E0665 — Non-segmental pneumatic appliance for use with pneumatic compressor, full arm
HCPCS Level II E-code · short descriptor: “Pneumatic appliance full 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
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 2
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-26; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). 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 (CMS Required F2F & WOPD List — 83 items in force on 2026-10-26; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
E0665 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $165.96 to $195.25 depending on state and rural status.
Former-CBA payment limits: ceiling $195.25 · floor $165.96
| State | Non-rural | Rural |
|---|---|---|
| AK | $176.70 | — |
| AL | $192.70 | — |
| AR | $195.25 | — |
| AZ | $195.25 | — |
| CA | $174.99 | — |
| CO | $174.33 | — |
| CT | $165.96 | — |
| DC | $165.96 | — |
| DE | $165.96 | — |
| FL | $179.61 | — |
| GA | $191.03 | — |
| HI | $188.96 | — |
| IA | $165.96 | — |
| ID | $195.25 | — |
| IL | $195.25 | — |
| IN | $195.25 | — |
| KS | $195.25 | — |
| KY | $195.25 | — |
| LA | $195.25 | — |
| MA | $195.25 | — |
| MD | $171.92 | — |
| ME | $195.25 | — |
| MI | $178.60 | — |
| MN | $184.18 | — |
| MO | $165.96 | — |
| MS | $165.96 | — |
| MT | $195.25 | — |
| NC | $187.40 | — |
| ND | $195.25 | — |
| NE | $195.25 | — |
| NH | $195.25 | — |
| NJ | $165.96 | — |
| NM | $195.25 | — |
| NV | $195.25 | — |
| NY | $195.25 | — |
| OH | $165.96 | — |
| OK | $195.25 | — |
| OR | $195.25 | — |
| PA | $173.25 | — |
| PR | $192.09 | — |
| RI | $193.56 | — |
| SC | $189.48 | — |
| SD | $195.25 | — |
| TN | $195.25 | — |
| TX | $195.25 | — |
| UT | $195.25 | — |
| VA | $168.00 | — |
| VI | $195.25 | — |
| VT | $195.25 | — |
| WA | $180.77 | — |
| WI | $195.25 | — |
| WV | $165.96 | — |
| WY | $195.25 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $17.03 to $24.00 depending on state and rural status.
Former-CBA payment limits: ceiling $20.04 · floor $17.03
| State | Non-rural | Rural |
|---|---|---|
| AK | $17.68 | — |
| AL | $20.04 | — |
| AR | $20.04 | — |
| AZ | $20.04 | — |
| CA | $17.48 | — |
| CO | $17.43 | — |
| CT | $17.03 | — |
| DC | $20.04 | — |
| DE | $20.04 | — |
| FL | $17.97 | — |
| GA | $19.11 | — |
| HI | $18.88 | — |
| IA | $18.83 | — |
| ID | $20.04 | — |
| IL | $20.04 | — |
| IN | $19.69 | — |
| KS | $19.89 | — |
| KY | $20.04 | — |
| LA | $20.04 | — |
| MA | $18.83 | — |
| MD | $20.04 | — |
| ME | $18.83 | — |
| MI | $17.89 | — |
| MN | $18.43 | — |
| MO | $17.03 | — |
| MS | $17.03 | — |
| MT | $20.04 | — |
| NC | $18.74 | — |
| ND | $20.04 | — |
| NE | $20.04 | — |
| NH | $18.83 | — |
| NJ | $20.04 | — |
| NM | $20.04 | — |
| NV | $20.04 | — |
| NY | $19.71 | — |
| OH | $17.03 | — |
| OK | $20.04 | — |
| OR | $20.04 | — |
| PA | $20.04 | — |
| PR | $24.00 | — |
| RI | $18.51 | — |
| SC | $18.91 | — |
| SD | $20.04 | — |
| TN | $20.04 | — |
| TX | $19.69 | — |
| UT | $18.70 | — |
| VA | $20.04 | — |
| VI | $19.71 | — |
| VT | $18.83 | — |
| WA | $20.04 | — |
| WI | $20.04 | — |
| WV | $17.03 | — |
| WY | $20.04 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $110.64 to $146.61 depending on state and rural status.
Former-CBA payment limits: ceiling $146.61 · floor $124.62
| State | Non-rural | Rural |
|---|---|---|
| AK | $110.64 | — |
| AL | $146.61 | — |
| AR | $146.61 | — |
| AZ | $146.45 | — |
| CA | $124.62 | — |
| CO | $130.69 | — |
| CT | $124.62 | — |
| DC | $124.62 | — |
| DE | $124.62 | — |
| FL | $134.73 | — |
| GA | $146.61 | — |
| HI | $118.31 | — |
| IA | $124.62 | — |
| ID | $146.61 | — |
| IL | $146.61 | — |
| IN | $146.61 | — |
| KS | $146.61 | — |
| KY | $146.61 | — |
| LA | $146.61 | — |
| MA | $146.61 | — |
| MD | $128.95 | — |
| ME | $146.61 | — |
| MI | $133.97 | — |
| MN | $138.13 | — |
| MO | $124.62 | — |
| MS | $124.62 | — |
| MT | $146.61 | — |
| NC | $140.55 | — |
| ND | $146.61 | — |
| NE | $146.61 | — |
| NH | $146.61 | — |
| NJ | $124.62 | — |
| NM | $146.61 | — |
| NV | $146.45 | — |
| NY | $146.61 | — |
| OH | $124.62 | — |
| OK | $146.61 | — |
| OR | $146.61 | — |
| PA | $129.94 | — |
| PR | $144.09 | — |
| RI | $145.17 | — |
| SC | $142.11 | — |
| SD | $146.61 | — |
| TN | $146.61 | — |
| TX | $146.61 | — |
| UT | $124.62 | — |
| VA | $126.03 | — |
| VI | $146.61 | — |
| VT | $146.61 | — |
| WA | $135.63 | — |
| WI | $146.61 | — |
| WV | $124.62 | — |
| WY | $146.61 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0665 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.
Common denial codes to watch
Related E-codes
Bill E0665 with confidence
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