HCPCS Code E1236: Wheelchair, Pediatric Size, Folding, Adjustable, With Seating System

Learn about the HCPCS code E1236 for wheelchair, pediatric size, folding, adjustable, with seating system, through this guide.

Use Code

## **What is the HCPCS code E1236 for?** The HCPCS code E1236 is a manual wheelchair base code, intended to designate the customization, fitting, and provision of a pediatric-sized wheelchair. When a wheelchair is considered to have a complete manual wheelchair base, it means it has the following: - A complete wheelchair frame - Propulsion wheels - Casters - Brakes - A sling seat and seat pan that can accommodate a wheelchair seat cushion, or a seat frame structured in such a way that it can accommodate a seating system - A sling back and other seat back support that can accommodate a wheelchair back cushion, or a back frame structured in a way that allows it to accommodate a back system - Standard leg and footrests, armrests, safety accessories The wheelchair this HCPCS code designates has all these, plus a foldable frame that makes it easy for storage and transport. For Medicare coding purposes, this code designates a complete product. It also comes with adjustable components to accommodate the growth of the child using it, plus a specialized seating system that can provide the child with comfort and ensure they have proper posture. It's meant to be provided to children with disabilities, especially those who have conditions like spinal cord injuries, cerebral palsy, muscular dystrophy, and other muscular or neurological problems.

## **Documentation requirements for E1236** As with all HCPCS codes, this one requires documentation. Please make sure you have the following: The full name of the pediatric patient - A comprehensive evaluation by a qualified provider/professional (e.g., a physical therapist, occupational therapist, pediatric physician, etc.) that addresses the child patient's functional limitations and justifies the need for a specialized mobility device. This has to support medical necessity, and not for the convenience of caregivers - The full name of the healthcare professional/provider handling the child - The child's medical records indicating the reason why standard wheelchairs are inadequate or inappropriate for the child - Specific customizations/adjustments made for the wheelchair to accommodate the child's needs - An assessment of the child's home environment that supports the usability of the wheelchair that this code designates

## **Billing requirements for E1236** Besides the documentation requirements above, make sure to have a valid written order prior to provision, or written order prior to delivery. You must also use certain modifiers: - KX if all the LCD coverage criteria are met - GA if coverage criteria aren't met, but you have obtained a properly executed Advance Beneficiary Notice (ABN) - GZ if coverage criteria aren't met and no ABN was obtained - GY if the wheelchair is only used for mobility outside the home If you file a claim without any one of these modifiers, your claim will be rejected. Please follow CMS guidelines. Also, remember that this wheelchair, along with its customizations/adjustments, is billed as a full product. Separate components of the wheelchair are not reimbursable at the initial issuance. If repairs or replacements are necessary, please use the modifier RB.

## **Other similar codes** - **E1235** - Wheelchair, pediatric size, rigid, adjustable, with seating system - **E1232** - Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system - **E1238** - Wheelchair, pediatric size, folding, adjustable, without seating system - **E1234** - Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system - **E1233** - Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system

Frequently asked questions

It should take around an hour or two.

The reason for having a fitting and adjustment session is to make sure the child is comfortable in the seat. If the fit isn't perfect, it's possible for the child to deal with mild skin irritation, or worse, pressure sores. It's also important that the wheelchair is used properly and maintained regularly to prevent wear and tear from getting so bad that it increases the chance of them suffering injuries due to accidents.

Every 6 months is ideal because they are still growing.