Question 1

What is HCPCS code E1225?

Accepted Answer

HCPCS code E1225 is "Manual semi-reclining back". Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each

Question 2

What category is E1225 in?

Accepted Answer

E1225 belongs to HCPCS Category E (Durable Medical Equipment (DME)).

Question 3

When should I use HCPCS code E1225?

Accepted Answer

Use E1225 when billing for manual semi-reclining back. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is E1225 covered by Medicare?

Accepted Answer

Coverage for E1225 (Manual semi-reclining back) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for E1225?

Accepted Answer

Documentation for E1225 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).