E0667 — Segmental pneumatic appliance for use with pneumatic compressor, full leg
HCPCS Level II E-code · short descriptor: “Seg pneumatic appl full leg”
- 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.
E0667 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $392.20 to $1054.26 depending on state and rural status.
Former-CBA payment limits: ceiling $461.41 · floor $392.20
| State | Non-rural | Rural |
|---|---|---|
| AK | $985.95 | — |
| AL | $461.41 | — |
| AR | $461.41 | — |
| AZ | $461.41 | — |
| CA | $461.41 | — |
| CO | $392.20 | — |
| CT | $461.41 | — |
| DC | $461.41 | — |
| DE | $461.41 | — |
| FL | $461.41 | — |
| GA | $461.41 | — |
| HI | $1054.26 | — |
| IA | $392.20 | — |
| ID | $461.41 | — |
| IL | $461.41 | — |
| IN | $392.20 | — |
| KS | $392.20 | — |
| KY | $461.41 | — |
| LA | $461.41 | — |
| MA | $392.20 | — |
| MD | $461.41 | — |
| ME | $392.20 | — |
| MI | $461.41 | — |
| MN | $392.20 | — |
| MO | $392.20 | — |
| MS | $392.20 | — |
| MT | $392.20 | — |
| NC | $461.41 | — |
| ND | $392.20 | — |
| NE | $392.20 | — |
| NH | $392.20 | — |
| NJ | $461.41 | — |
| NM | $461.41 | — |
| NV | $461.41 | — |
| NY | $461.41 | — |
| OH | $461.39 | — |
| OK | $441.03 | — |
| OR | $461.41 | — |
| PA | $461.41 | — |
| PR | $621.48 | — |
| RI | $461.41 | — |
| SC | $461.41 | — |
| SD | $392.20 | — |
| TN | $461.41 | — |
| TX | $461.41 | — |
| UT | $444.17 | — |
| VA | $392.20 | — |
| VI | $461.41 | — |
| VT | $392.20 | — |
| WA | $461.41 | — |
| WI | $461.41 | — |
| WV | $461.39 | — |
| WY | $392.20 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $44.29 to $105.41 depending on state and rural status.
Former-CBA payment limits: ceiling $52.10 · floor $44.29
| State | Non-rural | Rural |
|---|---|---|
| AK | $98.58 | — |
| AL | $52.10 | — |
| AR | $52.10 | — |
| AZ | $52.10 | — |
| CA | $52.10 | — |
| CO | $44.29 | — |
| CT | $52.10 | — |
| DC | $46.18 | — |
| DE | $46.18 | — |
| FL | $52.10 | — |
| GA | $52.10 | — |
| HI | $105.41 | — |
| IA | $44.29 | — |
| ID | $52.10 | — |
| IL | $52.10 | — |
| IN | $44.29 | — |
| KS | $44.29 | — |
| KY | $52.10 | — |
| LA | $52.10 | — |
| MA | $52.10 | — |
| MD | $46.18 | — |
| ME | $52.10 | — |
| MI | $52.10 | — |
| MN | $44.29 | — |
| MO | $44.29 | — |
| MS | $44.29 | — |
| MT | $44.29 | — |
| NC | $52.10 | — |
| ND | $44.29 | — |
| NE | $44.29 | — |
| NH | $52.10 | — |
| NJ | $46.18 | — |
| NM | $48.35 | — |
| NV | $52.10 | — |
| NY | $52.10 | — |
| OH | $46.18 | — |
| OK | $44.29 | — |
| OR | $52.10 | — |
| PA | $46.18 | — |
| PR | $77.67 | — |
| RI | $52.10 | — |
| SC | $52.10 | — |
| SD | $44.29 | — |
| TN | $52.10 | — |
| TX | $52.10 | — |
| UT | $44.44 | — |
| VA | $44.29 | — |
| VI | $52.10 | — |
| VT | $52.10 | — |
| WA | $52.10 | — |
| WI | $52.10 | — |
| WV | $46.18 | — |
| WY | $44.29 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $294.17 to $790.68 depending on state and rural status.
Former-CBA payment limits: ceiling $346.08 · floor $294.17
| State | Non-rural | Rural |
|---|---|---|
| AK | $739.45 | — |
| AL | $346.08 | — |
| AR | $346.08 | — |
| AZ | $346.08 | — |
| CA | $346.08 | — |
| CO | $294.17 | — |
| CT | $346.08 | — |
| DC | $346.07 | — |
| DE | $346.07 | — |
| FL | $346.08 | — |
| GA | $346.08 | — |
| HI | $790.68 | — |
| IA | $294.17 | — |
| ID | $346.08 | — |
| IL | $346.08 | — |
| IN | $294.17 | — |
| KS | $294.17 | — |
| KY | $346.08 | — |
| LA | $346.08 | — |
| MA | $294.17 | — |
| MD | $346.08 | — |
| ME | $294.17 | — |
| MI | $346.08 | — |
| MN | $294.17 | — |
| MO | $294.17 | — |
| MS | $294.17 | — |
| MT | $294.17 | — |
| NC | $346.08 | — |
| ND | $294.17 | — |
| NE | $294.17 | — |
| NH | $294.17 | — |
| NJ | $346.07 | — |
| NM | $346.08 | — |
| NV | $346.08 | — |
| NY | $346.08 | — |
| OH | $346.07 | — |
| OK | $330.75 | — |
| OR | $346.08 | — |
| PA | $346.08 | — |
| PR | $466.12 | — |
| RI | $346.08 | — |
| SC | $346.08 | — |
| SD | $294.17 | — |
| TN | $346.08 | — |
| TX | $346.08 | — |
| UT | $333.11 | — |
| VA | $294.17 | — |
| VI | $346.08 | — |
| VT | $294.17 | — |
| WA | $346.08 | — |
| WI | $346.08 | — |
| WV | $346.07 | — |
| WY | $294.17 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0667 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 E0667 with confidence
Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →
Building an AI agent? Try the agent API in the playground — free PA-required lookups, E0667 included, and starter credits via POST /bot-marketplace/register.