E1238 HCPCS code: Wheelchair, pediatric size, folding, adjustable, without seating system
E1238 is the HCPCS Level II code for wheelchair, pediatric size, folding, adjustable, without seating system. The 2026 Medicare DMEPOS fee schedule pays $233.55 to $280.26 (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 fell 17% from 2022 to 2024 (374 to 310 services). In 2024, 41 suppliers billed Medicare for E1238 (rentals), serving 60 beneficiaries; Florida, South Carolina, Texas accounted for 52% of services. Its average fee ranks 18 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 E1238
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $233.55 | $280.26 | $233.55 | $198.52 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $233.55 | — |
| AL | RR | $233.55 | — |
| AR | RR | $233.55 | — |
| AZ | RR | $233.55 | — |
| CA | RR | $233.55 | — |
| CO | RR | $233.55 | — |
| CT | RR | $233.55 | — |
| DC | RR | $233.55 | — |
| DE | RR | $233.55 | — |
| FL | RR | $233.55 | — |
| GA | RR | $233.55 | — |
| HI | RR | $233.55 | — |
| IA | RR | $233.55 | — |
| ID | RR | $233.55 | — |
| IL | RR | $233.55 | — |
| IN | RR | $233.55 | — |
| KS | RR | $233.55 | — |
| KY | RR | $233.55 | — |
| LA | RR | $233.55 | — |
| MA | RR | $233.55 | — |
| MD | RR | $233.55 | — |
| ME | RR | $233.55 | — |
| MI | RR | $233.55 | — |
| MN | RR | $233.55 | — |
| MO | RR | $233.55 | — |
| MS | RR | $233.55 | — |
| MT | RR | $233.55 | — |
| NC | RR | $233.55 | — |
| ND | RR | $233.55 | — |
| NE | RR | $233.55 | — |
| NH | RR | $233.55 | — |
| NJ | RR | $233.55 | — |
| NM | RR | $233.55 | — |
| NV | RR | $233.55 | — |
| NY | RR | $233.55 | — |
| OH | RR | $233.55 | — |
| OK | RR | $233.55 | — |
| OR | RR | $233.55 | — |
| PA | RR | $233.55 | — |
| PR | RR | $280.26 | — |
| RI | RR | $233.55 | — |
| SC | RR | $233.55 | — |
| SD | RR | $233.55 | — |
| TN | RR | $233.55 | — |
| TX | RR | $233.55 | — |
| UT | RR | $233.55 | — |
| VA | RR | $233.55 | — |
| VI | RR | $233.55 | — |
| VT | RR | $233.55 | — |
| WA | RR | $233.55 | — |
| WI | RR | $233.55 | — |
| WV | RR | $233.55 | — |
| WY | RR | $233.55 | — |
How the E1238 fee compares
| Measure | Value |
|---|---|
| Rank among 24 E12 codes billed RR (lowest = 1) | 18 |
| Family fee range (average of state fees) | $16.56–$316.95 |
| Rural fee uplift | — |
Who bills E1238 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 41 |
| Suppliers billing purchases | — |
| Referring clinicians | 59 |
| Medicare beneficiaries | 60 |
| States with claims | 9 |
| Share of services in top 3 states (Florida, South Carolina, Texas) | 52% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 42 | 58 |
| 2023 | 35 | 51 |
| 2024 | 41 | 60 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E1238, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 374 | 58 | $160.92 | $118.15 |
| 2023 | 302 | 51 | $174.41 | $128.85 |
| 2024 | 310 | 60 | $181.43 | $136.00 |
States with the most E1238 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 44 | $150.40 |
| South Carolina | 28 | $137.09 |
| Texas | 27 | $142.84 |
| California | 25 | $132.72 |
| Nevada | 17 | $154.68 |
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 E1238
- 2026-01-01: Average state fee (RR) rose 2.0%: $229.83 to $234.43
- 2003-01-01: E1238 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 E1238?
E1238 is the HCPCS Level II code for wheelchair, pediatric size, folding, adjustable, without seating system. Short descriptor: "Fld ped wc adjstabl w/o seat".
How much does Medicare pay for E1238?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $233.55–$280.26. Rural fees can be higher.
Does Medicare cover E1238?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for E1238 change in 2026?
The average non-rural state fee for RR moved from $229.83 in 2025 to $234.43 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of E1238 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 E1238
- Watch E1238 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E1238
Sources: CMS HCPCS Level II release October 2025; 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.