MyMedi-AI

E1280 — Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests

HCPCS Level II E-code · short descriptor: “Whchr h-duty det arm leg res”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Capped rental
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
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))

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.

E1280 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $140.99 to $295.83 depending on state and rural status.

Former-CBA payment limits: ceiling $187.06 · floor $159.00

StateNon-ruralRural
AK$140.99—
AL$187.06—
AR$159.00—
AZ$187.06—
CA$159.00—
CO$187.06—
CT$187.06—
DC$187.06—
DE$159.00—
FL$159.00—
GA$162.92—
HI$150.78—
IA$181.33—
ID$187.06—
IL$187.06—
IN$185.63—
KS$187.06—
KY$187.06—
LA$159.00—
MA$187.06—
MD$187.06—
ME$187.06—
MI$174.45—
MN$159.00—
MO$182.02—
MS$159.00—
MT$187.06—
NC$178.67—
ND$187.06—
NE$187.06—
NH$187.06—
NJ$175.02—
NM$187.06—
NV$187.06—
NY$187.06—
OH$171.16—
OK$164.28—
OR$159.00—
PA$187.06—
PR$295.83—
RI$161.06—
SC$162.25—
SD$187.06—
TN$159.00—
TX$187.06—
UT$159.00—
VA$187.06—
VI$187.06—
VT$187.06—
WA$185.02—
WI$159.00—
WV$159.00—
WY$187.06—
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 E1280 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

Bill E1280 with confidence

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