CC-Manual Swingaway

New HCPCS Codes for Wheelchair Accessories Effective April 1, 2025

Noel Neil | April 28, 2025 |

COMPLIANCE CORNER UPDATE

The Pricing Data Analysis and Coding Contractor (PDAC), Palmetto GBA, submitted a request to revise HCPCS Level II code E1028 and establish three new HCPCS Level II codes to further identify wheelchair mounting hardware accessories. Palmetto GBA further requested HCPCS Level II code E1028 be revised to account for any type of mounting hardware that does not fall into the three requested new HCPCS Level II codes. ACU-Serve and other industry stakeholders submitted written support of the request during the Centers for Medicare & Medicaid Services’ (CMS) Healthcare Common Procedure Coding System (HCPCS) Level II Second Biannual (B2), 2024 Coding Cycle. Additionally, we asked CMS to consider adding purchase option for the newly created codes allowing patient to purchase these accessories when used with a complex rehabilitative technology (CRT) power wheelchair. Finally, we asked CMS to consider the various fee schedule options available for the E1028 and to ensure all the same prices will apply to the new codes. CMS’ final decision addressed all the concerns shared in the comments. Below is a summary of our understanding along with some practical recommendations:

Per the CGS March 13, 2025 publication titled New HCPCS Codes for Wheelchair Accessories – Coding and Billing, “Effective for dates of service on or after April 1, 2025, CMS is revising HCPCS code E1028 and creating three (3) new HCPCS codes for wheelchair accessories:

  1. Revise existing HCPCS Level II code E1028, “Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory” to instead read “Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other”
  2. Establish a new HCPCS Level II code E1032, “Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface.”
  3. Establish a new HCPCS Level II code E1033, “Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type”
  4. Establish a new HCPCS Level II code E1034, “Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type”

Codes E1032, E1033 and E1034 are in the capped rental payment category. To avoid potential overpayments, items previously coded and billed under E1028 that are still in the capped rental period should continue to be billed under code E1028 rather than switching mid-capped rental to the new HCPCS code. Codes E1032, E1033 and E1034 must only be billed for new items dispensed with dates of service on or after April 1, 2025.”

  • CMS will update the common working file (CWF) to load the HCPCS codes E1032, E1033 and E1034 as capped rental item with the BP purchase option when used on a CRT power wheelchair.    
  • Medicare will pay the (2015) unadjusted fee schedule amount for the E1028, E1032, E1033, and E1034 when these codes are used on a group 3 power wheelchair or a manual CRT chair: K0005 or E1161. Suppliers must append the KU modifier to receive the unadjusted pricing.
  • Medicare will pay the adjusted fee schedule amount for the E1028, E1032, E1033, and E1034 when they are used on a group 2 power CRT wheelchair (K0835-K0843) as these chairs were never included in the competitive bidding program. Suppliers must append the KY modifier to receive the adjusted fee schedule for beneficiaries who reside in the former CBA. Failure to append the KY modifier will result in the default rate of the single payment amount (SPA) which is lower than the adjusted fee schedule. 
  • Medicare will pay the adjusted fee schedule amount for the E1028, E1032, E1033, and E1034 when used on a manual and power wheelchair previously included in competitive bidding program only for the beneficiaries whose permanent address is outside of the former CBA. For example, Medicare will pay the adjusted fee schedule for the E1028 used on a K0001 or a K0823 for a beneficiary whose permanent address is outside of the former CBA.  
  • Medicare will pay the single payment amount (SPA) for the E1028, E1032, E1033, and E1034 when used on a manual and power wheelchair previously included in the competitive bidding program for the beneficiaries whose permanent address is inside the former CBA. For example, Medicare will pay the SPA for the E1028 used on a K0001 or a K0823 for a beneficiary whose permanent address is inside of the former CBA. Suppliers can locate the former CBA zip codes and SPA by quarter at DMEPOS Fee Schedule Files | CMS.

Practical Recommendations/Reminders:

  • Suppliers should check with their software vendors to ensure these new codes are updated for Medicare FFS.
  • Suppliers should ensure their billing staff is aware of the changes so the appropriate HCPCS code can be billed to avoid rejections or delays in payment. The billing staff should also be made aware of the appropriate pricing modifiers. 
  • Technically the newly created codes should identify the accessory they will be used on based on their description, however, ACU-Serve recommends suppliers continue to include the narrative on the claims where applicable to identify the accessory the hardware will be used on. For example, E1034 can be used with lateral trunk or hip support. 
  • Out of an abundance of caution and to avoid delays in payment, suppliers are encouraged to specify which accessory the hardware will be used with; trunk or hip support.
  • We believe suppliers should continue billing the E1028 when used with the E0953; lateral thigh or knee support as CMS did not create a specific code for those accessories.
  • If the SWO is signed prior to April 01, 2025, contains only the HCPCS E1028 and the items are delivered on or after April 01, 2025, Medicare will require a new SWO prior to the claim submission reflecting the appropriate code E1032, E1033 or E1034. For example, your SWO signed 03/15/2025 had the E1028 for the removable headrest hardware but it wasn’t delivered until April 15, 2025, supplier would need a new SWO prior to claim submission for the E1033. However, if instead of only the HCPCS code E1028, the supplier had a generic description or a detailed description for the actual item provided on the SWO, a new SWO will not be required.
  • If you are working on new chairs for Medicare that have not yet been submitted for prior authorization or ADMC, it is our recommendation to include the new codes, generic description or detail description for the new codes as it is unlikely those chairs will be authorized and delivered prior to April 01, 2025.
  • Be mindful that other payers such as Medicaid, Medicaid MCO, Medicare Advantage and Commercial Plans may or may not adopt the new codes. We encourage you to work closely with your ACU-Serve
  • Client Success Manager and our internal billing team to update your billing codes as payers slowly adopt the new codes. 

Soft Definitions:

  • Unadjusted Fee Schedule: This is the 2015 fee schedule prior to the implementation of the competitive bidding program.
  • Single Payment Amount (SPA): This is the fee schedule established by the competitive bidding program.
  • Adjusted Fee Schedule: The is the current rural and non-contiguous (non-rural) fee schedule. CMS established these fee schedules by blending the unadjusted fee schedule and the single payment amount.

If you have additional questions or concerns, please do not hesitate to contact Noel Neil directly at [email protected].