HCPCS code E1007: Wheelchair accessory, power seating system

Obtain a list of the documentation and billing requirements needed to properly use and code HCPCS code E1007 from our short guide.

Use Code

## **What is HCPCS code E1007?** HCPCS code E1007, maintained by CMS, has a description of: "wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction," is a code that falls under Durable Medical Equipment (DME), specifically wheelchair accessories, and part of Complex Rehabilitation Technology (CRT). The equipment is an advanced wheelchair accessory designed to optimize seated posture, comfort, and pressure redistribution. It allows controlled, powered tilting and reclining movements, while mechanically reducing shear forces to protect skin integrity. This functionality aims to minimize the development of pressure ulcers, improve postural alignment, and support caregivers in providing pressure relief for individuals who cannot reposition independently. Suitable candidates often include wheelchair users with severe neuromuscular, spinal cord, or degenerative conditions necessitating sophisticated seating solutions.

## **HCPCS code E1007 documentation requirements** Coverage for power seating systems like E1007 is contingent upon detailed documentation demonstrating medical necessity. While specific requirements may vary by payer (e.g., Medicare, Medicaid, private insurance), general requirements often include: - **Physician Order/Standard Written Order (SWO)/ Prescription**: A detailed written order from a physician or other prescribing practitioner. - **Mobility limitation**: Documentation that the patient has a significant mobility limitation that impairs their ability to perform one or more Mobility-Related Activities of Daily Living (MRADLs), such as toileting, feeding, dressing, grooming, and bathing, in customary locations within the home. - **Power wheelchair need**: The patient must meet the medical necessity criteria for operating the Power Wheelchair (PWC) base with which the seating system is used. - **Specialty evaluation**: A comprehensive assessment, often performed by a licensed or certified medical professional (like a Physical Therapist or Occupational Therapist) with specific training in rehabilitation wheelchair evaluations. The wheelchair must be provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the beneficiary. This documentation must clearly justify the need for the combination tilt and recline function with mechanical shear reduction. - **Justification for tilt and recline**: Records must show that the patient must be unable to effectively reposition themselves independently in a standard seating system. Furthermore, the system must be required for specific medical reasons, such as managing pressure ulcers or high risk of their development, managing postural deformities or instability, etc. - **Justification for shear reduction**: Documentation must demonstrate the need for the mechanical shear reduction feature, often related to severe skin integrity issues or risk factors where minimizing shear is crucial during positional changes.

## **E1007 billing requirements** The reduce the chances of denied claims, the following guidelines must be considered by the healthcare provider: - **Authorization**: Prior Authorization (PA) or Certificate of Medical Necessity (CMN) is often required before dispensing the equipment. - **Units of Service (UOS)**: Typically, the unit of service is "each." - **Modifiers**: Appropriate modifiers are essential for correct billing, such as NU (New Equipment Purchase), RR (Rental), etc. - **Bundling/separate payment**: The item should not be billed separately if it's considered an integral part of another billed code or service (e.g., if the PWC base code includes this specific seating system as part of its basic equipment package—though this is rare for high-end accessories like E1007).

## **Other relevant codes** - **E1002**: Power seating system, tilt only - **E1003**: Power seating system, recline only, without shear reduction - **E1004**: Power seating system, recline only, with mechanical shear reduction - **E1005**: Power seating system, recline only, with power shear reduction - **E1006**: Power seating system, combination tilt and recline, without shear reduction - **E1008**: Power seating system, combination tilt and recline, with power shear reduction

Frequently asked questions

Yes. A qualified physical or occupational therapist (or practitioner trained in seating assessments with no financial interest in the supplier) must conduct an in-person evaluation and document the need for tilt, recline, and shear control.

No. E1007 is specifically an accessory for a power seating system, which is generally used with a power wheelchair (PWC) base (typically Group 3 or higher).

Mechanical shear reduction refers to a mechanism built into the power seating system that physically moves the seating components (like the backrest or seat) slightly as the system is reclined or tilted to minimize the friction and drag (shear force) exerted on the user's skin. This is a critical feature for users at high risk of pressure ulcers.