E0655 — Non-segmental pneumatic appliance for use with pneumatic compressor, half arm
HCPCS Level II E-code · short descriptor: “Pneumatic appliance half arm”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Inexpensive or routinely purchased
- Prior authorization
- Not on Medicare required-PA 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.
E0655 Medicare fee schedule (April 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $130.75 to $166.54 depending on state and rural status.
Former-CBA payment limits: ceiling $153.82 · floor $130.75
| State | Non-rural | Rural |
|---|---|---|
| AK | $155.73 | — |
| AL | $153.82 | — |
| AR | $153.82 | — |
| AZ | $153.82 | — |
| CA | $153.82 | — |
| CO | $153.82 | — |
| CT | $130.75 | — |
| DC | $130.75 | — |
| DE | $130.75 | — |
| FL | $147.11 | — |
| GA | $134.53 | — |
| HI | $166.54 | — |
| IA | $153.82 | — |
| ID | $153.82 | — |
| IL | $153.82 | — |
| IN | $143.12 | — |
| KS | $153.82 | — |
| KY | $138.88 | — |
| LA | $153.82 | — |
| MA | $145.00 | — |
| MD | $151.11 | — |
| ME | $145.00 | — |
| MI | $153.82 | — |
| MN | $148.34 | — |
| MO | $153.82 | — |
| MS | $130.75 | — |
| MT | $152.35 | — |
| NC | $137.65 | — |
| ND | $153.82 | — |
| NE | $153.82 | — |
| NH | $145.00 | — |
| NJ | $149.00 | — |
| NM | $153.82 | — |
| NV | $153.82 | — |
| NY | $139.23 | — |
| OH | $130.75 | — |
| OK | $153.82 | — |
| OR | $153.82 | — |
| PA | $130.75 | — |
| PR | $136.15 | — |
| RI | $142.59 | — |
| SC | $152.27 | — |
| SD | $153.82 | — |
| TN | $131.34 | — |
| TX | $149.00 | — |
| UT | $153.82 | — |
| VA | $153.82 | — |
| VI | $139.23 | — |
| VT | $145.00 | — |
| WA | $153.82 | — |
| WI | $153.82 | — |
| WV | $153.82 | — |
| WY | $153.82 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $15.37 to $18.08 depending on state and rural status.
Former-CBA payment limits: ceiling $18.08 · floor $15.37
| State | Non-rural | Rural |
|---|---|---|
| AK | $15.58 | — |
| AL | $16.02 | — |
| AR | $18.08 | — |
| AZ | $18.08 | — |
| CA | $15.41 | — |
| CO | $18.08 | — |
| CT | $15.37 | — |
| DC | $18.08 | — |
| DE | $18.08 | — |
| FL | $15.37 | — |
| GA | $15.37 | — |
| HI | $16.66 | — |
| IA | $18.08 | — |
| ID | $15.85 | — |
| IL | $18.08 | — |
| IN | $15.37 | — |
| KS | $18.08 | — |
| KY | $15.37 | — |
| LA | $18.08 | — |
| MA | $15.37 | — |
| MD | $18.08 | — |
| ME | $15.37 | — |
| MI | $18.08 | — |
| MN | $15.37 | — |
| MO | $17.04 | — |
| MS | $15.37 | — |
| MT | $15.37 | — |
| NC | $15.37 | — |
| ND | $18.08 | — |
| NE | $18.08 | — |
| NH | $15.37 | — |
| NJ | $18.08 | — |
| NM | $18.08 | — |
| NV | $18.08 | — |
| NY | $18.08 | — |
| OH | $15.37 | — |
| OK | $18.08 | — |
| OR | $18.08 | — |
| PA | $18.08 | — |
| PR | $16.96 | — |
| RI | $15.37 | — |
| SC | $15.37 | — |
| SD | $18.08 | — |
| TN | $15.37 | — |
| TX | $15.37 | — |
| UT | $16.31 | — |
| VA | $18.08 | — |
| VI | $18.08 | — |
| VT | $15.37 | — |
| WA | $15.48 | — |
| WI | $18.08 | — |
| WV | $18.08 | — |
| WY | $18.08 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $98.18 to $144.09 depending on state and rural status.
Former-CBA payment limits: ceiling $115.50 · floor $98.18
| State | Non-rural | Rural |
|---|---|---|
| AK | $134.75 | — |
| AL | $115.50 | — |
| AR | $115.50 | — |
| AZ | $115.50 | — |
| CA | $115.50 | — |
| CO | $115.50 | — |
| CT | $98.18 | — |
| DC | $98.18 | — |
| DE | $98.18 | — |
| FL | $110.35 | — |
| GA | $115.50 | — |
| HI | $144.09 | — |
| IA | $115.50 | — |
| ID | $115.50 | — |
| IL | $115.50 | — |
| IN | $107.37 | — |
| KS | $115.50 | — |
| KY | $104.20 | — |
| LA | $115.50 | — |
| MA | $108.75 | — |
| MD | $113.35 | — |
| ME | $108.75 | — |
| MI | $115.50 | — |
| MN | $111.31 | — |
| MO | $115.50 | — |
| MS | $98.18 | — |
| MT | $114.26 | — |
| NC | $103.23 | — |
| ND | $115.50 | — |
| NE | $115.50 | — |
| NH | $108.75 | — |
| NJ | $111.71 | — |
| NM | $115.50 | — |
| NV | $115.50 | — |
| NY | $104.36 | — |
| OH | $98.18 | — |
| OK | $115.50 | — |
| OR | $115.50 | — |
| PA | $98.18 | — |
| PR | $101.12 | — |
| RI | $106.97 | — |
| SC | $114.21 | — |
| SD | $115.50 | — |
| TN | $98.53 | — |
| TX | $111.71 | — |
| UT | $115.50 | — |
| VA | $115.40 | — |
| VI | $104.36 | — |
| VT | $108.75 | — |
| WA | $115.50 | — |
| WI | $115.50 | — |
| WV | $115.50 | — |
| WY | $115.50 | — |
Common denial codes to watch
Related E-codes
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