HCPCS Level II E1220: Specially Sized or Constructed Wheelchair

HCPCS Level II code E1220 describes a specially sized or constructed wheelchair (brand/model to be indicated and medical justification required) used for mobility assistance; the service is durable medical equipment for mobility, typically provided through durable medical equipment suppliers and used in the home or community settings for patients who require a custom or non-standard wheelchair size or construction.

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HCPCS Level II E1220: Specially Sized or Constructed Wheelchair

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Clinical & Coding Specifications

Clinical Context

A patient with progressive mobility limitation presents to a durable medical equipment (DME) supplier after evaluation by a physiatrist or primary care physician. The patient has significant anthropometric needs (e.g., very tall, very short, or unusual body proportions), prior spine surgery, or anatomical deformities that preclude use of standard wheelchairs. The clinical workflow begins with the ordering clinician documenting medical necessity for a specially sized or constructed wheelchair E1220, including brand and model if known, specific measurements, functional limitations, and previous equipment trial results. A seating and mobility evaluation by a physical therapist or occupational therapist with DME expertise is obtained, including measurements, pressure-mapping or accommodation requirements, and justification for customization. The supplier prepares a written quote listing the requested wheelchair E1220, brand/model, custom features, and cost, then submits the prescription, evaluation, and any supporting clinical notes to the payer (e.g., Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) for prior authorization. After authorization, fabrication or ordering occurs, followed by delivery, fitting, patient education, and documentation of final measurements, fit, and functional outcomes in the medical record.

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	Used during functional training with the newly delivered specially constructed wheelchair for transfers, propulsion, and ADL practice.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	Not directly related to wheelchair provision; include only when multidisciplinary services are provided for complex patients.
`97760`	Orthotic(s) management and training, upper extremity, lower extremity and/or trunk; first orthotic device	May be billed when gait or orthotic training is required in conjunction with wheelchair use and mobility training.
`97001`	Physical therapy evaluation	Used when a physical therapist conducts the initial seating and mobility evaluation to support `E1220` medical necessity.
`99070`	Supplies and materials (except spectacles), provided by the physician or supplier over and above those usually included with the office visit or other services	Used for miscellaneous supplies related to fitting, cushioning, or minor accessories during delivery of the specially constructed wheelchair.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
171M00000X	Case Manager/Care Coordinator	A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other servic…
3336C0002X	Clinic Pharmacy	A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is us…
2080H0002X	Pediatric Hospice and Palliative Medicine Physician	A pediatrician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This speci…
207WX0109X	Neuro-ophthalmology Physician	A neuro-ophthalmologist is a subspecialist of ophthalmology. This physician evaluates, treats, and studies disorders of the eye, orbit and nervous sy…
1835N1003X	Nutrition Support Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing …

HCPCS E0100: Cane, Adjustable or Fixed, With Tip

HCPCS-E0105-CANE-QUAD-THREE-PRONG-MOBILITY-AID

HCPCS Level II E0105: Cane, Quad or Three-Prong, Includes Tips

HCPCS-E0110-FOREARM-CRUTCHES-PAIR-DME-MOBILITY

HCPCS Level II E0110: Forearm Crutches, Pair, Complete with Tips and Handgrips

HCPCS-E0111-CRUTCH-FOREARM-DURABLE-MEDICAL-EQUIPMENT

HCPCS Level II E0111: Crutch, Forearm, With Tip and Handgrips

HCPCS-E0112-UNDERARM-WOOD-CRUTCHES-PAIR

HCPCS Level II E0112: Underarm Wooden Crutches, Pair

HCPCS-E0113-CRUTCH-UNDERARM-WOOD-ADJUSTABLE-FIXED-WITH-PAD-TIP-HANDGRIP

HCPCS Level II E0113: Crutch Underarm, Wood, Adjustable or Fixed

HCPCS-E0114-UNDERARM-CRUTCHES-PAIR-ADJUSTABLE-FIXED

HCPCS Level II E0114: Underarm (Axillary) Crutches, Adjustable or Fixed, Pair

HCPCS-E0116-UNDERARM-CRUTCH-NON-WOOD-ADJUSTABLE-FIXED

HCPCS E0116: Underarm Crutch, Non-Wood, Adjustable/Fixed with Pad

HCPCS-E0117-ARTICULATING-SPRING-ASSISTED-UNDERARM-CRUTCH

HCPCS Level II E0117: Crutch, Underarm, Articulating, Spring-Assisted

HCPCS-E0118-LOWER-LEG-PLATFORM-CRUTCH-SUBSTITUTE

HCPCS E0118: Crutch Substitute, Lower Leg Platform

Showing 1–10 of 670

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

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	Used during functional training with the newly delivered specially constructed wheelchair for transfers, propulsion, and ADL practice.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	Not directly related to wheelchair provision; include only when multidisciplinary services are provided for complex patients.
`97760`	Orthotic(s) management and training, upper extremity, lower extremity and/or trunk; first orthotic device	May be billed when gait or orthotic training is required in conjunction with wheelchair use and mobility training.
`97001`	Physical therapy evaluation	Used when a physical therapist conducts the initial seating and mobility evaluation to support `E1220` medical necessity.
`99070`	Supplies and materials (except spectacles), provided by the physician or supplier over and above those usually included with the office visit or other services	Used for miscellaneous supplies related to fitting, cushioning, or minor accessories during delivery of the specially constructed wheelchair.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
171M00000X	Case Manager/Care Coordinator	A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other servic…
3336C0002X	Clinic Pharmacy	A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is us…
2080H0002X	Pediatric Hospice and Palliative Medicine Physician	A pediatrician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This speci…
207WX0109X	Neuro-ophthalmology Physician	A neuro-ophthalmologist is a subspecialist of ophthalmology. This physician evaluates, treats, and studies disorders of the eye, orbit and nervous sy…
1835N1003X	Nutrition Support Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing …

HCPCS E0100: Cane, Adjustable or Fixed, With Tip

HCPCS-E0105-CANE-QUAD-THREE-PRONG-MOBILITY-AID

HCPCS Level II E0105: Cane, Quad or Three-Prong, Includes Tips

HCPCS-E0110-FOREARM-CRUTCHES-PAIR-DME-MOBILITY

HCPCS Level II E0110: Forearm Crutches, Pair, Complete with Tips and Handgrips

HCPCS-E0111-CRUTCH-FOREARM-DURABLE-MEDICAL-EQUIPMENT

HCPCS Level II E0111: Crutch, Forearm, With Tip and Handgrips

HCPCS-E0112-UNDERARM-WOOD-CRUTCHES-PAIR

HCPCS Level II E0112: Underarm Wooden Crutches, Pair

HCPCS-E0113-CRUTCH-UNDERARM-WOOD-ADJUSTABLE-FIXED-WITH-PAD-TIP-HANDGRIP

HCPCS Level II E0113: Crutch Underarm, Wood, Adjustable or Fixed

HCPCS-E0114-UNDERARM-CRUTCHES-PAIR-ADJUSTABLE-FIXED

HCPCS Level II E0114: Underarm (Axillary) Crutches, Adjustable or Fixed, Pair

HCPCS-E0116-UNDERARM-CRUTCH-NON-WOOD-ADJUSTABLE-FIXED

HCPCS E0116: Underarm Crutch, Non-Wood, Adjustable/Fixed with Pad

HCPCS-E0117-ARTICULATING-SPRING-ASSISTED-UNDERARM-CRUTCH

HCPCS Level II E0117: Crutch, Underarm, Articulating, Spring-Assisted

HCPCS-E0118-LOWER-LEG-PLATFORM-CRUTCH-SUBSTITUTE

HCPCS E0118: Crutch Substitute, Lower Leg Platform

Showing 1–10 of 670

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS Level II E1220: Specially Sized or Constructed Wheelchair

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OpenPayer

HCPCS Level II E1220: Specially Sized or Constructed Wheelchair

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS Level II E1220: Specially Sized or Constructed Wheelchair

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HCPCS Level II E1220: Specially Sized or Constructed Wheelchair

Sign up for hcpcs E1220 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code E1220 represent and when is it used?

What clinical and documentation elements are required to support medical necessity for E1220?

Which clinicians and supplier specialties typically participate in the E1220 workflow?

Which CPT or ancillary service codes are commonly billed alongside E1220?

Which modifiers are relevant when billing for a specially constructed wheelchair under E1220?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code E1220 represent and when is it used?

What clinical and documentation elements are required to support medical necessity for E1220?

Which clinicians and supplier specialties typically participate in the E1220 workflow?

Which CPT or ancillary service codes are commonly billed alongside E1220?

Which modifiers are relevant when billing for a specially constructed wheelchair under E1220?

References