E1225 HCPCS code: Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each
E1225 is the HCPCS Level II code for wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each. The 2026 Medicare DMEPOS fee schedule pays $43.15 to $61.82 (RR, rental (monthly)) depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 20% from 2022 to 2024 (11,687 to 14,018 services). In 2024, 478 suppliers billed Medicare for E1225 (rentals), serving 2,557 beneficiaries; New Jersey, California, Massachusetts accounted for 26% of services. Its average fee ranks 4 of 24 E12 codes billed RR (family range $16.56–$316.95); rural fees run 4% higher.
Code details
| Field | Value |
|---|---|
| Section | E codes — Durable medical equipment |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 36 — DMEPOS: capped rental item |
| BETOS category | D1D — Wheelchairs |
| Added | 1986-01-01 |
| Last action effective | 2005-01-01 |
2026 Medicare DMEPOS fee schedule for E1225
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $43.15 | $61.82 | — | — |
| RR | rental (monthly) | $49.77 | $70.60 | $64.41 | $54.75 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $49.78 | — |
| AL | RR | $54.75 | $52.76 |
| AR | RR | $61.66 | $56.21 |
| AZ | RR | $64.05 | $57.41 |
| CA | RR | $54.75 | $52.76 |
| CO | RR | $62.70 | $56.74 |
| CT | RR | $64.41 | $57.59 |
| DC | RR | $64.41 | $57.59 |
| DE | RR | $64.41 | $57.59 |
| FL | RR | $54.75 | $52.76 |
| GA | RR | $57.86 | $54.32 |
| HI | RR | $53.24 | — |
| IA | RR | $64.41 | $57.59 |
| ID | RR | $64.41 | $57.59 |
| IL | RR | $64.41 | $57.59 |
| IN | RR | $64.41 | $57.59 |
| KS | RR | $64.41 | $57.59 |
| KY | RR | $64.41 | $57.59 |
| LA | RR | $57.97 | $54.38 |
| MA | RR | $54.75 | $52.76 |
| MD | RR | $64.41 | $57.59 |
| ME | RR | $54.75 | $52.76 |
| MI | RR | $63.06 | $56.91 |
| MN | RR | $64.41 | $57.59 |
| MO | RR | $64.41 | $57.59 |
| MS | RR | $57.79 | $54.28 |
| MT | RR | $64.41 | $57.59 |
| NC | RR | $54.75 | $52.76 |
| ND | RR | $59.97 | $55.36 |
| NE | RR | $64.41 | $57.59 |
| NH | RR | $54.75 | $52.76 |
| NJ | RR | $64.41 | $57.59 |
| NM | RR | $61.00 | $55.88 |
| NV | RR | $64.41 | $57.59 |
| NY | RR | $64.41 | $57.59 |
| OH | RR | $64.41 | $57.59 |
| OK | RR | $61.86 | $56.31 |
| OR | RR | $64.41 | $57.59 |
| PA | RR | $64.41 | $57.59 |
| PR | RR | $70.60 | — |
| RI | RR | $54.75 | $52.76 |
| SC | RR | $56.91 | $53.84 |
| SD | RR | $64.41 | $57.59 |
| TN | RR | $54.75 | $52.76 |
| TX | RR | $54.75 | $52.76 |
| UT | RR | $64.41 | $57.59 |
| VA | RR | $57.82 | $54.30 |
| VI | RR | $64.41 | — |
| VT | RR | $54.75 | $52.76 |
| WA | RR | $64.41 | $57.59 |
| WI | RR | $55.37 | $53.06 |
| WV | RR | $64.41 | $57.59 |
| WY | RR | $64.41 | $57.59 |
How the E1225 fee compares
| Measure | Value |
|---|---|
| Rank among 24 E12 codes billed RR (lowest = 1) | 4 |
| Family fee range (average of state fees) | $16.56–$316.95 |
| Rural fee uplift | 3.7% |
Who bills E1225 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 478 |
| Suppliers billing purchases | — |
| Referring clinicians | 1,976 |
| Medicare beneficiaries | 2,557 |
| States with claims | 47 |
| Share of services in top 3 states (New Jersey, California, Massachusetts) | 26% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 446 | 2,142 |
| 2023 | 449 | 2,278 |
| 2024 | 478 | 2,557 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E1225, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 11,687 | 2,142 | $39.27 | $30.34 |
| 2023 | 12,193 | 2,278 | $43.15 | $33.31 |
| 2024 | 14,018 | 2,557 | $44.38 | $34.34 |
States with the most E1225 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New Jersey | 1,387 | $31.93 |
| California | 1,331 | $32.95 |
| Massachusetts | 930 | $28.27 |
| Texas | 922 | $32.76 |
| Ohio | 878 | $39.15 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52504: Wheelchair Options/Accessories - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for E1225
- 2026-01-01: Average state fee (RR) rose 2.3%: $52.70 to $53.90
- 1986-01-01: E1225 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code E1225?
E1225 is the HCPCS Level II code for wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each. Short descriptor: "Manual semi-reclining back".
How much does Medicare pay for E1225?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $43.15–$61.82; RR (rental (monthly)): $49.77–$70.60. Rural fees can be higher.
Does Medicare cover E1225?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for E1225 change in 2026?
The average non-rural state fee for RR moved from $52.70 in 2025 to $53.90 in 2026 (+2.3%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of E1225 can be billed per day?
1 on DME suppliers (NCCI medically unlikely edits).
Related E12 codes
- E1200 — Amputee wheelchair, fixed full length arms, swing away detachable footrest ($105.40–$179.59)
- E1220 — Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification
- E1221 — Wheelchair with fixed arm, footrests ($57.56–$87.75)
- E1222 — Wheelchair with fixed arm, elevating legrests ($82.09–$129.73)
- E1223 — Wheelchair with detachable arms, footrests ($89.66–$122.59)
- E1224 — Wheelchair with detachable arms, elevating legrests ($98.31–$139.00)
- E1226 — Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each ($41.94–$1,539.67)
- E1227 — Special height arms for wheelchair ($17.79–$474.54)
- E1228 — Special back height for wheelchair ($33.95–$41.50)
- E1229 — Wheelchair, pediatric size, not otherwise specified
- E1230 — Power operated vehicle (three or four wheel nonhighway) specify brand name and model number ($269.48–$3,830.63)
- E1231 — Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under E1225
- Watch E1225 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E1225
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.