MyMedi-AI

E2104 — Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge

HCPCS Level II E-code · short descriptor: “Glucose monitor w cartridge”

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
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.

E2104 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable: $54.52 in all listed states.

Former-CBA payment limits: ceiling $54.52 · floor $46.34

StateNon-ruralRural
AK$54.52—
AL$54.52—
AR$54.52—
AZ$54.52—
CA$54.52—
CO$54.52—
CT$54.52—
DC$54.52—
DE$54.52—
FL$54.52—
GA$54.52—
HI$54.52—
IA$54.52—
ID$54.52—
IL$54.52—
IN$54.52—
KS$54.52—
KY$54.52—
LA$54.52—
MA$54.52—
MD$54.52—
ME$54.52—
MI$54.52—
MN$54.52—
MO$54.52—
MS$54.52—
MT$54.52—
NC$54.52—
ND$54.52—
NE$54.52—
NH$54.52—
NJ$54.52—
NM$54.52—
NV$54.52—
NY$54.52—
OH$54.52—
OK$54.52—
OR$54.52—
PA$54.52—
PR$54.52—
RI$54.52—
SC$54.52—
SD$54.52—
TN$54.52—
TX$54.52—
UT$54.52—
VA$54.52—
VI$54.52—
VT$54.52—
WA$54.52—
WI$54.52—
WV$54.52—
WY$54.52—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable: $5.47 in all listed states.

Former-CBA payment limits: ceiling $5.47 · floor $4.65

StateNon-ruralRural
AK$5.47—
AL$5.47—
AR$5.47—
AZ$5.47—
CA$5.47—
CO$5.47—
CT$5.47—
DC$5.47—
DE$5.47—
FL$5.47—
GA$5.47—
HI$5.47—
IA$5.47—
ID$5.47—
IL$5.47—
IN$5.47—
KS$5.47—
KY$5.47—
LA$5.47—
MA$5.47—
MD$5.47—
ME$5.47—
MI$5.47—
MN$5.47—
MO$5.47—
MS$5.47—
MT$5.47—
NC$5.47—
ND$5.47—
NE$5.47—
NH$5.47—
NJ$5.47—
NM$5.47—
NV$5.47—
NY$5.47—
OH$5.47—
OK$5.47—
OR$5.47—
PA$5.47—
PR$5.47—
RI$5.47—
SC$5.47—
SD$5.47—
TN$5.47—
TX$5.47—
UT$5.47—
VA$5.47—
VI$5.47—
VT$5.47—
WA$5.47—
WI$5.47—
WV$5.47—
WY$5.47—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable: $40.92 in all listed states.

Former-CBA payment limits: ceiling $40.92 · floor $34.78

StateNon-ruralRural
AK$40.92—
AL$40.92—
AR$40.92—
AZ$40.92—
CA$40.92—
CO$40.92—
CT$40.92—
DC$40.92—
DE$40.92—
FL$40.92—
GA$40.92—
HI$40.92—
IA$40.92—
ID$40.92—
IL$40.92—
IN$40.92—
KS$40.92—
KY$40.92—
LA$40.92—
MA$40.92—
MD$40.92—
ME$40.92—
MI$40.92—
MN$40.92—
MO$40.92—
MS$40.92—
MT$40.92—
NC$40.92—
ND$40.92—
NE$40.92—
NH$40.92—
NJ$40.92—
NM$40.92—
NV$40.92—
NY$40.92—
OH$40.92—
OK$40.92—
OR$40.92—
PA$40.92—
PR$40.92—
RI$40.92—
SC$40.92—
SD$40.92—
TN$40.92—
TX$40.92—
UT$40.92—
VA$40.92—
VI$40.92—
VT$40.92—
WA$40.92—
WI$40.92—
WV$40.92—
WY$40.92—
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 E2104 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

CO-50 medical necessityCO-151 frequency/units

Related E-codes

E2100E2101E2102E2103E2120

Bill E2104 with confidence

Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, E2104 included, and starter credits via POST /bot-marketplace/register.