CMS, PDAC detail plans for new E1028 code

By HME News Staff
Updated 8:05 AM CST, Mon January 20, 2025
WASHINGTON – CMS has accepted some but not all NCART’s recommendations as part of its preliminary decision on the PDAC’s code application to review E1028 and establish three new codes to describe manual, swing-away and retractable or removable mounting hardware used in conjunction with medically necessary wheelchair accessories. NCART agreed with the programmatic need for the change but requested CMS consider several edits to more accurately describe the components associated with the hardware. CMS accepted the organization’s submitted description for E1032 and recognized the use of this type of hardware with other wheelchair accessories (like lateral thigh and knee supports, and medial thigh supports) but did not add its requested code EXXX4 as these components fall under the descriptions of “other” in the new E1028 HCPCS code. The new codes and descriptions are as follows:
- E1028 – Wheelchair accessory, manual swing-away, retractable or removable mounting hardware, other
- E1032 – Wheelchair accessory, manual swing-away, retractable or removable mounting hardware used with joystick or other drive control interface
- E1033 – Wheelchair accessory, manual swing-away, retractable or removable mounting hardware for headrest, cushioned, any type
- E1034 – Wheelchair accessory, manual swing-away, retractable or removable mounting hardware for lateral trunk or hip support, any type
The new E1028 HCPCS code is in the capped rental pricing category, has an established reimbursement rate and may be purchased in the first month when used on a CRT wheelchair. NCART recommended CMS map the reimbursement rate for the new codes to the E1028 code, recognize and implement the KU modifier for the new codes, and permit the purchase option in alignment with E1028. CMS acknowledged the fee schedules for the new codes will be mapped to the E1028 HCPCS codes by state. In addition, the KU modifier and purchase option will be recognized.
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