Summary & Overview
HCPCS E1100: Semi-Reclining Wheelchair with Fixed Arms and Elevating Leg Rests
HCPCS Level II code E1100 denotes a semi-reclining wheelchair with fixed full-length arms and swing-away detachable elevating leg rests. As a durable medical equipment code, it represents provision and fitting of a mobility device designed for patients who need a semi-reclining position and leg elevation for clinical reasons such as pressure management or lower-extremity edema. Nationally, DME wheelchair coding affects access to mobility aids, reimbursement pathways for suppliers, and prior authorization workflows for payers.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, typical payer coverage considerations, and areas where policy or documentation commonly affects claims adjudication. The publication outlines benchmarks for utilization and reimbursement expectations when available, summarizes relevant documentation and medical necessity themes, and highlights potential policy updates or administrative practices that influence coverage decisions.
This summary is intended for a national audience of policy analysts, billing professionals, and clinical staff seeking a practical reference on the clinical role and billing context of HCPCS Level II code E1100 for semi-reclining wheelchairs.
Billing Code Overview
HCPCS Level II code E1100 describes a semi-reclining wheelchair with fixed full-length arms and swing-away detachable elevating leg rests. This equipment is a durable medical device intended to provide seated mobility with semi-reclining capability for patients who require pressure relief, postural support, or periodic elevation of the lower extremities.
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Service type: Durable medical equipment (wheelchair provision and fitting)
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Typical site of service: Durable medical equipment suppliers, outpatient medical equipment provisioning locations, long-term care facilities, and patient residences where home delivery and adjustment occur.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with limited mobility due to neurologic injury, progressive neuromuscular disease, or advanced arthritis who requires a semi-reclining wheelchair with fixed full-length arms and swing-away detachable elevating leg rests for home and community mobility. The durable medical equipment (DME) request originates from a primary care physician, physiatrist, or neurologist after a clinical assessment documenting the patient’s inability to safely ambulate, frequent sitting tolerance issues, and need for pressure redistribution and leg elevation to manage edema or contracture risk. A DME supplier performs a home assessment to confirm fit, transfers, and environmental access; the supplier documents seat dimensions, back support needs, armrest height, and leg-rest configuration. The supplier delivers the device and provides training to the patient and caregiver on safe transfers, proper use of swing-away elevating leg rests, recline mechanisms, and basic maintenance. Follow-up visits with rehabilitation or home health clinicians occur as needed to reassess positioning, skin integrity, and functional mobility, and to document ongoing medical necessity for continued use or replacement of the wheelchair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / default | Use when no special modifier applies to the DME claim |