| Chair Description |
HCPCS |
HCPCS Code Description |
| Metro |
E1037 |
Transport chair, pediatric size |
| Cruiser |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| Cruiser Planar |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| CruisAire |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| Scout |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| EZ Rider |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| EZ Rider Planar |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| Lite Rider |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| Convertible |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| Convertible Planar |
E1236 |
Wheelchair, pediatric size, folding adjustable, with seating system |
| Safari Tilt |
E1232 |
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system |
| Rodeo Tilt |
E1232 |
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system |
| CuddleBug |
E1232 |
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system |
| Cruiser Profiler |
E1238 |
Wheelchair, pediatric size, folding, adjustable, without seating system |
| Mountee: Base |
E1234 |
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system |
| Planar Seat |
E2292 |
Seat, planar, for pediatric size wheelchair including fixed attaching hardware |
| Planar Back |
E2291 |
Back, planar, for pediatric size wheelchair including fixed attaching hardware |
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| Transit Accessories |
HCPCS |
HCPCS Code Description |
| 2-Point Belt |
E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
| 3-Point Belt |
E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
| Adjustable Contour Headrest |
E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
| Anterior Trunk Support |
E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
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| Frame Options |
HCPCS |
HCPCS Code Description |
| Recline |
E1225 |
Wheelchair accessory, manual semi-reclining back(recline greater than 15 degrees, but less than 80 degrees), each |
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| Profiler |
HCPCS |
HCPCS Code Description |
| Adjustable Contouring Back System |
E2293 |
Back, contoured, for pediatric size wheelchair including fixed attaching hardware |
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| Pelvis Positioning Options |
HCPCS |
HCPCS Code Description |
| 2-Point Belt |
E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
| 3-Point Belt |
E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
| Support Cushion - General Use Flat Solid Seat |
E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
| Position Cushion - Medial Thigh Support/Anti Thrust |
E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
| Align Cushion - Lateral Pelvis/Lateral Thigh Support |
E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
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| Foot & Leg Positioning |
HCPCS |
HCPCS Code Description |
| Angle Adjustable Footplates |
K0040 |
Adjustable angle footplate, each |
| Medial Thigh Support (Abductor) |
E0957 |
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware |
| Lateral Thigh Support (Adductor) |
E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
| Medial Thigh Support (Pommel) |
E0957 |
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware |
| S/A Adj. Hardware for Left Lateral Thoracic Support |
E0128 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory |
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| Trunk Positioning |
HCPCS |
HCPCS Code Description |
| H-harness with Padded covers |
E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
| Anterior Trunk Support |
E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
| SA Adj. Lateral Support (Single Flap) with Scoli Strap |
E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
| Thoracic Support |
E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
| Hardware for Thoracic Support |
E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory |
| Adj Firm Lateral Thoracic Supports (Contoured) |
E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
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| Head Support |
HCPCS |
HCPCS Code Description |
| Padded Headwings |
E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
| Headrest Extension |
E0966 |
Manual wheelchair accessory, headrest extension, each |
| Adjustable Contour Headrest |
E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
| Contoured Firm Headrest |
E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
| Firm Backrest Extension - Flat or Contoured |
E0966 |
Manual wheelchair accessory, headrest extension, each |
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| Wheel Locks |
HCPCS |
HCPCS Code Description |
| Caster Lock |
K0073 |
Caster pin lock each |
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| Accessories |
HCPCS |
HCPCS Code Description |
| Upper Extremity Support Surface (Tray) |
E0950 |
Wheelchair accessory, tray, each |
| Crash Tested Foam Tray |
E0950 |
Wheelchair accessory, tray, each |
| Oxygen Tank Bag |
E0950 |
Wheelchair accessory, cylinder tank carrier, each |
| Rear Anti-Tip Tubes |
E0971 |
Manual wheelchair accessory, anti-tipping device, each |
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