MyMedi-AI

E0995 — Wheelchair accessory, calf rest/pad, replacement only, each

HCPCS Level II E-code · short descriptor: “Wc calf rest, pad replacemnt”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
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.

E0995 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $31.74 to $80.63 depending on state and rural status.

StateNon-ruralRural
AK$80.63—
AL$31.74$31.74
AR$33.40$35.37
AZ$33.40$34.99
CA$33.40$35.37
CO$33.40$35.37
CT$31.74$31.74
DC$32.47$32.47
DE$32.47$32.47
FL$31.74$31.74
GA$33.40$35.37
HI$38.22—
IA$33.40$35.37
ID$33.40$34.87
IL$33.40$35.37
IN$31.74$31.74
KS$33.40$35.37
KY$33.40$33.74
LA$33.40$35.37
MA$31.74$31.74
MD$31.74$31.74
ME$31.74$31.74
MI$33.40$35.37
MN$33.40$35.37
MO$33.40$35.37
MS$31.74$31.74
MT$33.40$35.37
NC$33.40$34.41
ND$33.40$35.37
NE$33.40$35.37
NH$31.74$31.74
NJ$32.47$32.47
NM$33.40$35.37
NV$33.40$35.37
NY$31.74$31.74
OH$31.74$31.74
OK$33.40$35.37
OR$33.40$35.37
PA$32.47$32.47
PR$46.11—
RI$31.74$31.74
SC$33.40$35.37
SD$33.40$35.37
TN$33.40$35.37
TX$31.74$31.74
UT$33.40$35.37
VA$31.74$31.74
VI$31.74—
VT$31.74$31.74
WA$33.40$35.37
WI$33.40$35.37
WV$31.74$31.74
WY$33.40$35.37

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $34.24 to $89.90 depending on state and rural status.

StateNon-ruralRural
AK$89.90—
AL—$34.24
AR—$38.07
AZ—$37.65
CA—$38.07
CO—$38.07
CT—$34.24
DC—$35.03
DE—$35.03
FL—$34.24
GA—$38.07
HI$41.34—
IA—$38.07
ID—$37.51
IL—$38.07
IN—$34.24
KS—$38.07
KY—$36.21
LA—$38.07
MA—$34.24
MD—$34.24
ME—$34.24
MI—$38.07
MN—$38.07
MO—$38.07
MS—$34.24
MT—$38.07
NC—$36.98
ND—$38.07
NE—$38.07
NH—$34.24
NJ—$35.03
NM—$38.07
NV—$38.07
NY—$34.24
OH—$34.24
OK—$38.07
OR—$38.07
PA—$35.03
PR$50.37—
RI—$34.24
SC—$38.07
SD—$38.07
TN—$38.07
TX—$34.24
UT—$38.07
VA—$34.24
VI$34.87—
VT—$34.24
WA—$38.07
WI—$38.07
WV—$34.24
WY—$38.07

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $31.73 to $127.86 depending on state and rural status.

Former-CBA payment limits: ceiling $37.33 · floor $31.73

StateNon-ruralRural
AK$127.86—
AL$31.73—
AR$37.33—
AZ$36.59—
CA$37.33—
CO$37.33—
CT$31.73—
DC$32.49—
DE$32.49—
FL$31.73—
GA$37.33—
HI$43.03—
IA$37.33—
ID$36.33—
IL$37.33—
IN$31.73—
KS$37.33—
KY$34.10—
LA$37.33—
MA$31.73—
MD$31.73—
ME$31.73—
MI$37.33—
MN$37.33—
MO$37.33—
MS$31.73—
MT$37.33—
NC$35.42—
ND$37.33—
NE$37.33—
NH$31.73—
NJ$32.49—
NM$37.33—
NV$37.33—
NY$31.73—
OH$31.73—
OK$37.33—
OR$37.33—
PA$32.49—
PR$58.83—
RI$31.73—
SC$37.33—
SD$37.33—
TN$37.33—
TX$31.73—
UT$37.33—
VA$31.73—
VI$31.73—
VT$31.73—
WA$37.33—
WI$37.33—
WV$31.73—
WY$37.33—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.18 to $8.08 depending on state and rural status.

StateNon-ruralRural
AK$8.08—
AL$3.18$3.18
AR$3.34$3.54
AZ$3.34$3.54
CA$3.34$3.54
CO$3.34$3.54
CT$3.18$3.18
DC$3.26$3.26
DE$3.26$3.26
FL$3.18$3.18
GA$3.34$3.54
HI$3.83—
IA$3.34$3.54
ID$3.34$3.50
IL$3.34$3.54
IN$3.18$3.18
KS$3.34$3.54
KY$3.34$3.38
LA$3.34$3.54
MA$3.27$3.27
MD$3.18$3.18
ME$3.27$3.27
MI$3.34$3.54
MN$3.34$3.54
MO$3.34$3.54
MS$3.18$3.18
MT$3.34$3.54
NC$3.34$3.44
ND$3.34$3.54
NE$3.34$3.54
NH$3.26$3.26
NJ$3.26$3.26
NM$3.34$3.54
NV$3.34$3.54
NY$3.18$3.18
OH$3.18$3.18
OK$3.34$3.54
OR$3.34$3.54
PA$3.26$3.26
PR$5.34—
RI$3.21$3.21
SC$3.34$3.54
SD$3.34$3.54
TN$3.34$3.54
TX$3.18$3.18
UT$3.34$3.54
VA$3.18$3.18
VI$3.18—
VT$3.26$3.26
WA$3.34$3.54
WI$3.34$3.54
WV$3.18$3.18
WY$3.34$3.54

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.44 to $9.01 depending on state and rural status.

StateNon-ruralRural
AK$9.01—
AL—$3.44
AR—$3.82
AZ—$3.82
CA—$3.82
CO—$3.82
CT—$3.44
DC—$3.52
DE—$3.52
FL—$3.44
GA—$3.82
HI$4.14—
IA—$3.82
ID—$3.77
IL—$3.82
IN—$3.44
KS—$3.82
KY—$3.63
LA—$3.82
MA—$3.53
MD—$3.44
ME—$3.53
MI—$3.82
MN—$3.82
MO—$3.82
MS—$3.44
MT—$3.82
NC—$3.69
ND—$3.82
NE—$3.82
NH—$3.52
NJ—$3.52
NM—$3.82
NV—$3.82
NY—$3.44
OH—$3.44
OK—$3.82
OR—$3.82
PA—$3.52
PR$5.87—
RI—$3.46
SC—$3.82
SD—$3.82
TN—$3.82
TX—$3.44
UT—$3.82
VA—$3.44
VI$3.49—
VT—$3.52
WA—$3.82
WI—$3.82
WV—$3.44
WY—$3.82

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.20 to $12.80 depending on state and rural status.

Former-CBA payment limits: ceiling $3.76 · floor $3.20

StateNon-ruralRural
AK$12.80—
AL$3.20—
AR$3.76—
AZ$3.76—
CA$3.76—
CO$3.76—
CT$3.20—
DC$3.27—
DE$3.27—
FL$3.20—
GA$3.76—
HI$4.31—
IA$3.76—
ID$3.66—
IL$3.76—
IN$3.20—
KS$3.76—
KY$3.43—
LA$3.76—
MA$3.29—
MD$3.20—
ME$3.29—
MI$3.76—
MN$3.76—
MO$3.76—
MS$3.20—
MT$3.76—
NC$3.54—
ND$3.76—
NE$3.76—
NH$3.27—
NJ$3.27—
NM$3.76—
NV$3.76—
NY$3.20—
OH$3.20—
OK$3.76—
OR$3.76—
PA$3.27—
PR$7.34—
RI$3.21—
SC$3.76—
SD$3.76—
TN$3.76—
TX$3.20—
UT$3.76—
VA$3.20—
VI$3.20—
VT$3.27—
WA$3.76—
WI$3.76—
WV$3.20—
WY$3.76—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $23.78 to $60.49 depending on state and rural status.

StateNon-ruralRural
AK$60.49—
AL$23.78$23.78
AR$25.05$26.51
AZ$25.05$26.26
CA$25.05$26.51
CO$25.05$26.51
CT$23.78$23.78
DC$24.38$24.38
DE$24.38$24.38
FL$23.78$23.78
GA$25.05$26.51
HI$28.66—
IA$25.05$26.51
ID$25.05$26.16
IL$25.05$26.51
IN$23.78$23.78
KS$25.05$26.51
KY$25.05$25.29
LA$25.05$26.51
MA$23.78$23.78
MD$23.78$23.78
ME$23.78$23.78
MI$25.05$26.51
MN$25.05$26.51
MO$25.05$26.51
MS$23.78$23.78
MT$25.05$26.51
NC$25.05$25.82
ND$25.05$26.51
NE$25.05$26.51
NH$23.78$23.78
NJ$24.38$24.38
NM$25.05$26.51
NV$25.05$26.51
NY$23.78$23.78
OH$23.78$23.78
OK$25.05$26.51
OR$25.05$26.51
PA$24.38$24.38
PR$42.56—
RI$23.78$23.78
SC$25.05$26.51
SD$25.05$26.51
TN$25.05$26.51
TX$23.78$23.78
UT$25.05$26.51
VA$23.78$23.78
VI$23.78—
VT$23.78$23.78
WA$25.05$26.51
WI$25.05$26.51
WV$23.78$23.78
WY$25.05$26.51

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $25.65 to $67.44 depending on state and rural status.

StateNon-ruralRural
AK$67.44—
AL—$25.65
AR—$28.54
AZ—$28.25
CA—$28.54
CO—$28.54
CT—$25.65
DC—$26.31
DE—$26.31
FL—$25.65
GA—$28.54
HI$31.00—
IA—$28.54
ID—$28.14
IL—$28.54
IN—$25.65
KS—$28.54
KY—$27.14
LA—$28.54
MA—$25.65
MD—$25.65
ME—$25.65
MI—$28.54
MN—$28.54
MO—$28.54
MS—$25.65
MT—$28.54
NC—$27.75
ND—$28.54
NE—$28.54
NH—$25.65
NJ—$26.31
NM—$28.54
NV—$28.54
NY—$25.65
OH—$25.65
OK—$28.54
OR—$28.54
PA—$26.31
PR$46.91—
RI—$25.65
SC—$28.54
SD—$28.54
TN—$28.54
TX—$25.65
UT—$28.54
VA—$25.65
VI$26.14—
VT—$25.65
WA—$28.54
WI—$28.54
WV—$25.65
WY—$28.54

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $23.78 to $95.92 depending on state and rural status.

Former-CBA payment limits: ceiling $27.98 · floor $23.78

StateNon-ruralRural
AK$95.92—
AL$23.78—
AR$27.98—
AZ$27.47—
CA$27.98—
CO$27.98—
CT$23.78—
DC$24.38—
DE$24.38—
FL$23.78—
GA$27.98—
HI$32.27—
IA$27.98—
ID$27.29—
IL$27.98—
IN$23.78—
KS$27.98—
KY$25.54—
LA$27.98—
MA$23.78—
MD$23.78—
ME$23.78—
MI$27.98—
MN$27.98—
MO$27.98—
MS$23.78—
MT$27.98—
NC$26.59—
ND$27.98—
NE$27.98—
NH$23.78—
NJ$24.38—
NM$27.98—
NV$27.98—
NY$23.78—
OH$23.78—
OK$27.98—
OR$27.98—
PA$24.38—
PR$60.08—
RI$23.78—
SC$27.98—
SD$27.98—
TN$27.98—
TX$23.78—
UT$27.98—
VA$23.78—
VI$23.78—
VT$23.78—
WA$27.98—
WI$27.98—
WV$23.78—
WY$27.98—
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 E0995 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

E0900E0910E0911E0912E0920E0930E0935E0936E0940E0941E0942E0944

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