HCPCS E1226 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Durable Medical Equipment • Other Wheelchairs and Accessories |
| Common Place of Service | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for HCPCS E1226 by major payers:
$271.22
$328.73
$293.90
$561.47
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS E1226 | ||||||
United | E1226 | $23.29 | 1508900101 - MICHAEL KOCH | 208418894 - (GA) PATHOLOGY LAB OF GEORGIA LLC | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $119.11 | 1588640692 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566256 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $354.67 | 1255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN | 581685139 - (GA) THE MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $641.67 | 1992789721 - PHOEBE PUTNEY MEMORIAL HOSPITAL INC, PHOEBE PUTNEY MEMORIAL HOSPTIAL | 263792403 - PHOEBE PHYSICIAN GROUP INC | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $179.05 | 1790888089 - HOSPITAL AUTHORITY OF CANDLER COUNTY, CANDLER COUNTY HOSPITAL | 586004640 | GA | Critical Access Hospital (282NC0060X) |
United | E1226 | $351.66 | 1255891958 - PIEDMONT NEWTON EKG BILLING LLC | 582155150 - (GA) PIEDMONT NEWTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $271.45 | 1649646472 - LEIGH TAYLOR | 273818647 | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $812.10 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 582030692 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $271.45 | 1841651056 - KAMRAN RAJAEE | 273818647 | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $230.55 | 1417157405 - EMORY HEALTHCARE | 711018941 - CARDIAC ARRHYTHMIA INSTITUTE | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $354.67 | 1033191267 - STEPHENS COUNTY HOSPITAL AUTHORITY | 586001667 - (GA) STEPHENS COUNTY HOSPITAL AUTHORITY | GA | Rural Acute Care Hospital (282NR1301X) |
United | E1226 | $358.01 | 1790942381 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM MEDICAL CENTER - TATTNALL | 300466706 | GA | Critical Access Hospital (282NC0060X) |
United | E1226 | $36.50 | 1235129214 - EMANUEL COUNTY HOSPITAL AUTHORITY, EMANUEL MEDICAL CENTER | 586002922 | GA | Rural Acute Care Hospital (282NR1301X) |
United | E1226 | $203.58 | 1841651056 - KAMRAN RAJAEE | 273818647 | GA | General Acute Care Hospital (282N00000X) |
United | E1226 | $230.55 | 1417157405 - EMORY HEALTHCARE | 901116753 | GA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
HCPCS E1226 vs. Other Other Wheelchairs and Accessories Codes
The HCPCS E1226 code is part of the Durable Medical Equipment services used for Other Wheelchairs and Accessories. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS E1226 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| E1225 | Moderate | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
| E1226 | Moderate | Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
| E1227 | Moderate | Special height arms for wheelchair |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS E1226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the E1226 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS E1226) and we'll show you how you compare in 15 minutes or less.
Medicare Reimbursement Lookup Tool
PayerPrice provides a free medicare lookup tool for physician fee schedule, drug ASP, MS-DRG weights, anesthesia conversion factors and other medicare related data.