MyMedi-AI

E1161 — Manual adult size wheelchair, includes tilt in space

HCPCS Level II E-code · short descriptor: “Manual adult wc w tiltinspac”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Capped rental
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Required from 2026-10-28 (Manual wheelchairs)
MUE unit limit
1
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))

F2F + WOPD FROM 2026-10-28 E1161 joins Medicare's Required Face-to-Face & WOPD List for dates of service on or after 2026-10-28 (Manual wheelchairs — CMS-6109-N, 91 FR 47972 (published 2026-07-30)). From that date two extra conditions of payment apply:

  • Face-to-face encounter (in-person or telehealth) with the treating practitioner within the 6 months before the order date
  • Written order communicated to the supplier before delivery (WOPD)

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

E1161 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $337.19 to $404.64 depending on state and rural status.

Former-CBA payment limits: ceiling $337.19 · floor $286.61

StateNon-ruralRural
AK$337.19—
AL$337.19—
AR$337.19—
AZ$337.19—
CA$337.19—
CO$337.19—
CT$337.19—
DC$337.19—
DE$337.19—
FL$337.19—
GA$337.19—
HI$337.19—
IA$337.19—
ID$337.19—
IL$337.19—
IN$337.19—
KS$337.19—
KY$337.19—
LA$337.19—
MA$337.19—
MD$337.19—
ME$337.19—
MI$337.19—
MN$337.19—
MO$337.19—
MS$337.19—
MT$337.19—
NC$337.19—
ND$337.19—
NE$337.19—
NH$337.19—
NJ$337.19—
NM$337.19—
NV$337.19—
NY$337.19—
OH$337.19—
OK$337.19—
OR$337.19—
PA$337.19—
PR$404.64—
RI$337.19—
SC$337.19—
SD$337.19—
TN$337.19—
TX$337.19—
UT$337.19—
VA$337.19—
VI$337.19—
VT$337.19—
WA$337.19—
WI$337.19—
WV$337.19—
WY$337.19—
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 E1161 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Code Descriptor / CPT Instruction.

Common denial codes to watch

Related E-codes

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