E1701 — Replacement cushions for jaw motion rehabilitation system, pkg. of 6
HCPCS Level II E-code · short descriptor: “Repl cushions for jaw motion”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Supplies
- 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.
E1701 Medicare fee schedule (April 2026)
Base (no modifier) Supplies
Medicare allowable ranges from $12.84 to $16.34 depending on state and rural status.
Former-CBA payment limits: ceiling $15.11 · floor $12.84
| State | Non-rural | Rural |
|---|---|---|
| AK | $15.30 | — |
| AL | $15.11 | — |
| AR | $15.11 | — |
| AZ | $15.11 | — |
| CA | $15.11 | — |
| CO | $15.11 | — |
| CT | $12.84 | — |
| DC | $14.78 | — |
| DE | $14.78 | — |
| FL | $14.35 | — |
| GA | $14.35 | — |
| HI | $16.34 | — |
| IA | $15.11 | — |
| ID | $15.11 | — |
| IL | $14.35 | — |
| IN | $15.11 | — |
| KS | $14.68 | — |
| KY | $15.11 | — |
| LA | $15.11 | — |
| MA | $14.78 | — |
| MD | $12.84 | — |
| ME | $14.78 | — |
| MI | $12.84 | — |
| MN | $15.11 | — |
| MO | $14.91 | — |
| MS | $12.84 | — |
| MT | $12.84 | — |
| NC | $15.11 | — |
| ND | $15.11 | — |
| NE | $14.62 | — |
| NH | $14.78 | — |
| NJ | $14.78 | — |
| NM | $15.11 | — |
| NV | $15.11 | — |
| NY | $15.11 | — |
| OH | $15.11 | — |
| OK | $15.11 | — |
| OR | $15.11 | — |
| PA | $14.78 | — |
| PR | $16.27 | — |
| RI | $14.78 | — |
| SC | $15.11 | — |
| SD | $15.11 | — |
| TN | $15.11 | — |
| TX | $14.41 | — |
| UT | $12.84 | — |
| VA | $14.42 | — |
| VI | $15.11 | — |
| VT | $14.78 | — |
| WA | $15.11 | — |
| WI | $13.18 | — |
| WV | $15.11 | — |
| WY | $15.11 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
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.
Common denial codes to watch
Related E-codes
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