Article Detail - JD DME

Claims billed with HCPCS code E1028 (wheelchair accessory, manual swing away, retractable or removable mounting hardware for joystick, other control interface or positioning accessory) must include a narrative description that indicates what the E1028 is to be used for (see examples below). This information must be included in the 2400 loop (line note), NTE02 segment (NTE01=ADD) of the ANSI X12N, version 5010A1 professional electronic claim format or in Item 19 on the paper claim form, the narrative field.

Any E1028 billed without a narrative will result in unprocessable claims that do not have appeal or reopening rights and cannot be adjusted. These claims cannot be adjusted and must be resubmitted as a new claim with a narrative.

An 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 from a power or manual wheelchair.

Narrative examples:
“Retractable joystick mounting"
“Removable headrest mount”

Since this code encompasses various types of hardware, suppliers must add a description for each E1028 that is billed.

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 wheelchair. If it is ordered for this indication, a GY modifier must be added to the code

Example with modifiers: E1028NUGY.

Additionally, the description provided should coincide with a corresponding HCPCS that requires or can accommodate specialty hardware.

Example: When billing an E1028 for swing away lateral support hardware, the corresponding code for lateral supports should be on the same claim. If your billing system does not allow this, then the corresponding code requiring the hardware must be in the beneficiary’s billing history or a claim processing at the same time for this item, for the E1028 to be paid.

Suppliers are reminded that fixed mounting hardware is not separately payable.

Suppliers are encouraged to read the entire Local Coverage Determination (LCD) and policy article for Wheelchair Options and Accessories and Wheelchair Seating for additional coverage, coding and documentation requirements.