E0967 — Manual wheelchair accessory, hand rim with projections, any type, replacement only, each
HCPCS Level II E-code · short descriptor: “Man wc rim/projection rep ea”
- 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.
E0967 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $83.53 to $105.02 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $92.06 | — |
| AL | $88.62 | $93.60 |
| AR | $88.62 | $93.60 |
| AZ | $87.64 | $92.06 |
| CA | $83.53 | $92.06 |
| CO | $90.92 | $93.60 |
| CT | $91.02 | $93.60 |
| DC | $86.82 | $93.60 |
| DE | $86.82 | $93.56 |
| FL | $88.62 | $93.56 |
| GA | $88.62 | $93.60 |
| HI | $92.06 | — |
| IA | $90.41 | $92.06 |
| ID | $90.92 | $92.06 |
| IL | $90.27 | $93.60 |
| IN | $90.27 | $93.60 |
| KS | $90.41 | $92.06 |
| KY | $88.62 | $93.60 |
| LA | $88.62 | $93.60 |
| MA | $91.02 | $93.60 |
| MD | $86.82 | $93.60 |
| ME | $91.02 | $93.60 |
| MI | $90.27 | $93.60 |
| MN | $90.41 | $93.60 |
| MO | $90.41 | $93.60 |
| MS | $88.62 | $93.60 |
| MT | $90.92 | $92.06 |
| NC | $88.62 | $93.60 |
| ND | $90.41 | $92.06 |
| NE | $90.41 | $92.06 |
| NH | $91.02 | $93.56 |
| NJ | $86.82 | $93.56 |
| NM | $87.64 | $93.60 |
| NV | $83.53 | $92.06 |
| NY | $86.82 | $93.56 |
| OH | $90.27 | $93.60 |
| OK | $87.64 | $93.60 |
| OR | $83.53 | $92.06 |
| PA | $86.82 | $93.56 |
| PR | $105.02 | — |
| RI | $91.02 | $93.56 |
| SC | $88.62 | $93.60 |
| SD | $90.41 | $92.06 |
| TN | $88.62 | $93.60 |
| TX | $87.64 | $93.56 |
| UT | $90.92 | $93.60 |
| VA | $88.62 | $93.60 |
| VI | $93.56 | — |
| VT | $91.02 | $93.60 |
| WA | $83.53 | $93.60 |
| WI | $90.27 | $93.60 |
| WV | $88.62 | $93.60 |
| WY | $90.92 | $92.06 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $92.03 to $112.32 depending on state and rural status.
Former-CBA payment limits: ceiling $93.60 · floor $79.56
| State | Non-rural | Rural |
|---|---|---|
| AK | $92.03 | — |
| AL | $93.60 | — |
| AR | $93.60 | — |
| AZ | $92.03 | — |
| CA | $92.03 | — |
| CO | $93.60 | — |
| CT | $93.60 | — |
| DC | $93.60 | — |
| DE | $93.56 | — |
| FL | $93.56 | — |
| GA | $93.60 | — |
| HI | $92.03 | — |
| IA | $92.03 | — |
| ID | $92.03 | — |
| IL | $93.60 | — |
| IN | $93.60 | — |
| KS | $92.03 | — |
| KY | $93.60 | — |
| LA | $93.60 | — |
| MA | $93.60 | — |
| MD | $93.60 | — |
| ME | $93.60 | — |
| MI | $93.60 | — |
| MN | $93.60 | — |
| MO | $93.60 | — |
| MS | $93.60 | — |
| MT | $92.03 | — |
| NC | $93.60 | — |
| ND | $92.03 | — |
| NE | $92.03 | — |
| NH | $93.56 | — |
| NJ | $93.56 | — |
| NM | $93.60 | — |
| NV | $92.03 | — |
| NY | $93.56 | — |
| OH | $93.60 | — |
| OK | $93.60 | — |
| OR | $92.03 | — |
| PA | $93.56 | — |
| PR | $112.32 | — |
| RI | $93.56 | — |
| SC | $93.60 | — |
| SD | $92.03 | — |
| TN | $93.60 | — |
| TX | $93.56 | — |
| UT | $93.60 | — |
| VA | $93.60 | — |
| VI | $93.56 | — |
| VT | $93.60 | — |
| WA | $93.60 | — |
| WI | $93.60 | — |
| WV | $93.60 | — |
| WY | $92.03 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $8.35 to $10.49 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $9.21 | — |
| AL | $8.86 | $9.37 |
| AR | $8.86 | $9.37 |
| AZ | $8.76 | $9.21 |
| CA | $8.35 | $9.21 |
| CO | $9.09 | $9.37 |
| CT | $9.10 | $9.37 |
| DC | $8.68 | $9.37 |
| DE | $8.68 | $9.36 |
| FL | $8.86 | $9.36 |
| GA | $8.86 | $9.37 |
| HI | $9.21 | — |
| IA | $9.04 | $9.21 |
| ID | $9.09 | $9.21 |
| IL | $9.03 | $9.37 |
| IN | $9.03 | $9.37 |
| KS | $9.04 | $9.21 |
| KY | $8.86 | $9.37 |
| LA | $8.86 | $9.37 |
| MA | $9.10 | $9.37 |
| MD | $8.68 | $9.37 |
| ME | $9.10 | $9.37 |
| MI | $9.03 | $9.37 |
| MN | $9.04 | $9.37 |
| MO | $9.04 | $9.37 |
| MS | $8.86 | $9.37 |
| MT | $9.09 | $9.21 |
| NC | $8.86 | $9.37 |
| ND | $9.04 | $9.21 |
| NE | $9.04 | $9.21 |
| NH | $9.10 | $9.36 |
| NJ | $8.68 | $9.36 |
| NM | $8.76 | $9.37 |
| NV | $8.35 | $9.21 |
| NY | $8.68 | $9.36 |
| OH | $9.03 | $9.37 |
| OK | $8.76 | $9.37 |
| OR | $8.35 | $9.21 |
| PA | $8.68 | $9.36 |
| PR | $10.49 | — |
| RI | $9.10 | $9.36 |
| SC | $8.86 | $9.37 |
| SD | $9.04 | $9.21 |
| TN | $8.86 | $9.37 |
| TX | $8.76 | $9.36 |
| UT | $9.09 | $9.37 |
| VA | $8.86 | $9.37 |
| VI | $9.36 | — |
| VT | $9.10 | $9.37 |
| WA | $8.35 | $9.37 |
| WI | $9.03 | $9.37 |
| WV | $8.86 | $9.37 |
| WY | $9.09 | $9.21 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $9.21 to $11.21 depending on state and rural status.
Former-CBA payment limits: ceiling $9.38 · floor $7.97
| State | Non-rural | Rural |
|---|---|---|
| AK | $9.21 | — |
| AL | $9.38 | — |
| AR | $9.38 | — |
| AZ | $9.21 | — |
| CA | $9.21 | — |
| CO | $9.38 | — |
| CT | $9.38 | — |
| DC | $9.38 | — |
| DE | $9.37 | — |
| FL | $9.37 | — |
| GA | $9.38 | — |
| HI | $9.21 | — |
| IA | $9.21 | — |
| ID | $9.21 | — |
| IL | $9.38 | — |
| IN | $9.38 | — |
| KS | $9.21 | — |
| KY | $9.38 | — |
| LA | $9.38 | — |
| MA | $9.38 | — |
| MD | $9.38 | — |
| ME | $9.38 | — |
| MI | $9.38 | — |
| MN | $9.38 | — |
| MO | $9.38 | — |
| MS | $9.38 | — |
| MT | $9.21 | — |
| NC | $9.38 | — |
| ND | $9.21 | — |
| NE | $9.21 | — |
| NH | $9.37 | — |
| NJ | $9.37 | — |
| NM | $9.38 | — |
| NV | $9.21 | — |
| NY | $9.37 | — |
| OH | $9.38 | — |
| OK | $9.38 | — |
| OR | $9.21 | — |
| PA | $9.37 | — |
| PR | $11.21 | — |
| RI | $9.37 | — |
| SC | $9.38 | — |
| SD | $9.21 | — |
| TN | $9.38 | — |
| TX | $9.37 | — |
| UT | $9.38 | — |
| VA | $9.38 | — |
| VI | $9.37 | — |
| VT | $9.38 | — |
| WA | $9.38 | — |
| WI | $9.38 | — |
| WV | $9.38 | — |
| WY | $9.21 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $62.65 to $78.79 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $69.01 | — |
| AL | $66.46 | $70.18 |
| AR | $66.46 | $70.18 |
| AZ | $65.73 | $69.01 |
| CA | $62.65 | $69.01 |
| CO | $68.19 | $70.18 |
| CT | $68.26 | $70.18 |
| DC | $65.12 | $70.18 |
| DE | $65.12 | $70.18 |
| FL | $66.46 | $70.18 |
| GA | $66.46 | $70.18 |
| HI | $69.01 | — |
| IA | $67.81 | $69.01 |
| ID | $68.19 | $69.01 |
| IL | $67.70 | $70.18 |
| IN | $67.70 | $70.18 |
| KS | $67.81 | $69.01 |
| KY | $66.46 | $70.18 |
| LA | $66.46 | $70.18 |
| MA | $68.26 | $70.18 |
| MD | $65.12 | $70.18 |
| ME | $68.26 | $70.18 |
| MI | $67.70 | $70.18 |
| MN | $67.81 | $70.18 |
| MO | $67.81 | $70.18 |
| MS | $66.46 | $70.18 |
| MT | $68.19 | $69.01 |
| NC | $66.46 | $70.18 |
| ND | $67.81 | $69.01 |
| NE | $67.81 | $69.01 |
| NH | $68.26 | $70.18 |
| NJ | $65.12 | $70.18 |
| NM | $65.73 | $70.18 |
| NV | $62.65 | $69.01 |
| NY | $65.12 | $70.18 |
| OH | $67.70 | $70.18 |
| OK | $65.73 | $70.18 |
| OR | $62.65 | $69.01 |
| PA | $65.12 | $70.18 |
| PR | $78.79 | — |
| RI | $68.26 | $70.18 |
| SC | $66.46 | $70.18 |
| SD | $67.81 | $69.01 |
| TN | $66.46 | $70.18 |
| TX | $65.73 | $70.18 |
| UT | $68.19 | $70.18 |
| VA | $66.46 | $70.18 |
| VI | $70.18 | — |
| VT | $68.26 | $70.18 |
| WA | $62.65 | $70.18 |
| WI | $67.70 | $70.18 |
| WV | $66.46 | $70.18 |
| WY | $68.19 | $69.01 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $68.99 to $84.26 depending on state and rural status.
Former-CBA payment limits: ceiling $70.16 · floor $59.64
| State | Non-rural | Rural |
|---|---|---|
| AK | $68.99 | — |
| AL | $70.16 | — |
| AR | $70.16 | — |
| AZ | $68.99 | — |
| CA | $68.99 | — |
| CO | $70.16 | — |
| CT | $70.16 | — |
| DC | $70.16 | — |
| DE | $70.16 | — |
| FL | $70.16 | — |
| GA | $70.16 | — |
| HI | $68.99 | — |
| IA | $68.99 | — |
| ID | $68.99 | — |
| IL | $70.16 | — |
| IN | $70.16 | — |
| KS | $68.99 | — |
| KY | $70.16 | — |
| LA | $70.16 | — |
| MA | $70.16 | — |
| MD | $70.16 | — |
| ME | $70.16 | — |
| MI | $70.16 | — |
| MN | $70.16 | — |
| MO | $70.16 | — |
| MS | $70.16 | — |
| MT | $68.99 | — |
| NC | $70.16 | — |
| ND | $68.99 | — |
| NE | $68.99 | — |
| NH | $70.16 | — |
| NJ | $70.16 | — |
| NM | $70.16 | — |
| NV | $68.99 | — |
| NY | $70.16 | — |
| OH | $70.16 | — |
| OK | $70.16 | — |
| OR | $68.99 | — |
| PA | $70.16 | — |
| PR | $84.26 | — |
| RI | $70.16 | — |
| SC | $70.16 | — |
| SD | $68.99 | — |
| TN | $70.16 | — |
| TX | $70.16 | — |
| UT | $70.16 | — |
| VA | $70.16 | — |
| VI | $70.16 | — |
| VT | $70.16 | — |
| WA | $70.16 | — |
| WI | $70.16 | — |
| WV | $70.16 | — |
| WY | $68.99 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0967 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
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