Summary & Overview
HCPCS E1190: Amputee Wheelchair with Detachable Arms and Elevating Legrests
HCPCS Level II code E1190 denotes an amputee wheelchair with detachable arms (desk or full length) and swing-away detachable elevating legrests. This code identifies a specialized durable medical equipment (DME) product that addresses mobility and positioning needs for patients with lower-limb amputation. Nationally, accurate coding of such assistive devices matters for appropriate coverage determinations, claims processing, and ensuring patients receive equipment matched to clinical needs.
Key payers commonly involved in coverage and reimbursement for E1190 include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers apply varied medical necessity criteria, documentation requirements, and prior authorization processes for complex mobility devices.
Readers will find a concise explanation of what E1190 represents, the service type and typical sites of service, and what to expect when evaluating coverage for amputee-specific wheelchairs. The publication provides benchmark-oriented context on payer coverage patterns, common documentation and policy considerations, and the clinical context that justifies this class of wheelchair. Data not included in the input (such as specific payer policy language, reimbursement rates, associated ICD-10 codes, and related codes) is noted as unavailable and is not fabricated.
Billing Code Overview
HCPCS Level II code E1190 describes an amputee wheelchair equipped with detachable arms (desk or full length) and swing-away detachable elevating legrests. This device is designed to accommodate individuals with lower-limb amputation who require specialized seating, leg elevation, and adaptable arm support.
Service type: Durable medical equipment (wheelchair for amputee)
Typical site of service: Home or outpatient durable medical equipment setting, including patient residences and outpatient medical equipment providers where wheelchairs are fitted, delivered, and adjusted.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a unilateral transtibial amputation from peripheral vascular disease requires a durable medical equipment wheelchair configured for residual-limb support and elevated leg positioning. The order is for an amputee wheelchair with detachable arms (desk or full length) and swing-away detachable elevating legrests, suitable for transfers, sitting tolerance, and limb protection. The clinical workflow begins with a treating clinician (physiatrist, orthopedic surgeon, or primary care physician) documenting functional limitations, weight capacity, and the medical necessity for the amputee-specific wheelchair. A DME supplier evaluates the patient in home or clinic for seat width, depth, cushion needs, and measures for legrest alignment. The supplier configures and delivers the device, provides user and caregiver training on transfers and elevating legrest operation, and documents delivery, medical necessity, and face-to-face or telehealth assessment as required by the payor. Follow-up includes device adjustments and repair or replacement coordination as the patient’s condition evolves.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | Use when a less-than-standard device or limited features are provided compared with the full prescription. |
53 |