E1235 HCPCS code: Wheelchair, pediatric size, rigid, adjustable, with seating system
E1235 is the HCPCS Level II code for wheelchair, pediatric size, rigid, adjustable, with seating system. The 2026 Medicare DMEPOS fee schedule pays $264.72 to $317.70 (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 60% from 2022 to 2024 (78 to 125 services). In 2024, 19 suppliers billed Medicare for E1235 (rentals), serving 22 beneficiaries. Its average fee ranks 20 of 24 E12 codes billed RR (family range $16.56–$316.95).
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 | 2003-01-01 |
| Last action effective | 2014-04-01 |
2026 Medicare DMEPOS fee schedule for E1235
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $264.72 | $317.70 | $264.72 | $225.01 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $264.72 | — |
| AL | RR | $264.72 | — |
| AR | RR | $264.72 | — |
| AZ | RR | $264.72 | — |
| CA | RR | $264.72 | — |
| CO | RR | $264.72 | — |
| CT | RR | $264.72 | — |
| DC | RR | $264.72 | — |
| DE | RR | $264.72 | — |
| FL | RR | $264.72 | — |
| GA | RR | $264.72 | — |
| HI | RR | $264.72 | — |
| IA | RR | $264.72 | — |
| ID | RR | $264.72 | — |
| IL | RR | $264.72 | — |
| IN | RR | $264.72 | — |
| KS | RR | $264.72 | — |
| KY | RR | $264.72 | — |
| LA | RR | $264.72 | — |
| MA | RR | $264.72 | — |
| MD | RR | $264.72 | — |
| ME | RR | $264.72 | — |
| MI | RR | $264.72 | — |
| MN | RR | $264.72 | — |
| MO | RR | $264.72 | — |
| MS | RR | $264.72 | — |
| MT | RR | $264.72 | — |
| NC | RR | $264.72 | — |
| ND | RR | $264.72 | — |
| NE | RR | $264.72 | — |
| NH | RR | $264.72 | — |
| NJ | RR | $264.72 | — |
| NM | RR | $264.72 | — |
| NV | RR | $264.72 | — |
| NY | RR | $264.72 | — |
| OH | RR | $264.72 | — |
| OK | RR | $264.72 | — |
| OR | RR | $264.72 | — |
| PA | RR | $264.72 | — |
| PR | RR | $317.70 | — |
| RI | RR | $264.72 | — |
| SC | RR | $264.72 | — |
| SD | RR | $264.72 | — |
| TN | RR | $264.72 | — |
| TX | RR | $264.72 | — |
| UT | RR | $264.72 | — |
| VA | RR | $264.72 | — |
| VI | RR | $264.72 | — |
| VT | RR | $264.72 | — |
| WA | RR | $264.72 | — |
| WI | RR | $264.72 | — |
| WV | RR | $264.72 | — |
| WY | RR | $264.72 | — |
How the E1235 fee compares
| Measure | Value |
|---|---|
| Rank among 24 E12 codes billed RR (lowest = 1) | 20 |
| Family fee range (average of state fees) | $16.56–$316.95 |
| Rural fee uplift | — |
Who bills E1235 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 19 |
| Suppliers billing purchases | — |
| Referring clinicians | 22 |
| Medicare beneficiaries | 22 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 11 | 14 |
| 2023 | 17 | 18 |
| 2024 | 19 | 22 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E1235, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 78 | 14 | $184.96 | $138.98 |
| 2023 | 90 | 18 | $202.88 | $152.48 |
| 2024 | 125 | 22 | $201.08 | $143.37 |
States with the most E1235 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 28 | $150.62 |
| Washington | 17 | $147.20 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52497: Manual Wheelchair Bases - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- 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 E1235
- 2026-01-01: Average state fee (RR) rose 2.0%: $260.51 to $265.72
- 2003-01-01: E1235 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 E1235?
E1235 is the HCPCS Level II code for wheelchair, pediatric size, rigid, adjustable, with seating system. Short descriptor: "Rigid ped wc adjustable".
How much does Medicare pay for E1235?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $264.72–$317.70. Rural fees can be higher.
Does Medicare cover E1235?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for E1235 change in 2026?
The average non-rural state fee for RR moved from $260.51 in 2025 to $265.72 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of E1235 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)
- E1225 — Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each ($43.15–$70.60)
- 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)
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Next steps
- Run a reimbursement report for a device billed under E1235
- Watch E1235 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E1235
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.