Summary & Overview
HCPCS E1235: Pediatric Rigid Adjustable Wheelchair with Seating System
HCPCS Level II code E1235 denotes a pediatric-size rigid wheelchair that is adjustable and includes an integrated seating system. This item is a category of durable medical equipment (DME) used to address mobility and postural needs in pediatric patients. Nationally, access to appropriate pediatric seating and mobility equipment affects functional independence, participation in education and community activities, and long-term health outcomes.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of reimbursement benchmarks and coverage considerations, descriptions of the clinical contexts in which E1235 is used, and typical sites of service such as the home, outpatient clinics, schools, and pediatric rehabilitation centers. The publication also summarizes common billing modifiers and administrative considerations where available. If specific data elements were not provided in the input, those items are noted as not available.
This summary provides clinicians, billing staff, and policy analysts a concise reference to understand what E1235 represents, why it matters for pediatric mobility and seating services, and what to expect in terms of payer coverage and clinical application at a national level.
Billing Code Overview
HCPCS Level II code E1235 describes a wheelchair, pediatric size, rigid, adjustable, with seating system. This code represents a durable medical equipment item specifically designed for children, featuring a rigid frame with adjustable components and an integrated seating system to provide postural support.
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Service type: Durable medical equipment (DME) for pediatric mobility and seating
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Typical site of service: Use in outpatient settings, home environments, schools, and pediatric rehabilitation facilities where mobility aids and individualized seating are provided
Clinical & Coding Specifications
Clinical Context
A pediatric patient with congenital spastic quadriplegic cerebral palsy (for example) is evaluated by a pediatric physiatrist and pediatric orthotist for mobility limitations and postural deformity. The child demonstrates progressive rib cage and pelvic asymmetry, poor trunk control, and inability to safely self-propel a standard stroller or small wheelchair. After a multidisciplinary assessment including measurements, pressure-mapping seating assessment, and gait/transfer observation, the team prescribes a custom rigid pediatric wheelchair with an adjustable frame and integrated seating system to provide postural support, prevent progression of contractures and pressure injury, and allow caregiver-provided mobility.
The clinical workflow includes: initial referral from the pediatrician or rehabilitation specialist; evaluation by a pediatric physical medicine and rehabilitation physician or occupational therapist; measurements and seating assessment by a certified seating specialist or orthotist; trial of seating components and adjustments in the clinic; fabrication or customization by a durable medical equipment supplier; delivery, fitting, caregiver training, and documentation of medical necessity and objective functional goals. Follow-up visits assess fit, pressure areas, and adjustments, with modifications billed if clinically necessary.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (standard) | Use when no special circumstances apply to the item or service. |