MyMedi-AI

E0196 — Gel pressure mattress

HCPCS Level II E-code

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Capped rental
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

E0196 Medicare fee schedule (April 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $37.71 to $58.06 depending on state and rural status.

StateNon-ruralRural
AK$51.17
AL$37.71$44.79
AR$37.71$39.35
AZ$39.10$39.35
CA$38.74$44.79
CO$39.14$44.79
CT$40.39$44.79
DC$39.60$44.79
DE$39.60$44.40
FL$37.71$44.79
GA$37.71$39.35
HI$53.08
IA$39.35$39.35
ID$39.14$39.35
IL$42.18$44.79
IN$42.18$44.79
KS$39.69$44.79
KY$37.71$39.35
LA$37.71$39.35
MA$39.35$39.35
MD$39.60$44.79
ME$39.35$39.35
MI$42.18$44.79
MN$39.35$39.35
MO$39.69$44.50
MS$37.71$39.35
MT$39.14$39.35
NC$37.71$44.79
ND$39.69$44.79
NE$39.69$44.79
NH$39.35$39.35
NJ$39.35$39.35
NM$39.10$41.92
NV$38.74$39.35
NY$39.60$44.79
OH$42.18$44.79
OK$39.10$44.79
OR$38.74$44.79
PA$39.60$44.79
PR$58.06
RI$39.35$39.35
SC$37.71$39.35
SD$39.69$44.79
TN$37.71$39.35
TX$39.10$44.79
UT$39.14$44.79
VA$37.71$44.79
VI$46.30
VT$39.35$39.35
WA$38.74$44.79
WI$42.18$43.45
WV$37.71$44.14
WY$39.14$44.79
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Common denial codes to watch

Related E-codes

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