Summary & Overview
HCPCS E2326: Power Wheelchair Breath Tube Kit for Sip-and-Puff Interface
HCPCS Level II code E2326 denotes a power wheelchair accessory: a breath tube kit for sip-and-puff interfaces. This accessory facilitates hands-free control for patients who use sip-and-puff systems to operate power mobility devices, making it clinically significant for mobility-impaired populations and durable medical equipment suppliers. Nationally, use of such specialized accessories supports independence and home mobility for patients with high-level spinal cord injuries, neuromuscular disorders, and other conditions that limit hand function.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what E2326 represents, typical service settings, and which major payers are included in the analysis. The publication covers reimbursement benchmarks, common billing practices, and relevant policy or coverage considerations that affect access to power wheelchair control accessories. Clinical context is summarized to explain why the accessory is prescribed and how it integrates with durable medical equipment services.
This brief equips billing managers, suppliers, and policy analysts with a focused reference on HCPCS Level II code E2326, its clinical role, and the payer landscape relevant to coverage and reimbursement discussions.
Billing Code Overview
HCPCS Level II code E2326 describes a power wheelchair accessory: breath tube kit for sip and puff interface. This item is an accessory used with power wheelchairs to enable sip-and-puff control systems, providing an interface that translates inhalation and exhalation into control signals for mobility devices.
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Service type: Durable medical equipment accessory for power mobility control
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Typical site of service: Use with power wheelchair; provided in durable medical equipment settings, home use, or during mobility device setup and training
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with high spinal cord injury and tetraplegia is receiving a powered wheelchair with a sip-and-puff control system to enable independent mobility. The patient presents to a durable medical equipment clinic for final seating and mobility fitting. The power wheelchair technician and rehabilitation clinician install a replacement breath tube kit for the sip-and-puff interface to restore reliable pneumatic signal transmission after the original tubing degraded. The clinical workflow includes verification of the prescription for the accessory E2326, inspection and testing of the sip-and-puff control prior to installation, exchange of the tubing kit, bench testing of the interface with the patient present, adjustments to control sensitivity as needed, documentation of the accessory serial/part number and condition, brief patient training on use and cleaning, and recording of the accessory installation in the durable medical equipment record for billing and warranty purposes. Typical site of service is an outpatient durable medical equipment (DME) clinic or the patient's residence when service is provided in-home.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier applicable | Use when no specific modifier is required for the line item |
52 | Reduced services | Use when the supplied accessory is provided in a limited form compared to prescription or expected configuration |
53 | Discontinued procedure | Use when the supply or installation is attempted but discontinued for clinical reasons prior to completion |
62 | Two surgeons | Rarely used; not typically applicable to DME but available if two qualified providers are required for installation in complex cases |
78 | Unplanned return to the operating/procedure room | Use if accessory installation required unplanned return to a procedural area (rare for DME) |
80 | Assistant surgeon | Not commonly applicable to accessory supply; used if an assistant performs billable portion of service |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service billing | Use when an advanced practice clinician documents and bills for professional services associated with the accessory fitting |
NU | New equipment | Use to indicate the accessory is new, not refurbished |
RR | Rental return | Use when billing reflects return of a rented accessory or change in rental status |
UE | Patient liability/Unassigned equipment | Use when the accessory is billed as patient-liability (non-covered) equipment |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
145H00000X | Physical Medicine & Rehabilitation (Physiatry) | Clinicians who evaluate and prescribe mobility equipment and controls |
223000000X | Occupational Therapy | Therapists who assess and train patients on sip-and-puff systems and controls |
331D00000X | Durable Medical Equipment & Supplies Provider | Suppliers and techs who furnish and install wheelchair accessories |
207L00000X | Physical Therapy | Provides mobility assessment and training related to powered wheelchair use |
367500000X | Prosthetics & Orthotics | May be involved when custom mounts or interfaces are required |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
G82.50 | Paraplegia, unspecified | Patients with lower extremity paralysis who may require powered mobility and alternative controls |
G82.20 | Quadriplegia, unspecified | High-level spinal cord injury resulting in loss of hand function; sip-and-puff controls commonly used |
G12.21 | Amyotrophic lateral sclerosis (ALS) | Progressive neuromuscular weakness often necessitating alternative control systems for wheelchairs |
G35 | Multiple sclerosis | Neurologic impairment with motor deficits where adaptive control interfaces are used to preserve independence |
Q04.3 | Congenital hydrocephalus (and other congenital CNS malformations) | Pediatric or adult congenital conditions resulting in significant motor impairment requiring alternative control systems |
R26.89 | Other abnormalities of gait and mobility | Patients with severe mobility limitations who may benefit from powered wheelchair with alternative controls |
S14.109A | Unspecified injury of cervical spinal cord, initial encounter | Traumatic cervical spinal cord injuries frequently lead to need for sip-and-puff control interfaces |
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 | Occupational or physical therapy training on use of sip-and-puff controls and functional mobility following accessory installation |
97535 | Self-care/home management training (e.g., activities of daily living and compensatory training), each 15 minutes | Training the patient in cleaning, maintenance, and safe operation of the sip-and-puff interface |
97760 | Orthotic(s) management and training, initial encounter | When additional orthotic or custom mounting components are managed in conjunction with the accessory installation |
97763 | Assistive technology assessment; modifications | Assessment and configuration of assistive technology control interfaces and programming for the powered wheelchair |
99070 | Supplies and materials (not included in procedure code) | Use to report non-covered supplies or small accessories provided in addition to the billed DME accessory |