENT

HCPCS Level II E0167: Pail or Pan for Commode Chair, Replacement Only

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Taxonomy Code	Specialty	Notes
`251B00000X`	Physical Therapist	Performs mobility and functional assessments, documents need for wheelchair.
`3336C0002X`	Rehabilitation Equipment Supplier	DME supplier who provides, fits, and trains on the wheelchair.
`207L00000X`	Physical Medicine & Rehabilitation Physician	Provides the face-to-face evaluation and certifies medical necessity.
`2084P0800X`	Geriatric Medicine Physician	Commonly involved for older adults with mobility decline and comorbidity considerations.
`363LP0800X`	Occupational Therapist	Assesses transfer safety, seating, and environmental fit for wheelchair use.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M16.11`	Unilateral primary osteoarthritis, right hip	Large-joint osteoarthritis causing mobility impairment and need for wheelchair assistance.
`M17.11`	Unilateral primary osteoarthritis, right knee	Knee osteoarthritis limiting ambulation and indicating long-term wheelchair use.
`G82.20`	Paraplegia, unspecified	Significant motor impairment requiring a high-strength wheelchair with elevating leg rests for positioning.
`G13.10`	Spinocerebellar disease, unspecified	Progressive neurologic disease producing gait instability and need for mobility device.
`R26.2`	Difficulty in walking, not elsewhere classified	Functional limitation often cited in documentation supporting wheelchair provision.
`I83.90`	Varicose veins of lower extremities, unspecified with unspecified complications	May necessitate leg elevation features to manage edema while seated.
`M25.569`	Pain in unspecified knee	Pain limiting ambulation and indicating need for wheelchair for community mobility.
`M62.81`	Muscle weakness (generalized)	Weakness that impairs safe ambulation and justifies a high-strength mobility device.

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	Frequently performed by occupational or physical therapists to train patients in wheelchair transfers and functional mobility.
`97112`	Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception	Used to address balance and coordination deficits that influence wheelchair prescription and training.
`97161`	Physical therapy evaluation, low complexity	Initial PT evaluation that documents functional limitations supporting the wheelchair order.
`99456`	Work-related or medical disability examination services (e.g., impairment rating)	Occasionally used when documenting work-related mobility limitations that support durable medical equipment needs.
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	Used if additional custom supplies or accessories are provided during fitting or delivery.