Summary & Overview
HCPCS E2617: Custom Fabricated Wheelchair Back Cushion, Any Size
HCPCS Level II code E2617 represents a custom fabricated wheelchair back cushion, including any required mounting hardware. Custom seating components like this are clinically important because they address individual postural and pressure needs, reduce risk of skin breakdown, and support mobility and functional independence for people who use wheelchairs. Nationally, these items are a significant component of durable medical equipment spending for complex mobility needs and are subject to varied payer coverage policies and documentation requirements.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of typical coverage and authorization practices across major payers, common billing and documentation expectations, and benchmarks for utilization and reimbursement where available. The publication also outlines clinical context for medical necessity determinations, typical sites of service for evaluation and fitting, and common service descriptors used in claims. Data not available in the input is noted where applicable.
This resource is designed for billing professionals, DME suppliers, clinicians involved in seating evaluations, and policy analysts seeking concise guidance on the role and payer considerations for custom wheelchair back cushions under HCPCS Level II code E2617.
Billing Code Overview
HCPCS Level II code E2617 describes a custom fabricated wheelchair back cushion, any size, including any type mounting hardware. This item is a durable medical equipment accessory fabricated to individual patient specifications to provide postural support and pressure redistribution for wheelchair users.
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Service type: Durable medical equipment (custom wheelchair seating component)
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Typical site of service: Durable medical equipment suppliers, prosthetic/orthotic clinics, outpatient rehabilitation settings, and patient homes when delivered and fitted by a supplier
Clinical & Coding Specifications
Clinical Context
A 68-year-old man with progressive postural instability and chronic lower back pain following a spinal cord injury presents to an outpatient durable medical equipment (DME) clinic for seating evaluation. He uses a manual wheelchair for community mobility but reports discomfort, increased sacral pressure, and mid‑thoracic kyphosis that impair sitting tolerance. A physical therapist performs a pressure-mapping assessment and postural analysis, documents asymmetrical weight-bearing and risk for skin breakdown over the sacrum and ischial tuberosities, and recommends a custom fabricated wheelchair back cushion for improved trunk support and pressure redistribution. The DME supplier measures the client, captures mounting requirements for the specific wheelchair frame, fabricates the custom back cushion including required mounting hardware, and coordinates delivery and fitting. Medicare or a commercial payor such as Aetna, Blue Cross Blue Shield, Cigna Health, or UnitedHealthcare receives documentation including the seating evaluation, measurable functional goals, photos/measurements of the wheelchair, and the certificate of medical necessity prior to authorization. Follow-up includes fit check and potential adjustments after delivery to verify proper support and skin protection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |