Question 1

What is HCPCS code E1226?

Accepted Answer

HCPCS code E1226 is "Manual fully reclining back". Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each

Question 2

What category is E1226 in?

Accepted Answer

E1226 belongs to HCPCS Category E (Durable Medical Equipment (DME)).

Question 3

When should I use HCPCS code E1226?

Accepted Answer

Use E1226 when billing for manual fully 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 E1226 covered by Medicare?

Accepted Answer

Coverage for E1226 (Manual fully 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 E1226?

Accepted Answer

Documentation for E1226 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).