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By Kim Turner, RN

HCPCS E1028 is a wheelchair options and accessories code defined as a "wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory".

One example (not all-inclusive) of a covered indication for swing-away, retractable, or removable hardware (E1028) would be to move the component out of the way so that a beneficiary can perform a slide transfer to a chair or bed while utilizing a manual or power wheelchair.

When billing HCPCS E1028 for dates of service on/after March 1, 2020, Item 19 of the CMS-1500 claim form or the electronic equivalent must include the accessory HCPCS code for which HCPCS E1028 was used. Examples includes “swing-away joystick” or “removable headrest mount”.

If Item 19 of the CMS-1500 claim form or the electronic equivalent is left blank, the claim will reject as unprocessable. Because an unprocessable claim does not have appeal rights, it cannot be reopened or submitted for adjustment. It must be resubmitted as a new claim.

Medicare coverage and payment reminder: swing-away, retractable, or removable hardware (E1028) is non-covered if the primary indication for its use is to allow the beneficiary to move close to desks or other surfaces while seated in a manual or power wheelchair. If it ordered for this indication, a GY modifier must be added to the code (example: E1028NUGY).

If you would like more information on this new requirement, contact The van Halem Group today!