HCPCS E0973: Wheelchair accessory, adjustable height, detachable armrest

## **HCPCS code E0973 documentation requirements** Proper documentation is crucial for reimbursement. The medical record must clearly support the medical necessity of the item. Key documentation elements often include: - **Written order/prescription**: A detailed written order (DWO) from the prescribing practitioner is generally required before the item is dispensed. It should include the patient's name, the item ordered (E0973), the date of the order, and the practitioner's signature. - **Medical necessity**: Documentation must verify that the patient requires an armrest height that is different from what is available with non-adjustable height armrests. Additionally, the patient typically spends a significant amount of time in the wheelchair (e.g., at least 2 hours per day, as per some payer policies) for the accessory to be considered medically necessary. Finally, the adjustable armrest is necessary to prevent complications, accommodate physical conditions, or facilitate the use of the wheelchair for mobility-related activities of daily living (MRADLs) within the home. - **Face-to-face evaluation (for the base wheelchair, if applicable)**: If this accessory is for a new power wheelchair or specific other mobility devices, a formal clinical evaluation by the prescribing practitioner and/or a physical/occupational therapist may be required. - **Other alternatives**: Documentation should explain why a less costly or non-adjustable alternative (such as a fixed or non-adjustable height detachable armrest, HCPCS code K0015) would not meet the patient's medical needs.

## **E0973 billing requirements** To properly bill for HCPCS code E0973, the following guidelines must be considered: - **Unit of service**: Billed as "each" (one unit for one complete armrest assembly). If both a left and a right armrest are provided, two units may be billed, often using the RT (Right side) and LT (Left side) modifiers on separate claim lines. - **Modifiers:** The following modifiers may be appended if needed: NU (New Equipment Purchase), RR (Rental), or UE (Used Equipment Purchase). These are typically required to indicate the nature of the transaction (purchase or rental). RT and LT are used for laterality if applicable. Other modifiers, like those indicating a capped rental period, may also apply based on payer policy. - **Bundling/separate payment**: E0973 (Adjustable Height, Detachable Armrest) is generally considered a priced-separately billable/reimbursable accessory. Non-adjustable height detachable armrests (K0015) are typically included in the base wheelchair price and are not separately reimbursed. - **Rental/purchase**: The code may be eligible for either rental or purchase, depending on the payer's guidelines and the classification of the item. Capped rental rules often apply to DME. - **Non-covered items**: An armrest or accessory that is primarily for leisure, vocational, or recreational activities is generally non-covered.

## **Other relevant codes** - **K0015**: Detachable, non-adjustable height armrest, replacement only, each - **K0017**: Detachable, adjustable height armrest, base, replacement only, each - **K0018**: Detachable, adjustable height armrest, upper portion, replacement only, each - **K0011**: Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking - **K0020**: Fixed, adjustable height armrest, pair - **K0733**: Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) - **E2209**: Accessory, arm trough, with or without hand support, each - **E2227**: Manual wheelchair accessory, gear reduction drive wheel, each - **E2230**: Manual wheelchair accessory, manual standing system