Summary & Overview
HCPCS E1250: Lightweight Wheelchair with Fixed Full-Length Arms, Swing-Away Footrest
HCPCS Level II code E1250 identifies a lightweight wheelchair with fixed full-length arms and a swing-away detachable footrest, categorized as durable medical equipment for mobility. Nationally, this code matters because it defines coverage eligibility, device specification, and billing for a commonly prescribed mobility aid used across outpatient, home, and DME supplier settings. Clear coding supports appropriate reimbursement and access for patients who require ambulatory support but do not need heavy-duty seating.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how E1250 is used in clinical and billing workflows, typical sites of service, and common billing modifiers associated with DME claims. The publication outlines benchmark considerations and relevant policy and coverage themes affecting claim adjudication and medical necessity determinations.
The report provides operational context for clinicians, billing staff, and policy teams: product description, expected use cases, payer landscape, and areas where plan-level documentation and coding precision influence coverage. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code E1250 describes a lightweight wheelchair with fixed full-length arms and swing-away detachable footrest. This device is intended to provide mobility assistance for patients who require a durable, transportable seating and mobility solution.
-
Service type: Durable medical equipment (wheelchair provision and fitting)
-
Typical site of service: Durable medical equipment suppliers, outpatient clinics, and patient home settings where wheelchair delivery and setup occur.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an ambulatory adult or pediatric patient with mobility limitation due to neuromuscular weakness, lower-extremity amputation, severe arthritis, or chronic neurologic disease who requires a lightweight manual wheelchair with fixed full-length armrests and swing-away detachable footrests for community mobility. The device is selected after a clinician or durable medical equipment (DME) supplier assessment documenting the need for a wheelchair to improve function, transfer ability, and safety for activities of daily living. The clinical workflow: the ordering clinician (physiatrist, orthopedic surgeon, neurologist, or primary care provider) documents the functional limitation, prior conservative measures, and goals of mobility; the DME supplier performs a face-to-face assessment, documents measurements and seating needs, verifies payer coverage and medical necessity, furnishes the E1250 device, provides patient and caregiver education on transfers and footrest removal, and documents delivery and follow-up plans. Typical sites of service include outpatient DME suppliers, outpatient rehabilitation clinics, long-term care facilities, and patient homes for delivery and training.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | General reporting when no modifier applies |