HCPCS Range Other Wheelchairs and Accessories

• 1 Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification ( E1220 )

• 2 Wheelchair with fixed arm, footrests ( E1221 )

• 3 Wheelchair with fixed arm, elevating legrests ( E1222 )

• 4 Wheelchair with detachable arms, footrests ( E1223 )

• 5 Wheelchair with detachable arms, elevating legrests ( E1224 )

• 6 Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each ( E1225 )

• 7 Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each ( E1226 )

• 8 Special height arms for wheelchair ( E1227 )

• 9 Special back height for wheelchair ( E1228 )