E0669 — Segmental pneumatic appliance for use with pneumatic compressor, half leg
HCPCS Level II E-code · short descriptor: “Seg pneumatic appli half 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
- 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.
E0669 Medicare fee schedule (April 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $248.03 to $297.69 depending on state and rural status.
Former-CBA payment limits: ceiling $261.25 · floor $222.06
| State | Non-rural | Rural |
|---|---|---|
| AK | $263.86 | — |
| AL | $261.25 | — |
| AR | $261.25 | — |
| AZ | $261.25 | — |
| CA | $261.25 | — |
| CO | $261.25 | — |
| CT | $248.06 | — |
| DC | $248.03 | — |
| DE | $248.06 | — |
| FL | $248.06 | — |
| GA | $258.01 | — |
| HI | $282.15 | — |
| IA | $261.25 | — |
| ID | $261.25 | — |
| IL | $248.03 | — |
| IN | $260.46 | — |
| KS | $261.25 | — |
| KY | $260.48 | — |
| LA | $261.25 | — |
| MA | $248.06 | — |
| MD | $248.03 | — |
| ME | $261.25 | — |
| MI | $258.00 | — |
| MN | $261.25 | — |
| MO | $261.25 | — |
| MS | $261.25 | — |
| MT | $261.25 | — |
| NC | $255.52 | — |
| ND | $261.25 | — |
| NE | $261.25 | — |
| NH | $261.25 | — |
| NJ | $248.06 | — |
| NM | $261.25 | — |
| NV | $261.25 | — |
| NY | $260.48 | — |
| OH | $248.03 | — |
| OK | $261.10 | — |
| OR | $261.25 | — |
| PA | $248.06 | — |
| PR | $297.69 | — |
| RI | $258.01 | — |
| SC | $260.48 | — |
| SD | $261.25 | — |
| TN | $261.25 | — |
| TX | $248.06 | — |
| UT | $261.25 | — |
| VA | $248.03 | — |
| VI | $260.48 | — |
| VT | $248.06 | — |
| WA | $261.25 | — |
| WI | $260.46 | — |
| WV | $248.03 | — |
| WY | $261.25 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $24.80 to $29.77 depending on state and rural status.
Former-CBA payment limits: ceiling $26.12 · floor $22.20
| State | Non-rural | Rural |
|---|---|---|
| AK | $26.40 | — |
| AL | $26.12 | — |
| AR | $26.12 | — |
| AZ | $26.12 | — |
| CA | $26.12 | — |
| CO | $26.12 | — |
| CT | $24.80 | — |
| DC | $24.80 | — |
| DE | $24.80 | — |
| FL | $24.80 | — |
| GA | $25.83 | — |
| HI | $28.22 | — |
| IA | $26.12 | — |
| ID | $26.12 | — |
| IL | $24.80 | — |
| IN | $26.02 | — |
| KS | $26.12 | — |
| KY | $26.02 | — |
| LA | $26.12 | — |
| MA | $24.80 | — |
| MD | $24.80 | — |
| ME | $26.12 | — |
| MI | $25.83 | — |
| MN | $26.12 | — |
| MO | $26.12 | — |
| MS | $26.12 | — |
| MT | $26.12 | — |
| NC | $25.54 | — |
| ND | $26.12 | — |
| NE | $26.12 | — |
| NH | $26.12 | — |
| NJ | $24.80 | — |
| NM | $26.12 | — |
| NV | $26.12 | — |
| NY | $26.02 | — |
| OH | $24.80 | — |
| OK | $26.11 | — |
| OR | $26.12 | — |
| PA | $24.80 | — |
| PR | $29.77 | — |
| RI | $25.83 | — |
| SC | $26.02 | — |
| SD | $26.12 | — |
| TN | $26.12 | — |
| TX | $24.80 | — |
| UT | $26.12 | — |
| VA | $24.80 | — |
| VI | $26.02 | — |
| VT | $24.80 | — |
| WA | $26.12 | — |
| WI | $26.02 | — |
| WV | $24.80 | — |
| WY | $26.12 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $186.02 to $223.26 depending on state and rural status.
Former-CBA payment limits: ceiling $195.96 · floor $166.57
| State | Non-rural | Rural |
|---|---|---|
| AK | $197.87 | — |
| AL | $195.96 | — |
| AR | $195.96 | — |
| AZ | $195.96 | — |
| CA | $195.96 | — |
| CO | $195.96 | — |
| CT | $186.06 | — |
| DC | $186.02 | — |
| DE | $186.06 | — |
| FL | $186.06 | — |
| GA | $193.53 | — |
| HI | $211.67 | — |
| IA | $195.96 | — |
| ID | $195.96 | — |
| IL | $186.02 | — |
| IN | $195.35 | — |
| KS | $195.96 | — |
| KY | $195.36 | — |
| LA | $195.96 | — |
| MA | $186.06 | — |
| MD | $186.02 | — |
| ME | $195.96 | — |
| MI | $193.50 | — |
| MN | $195.96 | — |
| MO | $195.96 | — |
| MS | $195.96 | — |
| MT | $195.96 | — |
| NC | $191.62 | — |
| ND | $195.96 | — |
| NE | $195.96 | — |
| NH | $195.96 | — |
| NJ | $186.06 | — |
| NM | $195.96 | — |
| NV | $195.96 | — |
| NY | $195.36 | — |
| OH | $186.02 | — |
| OK | $195.83 | — |
| OR | $195.96 | — |
| PA | $186.06 | — |
| PR | $223.26 | — |
| RI | $193.53 | — |
| SC | $195.36 | — |
| SD | $195.96 | — |
| TN | $195.96 | — |
| TX | $186.06 | — |
| UT | $195.96 | — |
| VA | $186.02 | — |
| VI | $195.36 | — |
| VT | $186.06 | — |
| WA | $195.96 | — |
| WI | $195.35 | — |
| WV | $186.02 | — |
| WY | $195.96 | — |
Common denial codes to watch
Related E-codes
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