E2607 Wheelchair Seat Cushion HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS E2607: Skin Protection & Positioning Wheelchair Seat Cushion

HCPCS Level II code E2607 represents a skin protection and positioning wheelchair seat cushion for widths under 22 inches. This durable medical equipment code identifies seating devices designed to prevent pressure injury and support posture for wheelchair users. Nationally, proper coding of seating cushions affects access to medically necessary equipment for individuals with mobility and pressure-relief needs and impacts claims processing across private and public payers.

Key payers included in this national overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of what the code covers clinically and operationally, an outline of payer coverage considerations, and the common contexts in which the item is supplied. The publication addresses billing benchmarks, typical sites of service, and coding practice nuances relevant to durable medical equipment suppliers and billing staff.

The analysis clarifies how E2607 fits within wheelchair seating services, highlights policy and documentation considerations that commonly affect coverage decisions, and summarizes typical payer approaches to similar seating cushion claims. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareE2607HCPCS Level IIwheelchair seatingdurable medical equipmentpressure redistributionwheelchair cushionmedical billingDME policy

Billing Code Overview

HCPCS Level II code E2607 denotes a skin protection and positioning wheelchair seat cushion specified for a width less than 22 inches, any depth. The item is a durable medical equipment product intended to reduce pressure and provide postural support for wheelchair users.

Service type: Durable Medical Equipment (DME) — wheelchair seating accessory

Typical site of service: Outpatient, home, or community settings where wheelchairs are used (e.g., home, skilled nursing, outpatient clinics)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with advanced bilateral hip osteoarthritis and limited mobility is evaluated by a durable medical equipment supplier after discharge from an inpatient rehabilitation stay. The patient uses a manual wheelchair for community mobility but has fragile skin and a history of stage II sacral pressure injury that healed with scarring. The clinician documents persistent localized pressure over the ischial tuberosities and reports frequent seat changes due to pain. An assessment indicates the patient requires a wheelchair cushion to provide skin protection and positioning. The supplier orders a skin protection and positioning wheelchair seat cushion described by HCPCS code E2607 (width less than 22 inches) to reduce shear and pressure, improve seated posture, and protect previously injured skin.

Clinical workflow:

Referral and prescription: The treating physician documents medical necessity, including diagnosis codes, mobility limitations, and prior conservative measures, and issues a DMEPOS order for a pressure-reducing wheelchair cushion.
Assessment: A physical or occupational therapist performs a seating assessment addressing skin integrity, pressure distribution, postural alignment, and measurements to confirm the required cushion width (less than 22 inches).
Procurement and delivery: The DME supplier verifies payer coverage, assigns appropriate modifiers for claim adjudication, delivers the E2607 cushion, provides fitting and education, and documents the patient’s tolerance and instructions for skin checks.
Follow-up: The clinician documents outcomes of use, any skin changes, and rationale for adjustments or replacement when clinically indicated.

Coding Specifications

Related Codes

HCPCS-E1637-HEMOSTATS-SINGLE-UNIT

HCPCS E1637: Hemostats, Single Unit

HCPCS-E1902-COMMUNICATION-BOARD-NON-ELECTRONIC-AAC-DEVICE

HCPCS Level II E1902: Communication Board, Non-Electronic AAC Device

HCPCS-E0157-CRUTCH-ATTACHMENT-WALKER

HCPCS E0157: Crutch Attachment for Walker, Each

HCPCS-E0740-NON-IMPLANTED-PELVIC-FLOOR-STIMULATOR-COMPLETE-SYSTEM

HCPCS E0740: Non-implanted Pelvic Floor Electrical Stimulator, Complete System

HCPCS-E2359-POWER-WHEELCHAIR-SEALED-LEAD-ACID-BATTERY

HCPCS E2359: Power Wheelchair Sealed Lead Acid Battery

HCPCS-E0485-ORAL-APPLIANCE-UPPER-AIRWAY-COLLAPSIBILITY

HCPCS E0485: Prefabricated Oral Appliance to Reduce Upper Airway Collapsibility

HCPCS-E0203-THERAPEUTIC-LIGHTBOX-10000-LUX-TABLETOP

HCPCS E0203: Therapeutic Lightbox, 10,000 lux Tabletop

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

HCPCS E0116: Underarm Crutch, Non‑Wood, Adjustable or Fixed

HCPCS-E0755-ELECTRONIC-SALIVARY-REFLEX-STIMULATOR-INTRA-ORAL

HCPCS E0755: Electronic Salivary Reflex Stimulator, Intra-Oral

HCPCS-E2330-POWER-WHEELCHAIR-HEAD-CONTROL-PROXIMITY-SWITCH

HCPCS E2330: Power Wheelchair Head Control, Proximity Switch

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Modifier	Description	When to Use
`KA`	Data not available in the input.	Data not available in the input.
`22`	Increased procedural services	Use when unusual procedural services beyond the typical supply or delivery complexity are documented (e.g., extensive customization or complex fitting).
`52`	Reduced services	Use when the item is provided with reduced scope, quantity, or both compared to the full description (document reason in record).
`53`	Discontinued procedure	Use if order is cancelled prior to delivery after initiation of the procurement process and documentation supports cancellation.
`62`	Two surgeons	Generally not applicable to DME supply; not typically used for `E2607`.
`80`	Assistant surgeon	Not applicable for DME supply; not typically used for `E2607`.
`KX`	Requirements specified in the medical policy are met	Use when the supplier and prescriber attest that payer-specific documentation and coverage criteria are satisfied.
`KY`	Item/service statutorily excluded, not paid by Medicare	Use when furnishing a cushion that Medicare statutorily excludes; supports correct adjudication with non-covered status.
`RR`	Recovering supplier billing	Use when a subcontractor or secondary supplier bills for services performed under arrangement with primary supplier.
`QK`	Performance and payment by an enrolled therapist	Use when an enrolled physical or occupational therapist performs a billing action related to custom seating evaluation (payer-dependent).
`TC`	Technical component	Use if billing separates technical components (rare for DME; used when a supplier bills technical supply separate from professional fitting).
`UE`	Services furnished in whole or part by a provider in the outpatient physical therapy department of a CAH	Use when applicable to facility-specific billing rules (payer-dependent).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when these clinicians perform parts of the furnishing or fitting service as allowed by payer rules.
`GY`	Item/service statutorily non-covered/by payer policy	Use when noting the item is not covered by the payer but is provided anyway; supports denial reason on claim.

Taxonomy Code	Specialty	Notes
`208N00000X`	Physical Therapist	Performs seating assessment, measurement, and functional evaluation for cushion selection.
`225100000X`	Occupational Therapist	Conducts skin integrity and positioning assessments and trains the patient/caregiver on cushion use.
`332B00000X`	Durable Medical Equipment Supplier	Orders, fits, and provides the wheelchair cushion and documents delivery and training.
`208000000X`	Physical Medicine & Rehabilitation Physician	Documents medical necessity and prescribes the appropriate pressure-relief cushion.
`207Q00000X`	Family Medicine Physician	May document follow-up care and ongoing need for the cushion.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M19.90`	Osteoarthritis, unspecified site, unspecified	Common cause of reduced mobility and prolonged sitting, necessitating pressure-relieving seating.
`L89.154`	Pressure ulcer of sacral region, stage 2	History of sacral pressure injury indicates need for skin protection cushions to prevent recurrence.
`R26.2`	Difficulty in walking, not elsewhere classified	Ambulatory limitation increases time spent seated and may require a therapeutic seat cushion.
`G82.20`	Paraplegia, unspecified	Neurologic impairment increases risk of pressure injuries and requires specialized skin protection cushions.
`M62.81`	Muscle weakness (generalized)	Weakness affecting transfers and repositioning increases dependence on supportive cushioning to prevent skin breakdown.

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	Performed by occupational or physical therapists to assess functional transfers and seating impact before or after cushion provision.
`97162`	Physical therapy evaluation, moderate complexity	Used when a therapist performs a standard evaluation that informs cushion selection and documentation of functional limitations.
`97755`	Assistive technology assessment (e.g., seating and mobility), each 15 minutes	Directly relevant for comprehensive seating and mobility evaluations that support medical necessity for `E2607`.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	Data not applicable to wheelchair cushion fitting; include only clinically relevant codes.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used by physicians to document medical necessity, review response to cushion, and manage ongoing care.