Summary & Overview
HCPCS Level II E2216: Manual Wheelchair Foam-Filled Propulsion Tire
HCPCS Level II code E2216 denotes a foam filled propulsion tire for manual wheelchairs, billed per tire. Wheelchair propulsion tires are durable medical equipment accessories that affect mobility, maintenance frequency, and user comfort. Nationally, proper coding for wheelchair components supports accurate claims processing and helps ensure individuals receive needed mobility aids without unnecessary billing disputes. Key payers typically involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. This publication provides a concise overview of code E2216, including clinical context, common sites where the item is provided, and payer considerations. Readers will find benchmark information on how payers commonly approach reimbursement for wheelchair accessories, notes on billing practice considerations, and the clinical rationale for foam-filled tires versus alternatives. Where specific input data is missing, the text indicates absence rather than inferring coverage rules. The focus is national in scope and intended for billing managers, DME suppliers, and clinical staff who handle durable medical equipment claims.
Billing Code Overview
HCPCS Level II code E2216 describes a manual wheelchair accessory: foam filled propulsion tire, any size, each. This item is an accessory component intended to replace or upgrade the propulsion tires on manual wheelchairs. Service type: durable medical equipment accessory. Typical site of service: durable medical equipment supplier, outpatient clinic, rehabilitation facility, or patient's home when provided by a supplier.
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Clinical & Coding Specifications
Clinical Context
A patient who uses a manual wheelchair for mobility presents for routine maintenance or replacement of worn propulsion tires. Typical patients include individuals with spinal cord injury, multiple sclerosis, cerebral palsy, post-polio syndrome, lower‑extremity amputation, or other neuromuscular or mobility‑limiting conditions who self‑propel or are assisted by caregivers. The clinical workflow begins with a clinician or durable medical equipment (DME) supplier assessment documenting functional limitation, mobility needs, and current equipment condition. The supplier verifies medical necessity, confirms wheelchair model and tire size, and orders the accessory: a foam‑filled propulsion tire billed as E2216 per tire. Installation may occur in the clinic, the supplier’s shop, or the patient’s residence. Documentation includes the patient’s diagnosis, description of the current tire condition, justification for replacement (wear, loss of traction, risk of puncture), tire size, quantity, and supplier details. Photos or supplier notes may accompany the order for reimbursement. Billing may include applicable modifiers (e.g., warranty circumstances, multiple procedures, or unexpected circumstances) as supported by payer policy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special modifier applies to the line item. |