MyMedi-AI

E0668 — Segmental pneumatic appliance for use with pneumatic compressor, full arm

HCPCS Level II E-code · short descriptor: “Seg pneumatic appl 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 2026-10-25; 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 2026-10-25; 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.

E0668 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $534.98 to $976.21 depending on state and rural status.

Former-CBA payment limits: ceiling $629.74 · floor $535.28

StateNon-ruralRural
AK$912.94—
AL$629.74—
AR$625.67—
AZ$629.74—
CA$629.74—
CO$535.28—
CT$629.74—
DC$535.28—
DE$535.28—
FL$629.74—
GA$629.74—
HI$976.21—
IA$535.28—
ID$535.28—
IL$629.74—
IN$535.28—
KS$535.28—
KY$629.74—
LA$629.74—
MA$629.74—
MD$535.28—
ME$629.74—
MI$535.28—
MN$535.28—
MO$535.28—
MS$535.28—
MT$535.28—
NC$629.74—
ND$535.28—
NE$535.28—
NH$629.74—
NJ$535.28—
NM$629.74—
NV$629.74—
NY$535.28—
OH$535.28—
OK$629.74—
OR$629.74—
PA$535.28—
PR$534.98—
RI$629.74—
SC$629.74—
SD$535.28—
TN$629.74—
TX$629.74—
UT$629.74—
VA$535.28—
VI$535.28—
VT$629.74—
WA$629.74—
WI$629.74—
WV$535.28—
WY$535.28—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $52.83 to $97.65 depending on state and rural status.

Former-CBA payment limits: ceiling $62.15 · floor $52.83

StateNon-ruralRural
AK$91.28—
AL$62.15—
AR$62.15—
AZ$62.15—
CA$62.15—
CO$52.83—
CT$62.15—
DC$52.83—
DE$52.83—
FL$62.15—
GA$62.15—
HI$97.65—
IA$52.83—
ID$52.83—
IL$62.15—
IN$52.83—
KS$52.83—
KY$62.15—
LA$62.15—
MA$62.15—
MD$52.83—
ME$62.15—
MI$52.83—
MN$52.83—
MO$52.83—
MS$52.83—
MT$52.83—
NC$62.15—
ND$52.83—
NE$52.83—
NH$62.15—
NJ$52.83—
NM$62.15—
NV$62.15—
NY$52.83—
OH$52.83—
OK$62.15—
OR$62.15—
PA$52.83—
PR$59.35—
RI$62.15—
SC$62.15—
SD$52.83—
TN$62.15—
TX$62.15—
UT$62.15—
VA$52.83—
VI$52.83—
VT$62.15—
WA$62.15—
WI$62.15—
WV$52.83—
WY$52.83—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $401.47 to $732.17 depending on state and rural status.

Former-CBA payment limits: ceiling $472.32 · floor $401.47

StateNon-ruralRural
AK$684.76—
AL$472.32—
AR$469.26—
AZ$472.32—
CA$472.32—
CO$401.47—
CT$472.32—
DC$401.47—
DE$401.47—
FL$472.32—
GA$472.32—
HI$732.17—
IA$401.47—
ID$401.47—
IL$472.32—
IN$401.47—
KS$401.47—
KY$472.32—
LA$472.32—
MA$472.32—
MD$401.47—
ME$472.32—
MI$401.47—
MN$401.47—
MO$401.47—
MS$401.47—
MT$401.47—
NC$472.32—
ND$401.47—
NE$401.47—
NH$472.32—
NJ$401.47—
NM$472.32—
NV$472.32—
NY$401.47—
OH$401.47—
OK$472.32—
OR$472.32—
PA$401.47—
PR$444.71—
RI$472.32—
SC$472.32—
SD$401.47—
TN$472.32—
TX$472.32—
UT$472.32—
VA$401.47—
VI$401.47—
VT$472.32—
WA$472.32—
WI$472.32—
WV$401.47—
WY$401.47—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). 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.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps E0668 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

CO-50 medical necessityCO-151 frequency/units

Related E-codes

E0600E0601E0602E0603E0604E0605E0606E0607E0610E0615E0616E0617

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