E1172 Amputee Wheelchair HCPCS — Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II E1172: Amputee Wheelchair with Detachable Arms

HCPCS Level II code E1172 denotes an amputee wheelchair configured with detachable arms (desk or full length) and provided without footrests or legrest. This durable medical equipment code identifies a mobility device tailored to patients with lower-limb amputation who need seating without attached lower-extremity supports. The code matters nationally because it informs coverage determinations, claims processing, and supply selection for an important population that requires specialized mobility solutions. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of the clinical use and typical settings for E1172, plus benchmarks and payer coverage context where available. The publication outlines common billing modifiers associated with durable medical equipment claims, discusses typical documentation and medical necessity considerations relevant to amputee wheelchairs, and highlights how E1172 fits into broader equipment coding frameworks. Also covered are reimbursement patterns and policy updates that influence supplier billing and payer adjudication. Data not available in the input is noted where specific figures, associated taxonomies, or ICD-10 pairings are not provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareE1172HCPCS Level IIwheelchairamputee wheelchairdurable medical equipmentmobility aidmedical billingreimbursementmedical supplies

Billing Code Overview

HCPCS Level II code E1172 describes an amputee wheelchair with detachable arms (desk or full length) without footrests or legrest. The device is a mobility aid specifically designed for patients with lower-limb amputation(s) who require a wheelchair configured without integrated footrests or leg supports.

Service type: Durable Medical Equipment (wheelchair/mobility device)

Typical site of service: Durable medical equipment supplied for use in outpatient settings, home use, or post-acute care environments

Clinical & Coding Specifications

Clinical Context

A 58-year-old male transtibial amputee presents to a durable medical equipment (DME) supplier after hospital discharge for prosthetic fitting and outpatient mobility needs. The patient has a healed below-knee amputation on the right lower extremity following peripheral arterial disease and diabetic complications. The clinical workflow includes DME evaluation by a certified prosthetist/orthotist or DME clinician, assessment of functional status and home environment, measurement for a wheelchair with detachable arms to accommodate residuum care and transfer, documentation of medical necessity, receipt of a physician’s order, and delivery with patient education on transfers and maintenance. The device provided is an amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (E1172), intended for seated mobility in community and home settings when lower limb prosthetic limitations or comorbidities necessitate a wheelchair.

Coding Specifications

Modifier	Description	When to Use
`52`	Reduced services	When a modified wheelchair or delivery provides reduced features compared to standard order
`53`

HCPCS E0185: Gel Pressure Pad for Standard Mattress

HCPCS-E2000-GASTRIC-SUCTION-PUMP-HOME-ELECTRIC

HCPCS E2000: Gastric Suction Pump, Home Electric

HCPCS-E1801-ELBOW-STATIC-PROGRESSIVE-STRETCH-DEVICE

HCPCS E1801: Static Progressive Elbow Stretch Device

HCPCS-E0920-FRACTURE-FRAME-BED-TRACTION-DEVICE

HCPCS E0920: Fracture Frame Attached to Bed, Includes Weights

HCPCS-E1093-WIDE-HEAVY-DUTY-WHEELCHAIR-DETACHABLE-ARMS

HCPCS Level II E1093: Wide Heavy Duty Wheelchair, Detachable Arms

HCPCS-E1310-WHIRLPOOL-NON-PORTABLE-BUILT-IN

HCPCS E1310: Whirlpool, Non-Portable (Built-In Type)

HCPCS-E0974-MANUAL-WHEELCHAIR-ANTI-ROLLBACK-DEVICE

HCPCS E0974: Manual Wheelchair Anti-Rollback Device

HCPCS-E1003-WHEELCHAIR-POWER-SEATING-RECLINE-ONLY

HCPCS E1003: Wheelchair Power Seating Accessory, Recline Only

HCPCS-E8001-PEDIATRIC-GAIT-TRAINER-UPRIGHT-SUPPORT

HCPCS E8001: Pediatric Gait Trainer with Upright Support

HCPCS-E1807-DYNAMIC-WRIST-EXTENSION-DEVICE

HCPCS E1807: Dynamic Adjustable Wrist Extension Device

Showing 1–10 of 670

Taxonomy Code	Specialty	Notes
225100000X	Prosthetics-Orthotics	Certified prosthetist/orthotist responsible for wheelchair fit and adjustments
221H00000X	Physical Medicine & Rehabilitation	Physiatrists overseeing mobility needs and prescribing DME
208VP0001X	Physical Therapy	Physical therapists performing mobility assessment and training
261QM0800X	Durable Medical Equipment & Medical Supplies	DME supplier specialty responsible for device provision
207Q00000X	Family Medicine	Primary care providers who may write the DME order

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z89.611`	Acquired absence of right lower leg above knee	Indicates an amputation requiring an amputee-specific wheelchair fit (use `RR` for right side)
`Z89.612`	Acquired absence of left lower leg above knee	Indicates left-sided amputation requiring device laterality documentation (`LL`)
`Z89.511`	Acquired absence of right lower leg below knee	Common indication for amputee wheelchair when prosthetic use is limited
`Z89.512`	Acquired absence of left lower leg below knee	Documentation for left transtibial amputee mobility needs
`E11.51`	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	Underlying disease leading to amputation and ongoing mobility limitations
`I70.213`	Atherosclerosis of native arteries of extremities with rest pain, right leg	Peripheral vascular disease leading to limb loss and need for wheelchair provision
`M21.62`	Acquired deformity of right lower leg	Secondary musculoskeletal conditions affecting seating and transfer needs
`R26.2`	Difficulty in walking, not elsewhere classified	Functional limitation supporting medical necessity for a wheelchair

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic and prosthetic management and training, initial encounter (includes assessment, fitting, training)	Used when providing training and fitting services for an amputee wheelchair and patient education on transfers
`97530`	Therapeutic activities, direct (one-on-one) for functional performance	May be billed by therapists to document activity-based mobility training post-delivery
`99213`	Office or other outpatient visit for evaluation and management of an established patient, low to moderate complexity	Common for the clinician visit documenting DME prescription and medical necessity
`99080`	Special reports such as forms, attendance at conferences, medical record reviews, etc.	Used for additional documentation requested by payors regarding medical necessity
`A9270`	Non-covered item or service (miscellaneous DME supply) — note this is HCPCS Level II, not CPT	Occasionally used in administrative contexts when a code for a specific accessory is not billable to insurance

Note: Data not available in the input for CPT codes; the above are commonly associated with wheelchair provision and post-delivery services.

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