E2204 — Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches
HCPCS Level II E-code · short descriptor: “Frame depth 22 to 25 in”
- 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
- 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.
E2204 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $825.89 to $1273.06 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1157.14 | — |
| AL | $921.34 | $1070.95 |
| AR | $921.34 | $1070.95 |
| AZ | $872.22 | $1070.95 |
| CA | $866.02 | $1070.95 |
| CO | $901.37 | $1070.95 |
| CT | $861.99 | $1070.95 |
| DC | $825.89 | $1070.95 |
| DE | $825.89 | $1070.95 |
| FL | $921.34 | $1070.95 |
| GA | $921.34 | $1070.95 |
| HI | $1157.14 | — |
| IA | $919.71 | $1070.95 |
| ID | $901.37 | $1070.95 |
| IL | $938.76 | $1070.95 |
| IN | $938.76 | $1070.95 |
| KS | $919.71 | $1070.95 |
| KY | $921.34 | $1070.95 |
| LA | $921.34 | $1070.95 |
| MA | $861.99 | $1070.95 |
| MD | $825.89 | $1070.95 |
| ME | $861.99 | $1070.95 |
| MI | $938.76 | $1070.95 |
| MN | $919.71 | $1070.95 |
| MO | $919.71 | $1070.95 |
| MS | $921.34 | $1070.95 |
| MT | $901.37 | $1070.95 |
| NC | $921.34 | $1070.95 |
| ND | $919.71 | $1070.95 |
| NE | $919.71 | $1070.95 |
| NH | $861.99 | $1070.95 |
| NJ | $825.89 | $1070.95 |
| NM | $872.22 | $1070.95 |
| NV | $866.02 | $1070.95 |
| NY | $825.89 | $1070.95 |
| OH | $938.76 | $1070.95 |
| OK | $872.22 | $1070.95 |
| OR | $866.02 | $1070.95 |
| PA | $825.89 | $1070.95 |
| PR | $1273.06 | — |
| RI | $861.99 | $1070.95 |
| SC | $921.34 | $1070.95 |
| SD | $919.71 | $1070.95 |
| TN | $921.34 | $1070.95 |
| TX | $872.22 | $1070.95 |
| UT | $901.37 | $1070.95 |
| VA | $921.34 | $1070.95 |
| VI | $1157.14 | — |
| VT | $861.99 | $1070.95 |
| WA | $866.02 | $1070.95 |
| WI | $938.76 | $1070.95 |
| WV | $921.34 | $1070.95 |
| WY | $901.37 | $1070.95 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $1159.22 to $1391.06 depending on state and rural status.
Former-CBA payment limits: ceiling $1159.22 · floor $985.34
| State | Non-rural | Rural |
|---|---|---|
| AK | $1159.22 | — |
| AL | $1159.22 | — |
| AR | $1159.22 | — |
| AZ | $1159.22 | — |
| CA | $1159.22 | — |
| CO | $1159.22 | — |
| CT | $1159.22 | — |
| DC | $1159.22 | — |
| DE | $1159.22 | — |
| FL | $1159.22 | — |
| GA | $1159.22 | — |
| HI | $1159.22 | — |
| IA | $1159.22 | — |
| ID | $1159.22 | — |
| IL | $1159.22 | — |
| IN | $1159.22 | — |
| KS | $1159.22 | — |
| KY | $1159.22 | — |
| LA | $1159.22 | — |
| MA | $1159.22 | — |
| MD | $1159.22 | — |
| ME | $1159.22 | — |
| MI | $1159.22 | — |
| MN | $1159.22 | — |
| MO | $1159.22 | — |
| MS | $1159.22 | — |
| MT | $1159.22 | — |
| NC | $1159.22 | — |
| ND | $1159.22 | — |
| NE | $1159.22 | — |
| NH | $1159.22 | — |
| NJ | $1159.22 | — |
| NM | $1159.22 | — |
| NV | $1159.22 | — |
| NY | $1159.22 | — |
| OH | $1159.22 | — |
| OK | $1159.22 | — |
| OR | $1159.22 | — |
| PA | $1159.22 | — |
| PR | $1391.06 | — |
| RI | $1159.22 | — |
| SC | $1159.22 | — |
| SD | $1159.22 | — |
| TN | $1159.22 | — |
| TX | $1159.22 | — |
| UT | $1159.22 | — |
| VA | $1159.22 | — |
| VI | $1159.22 | — |
| VT | $1159.22 | — |
| WA | $1159.22 | — |
| WI | $1159.22 | — |
| WV | $1159.22 | — |
| WY | $1159.22 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $82.59 to $127.31 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $115.72 | — |
| AL | $92.13 | $107.10 |
| AR | $92.13 | $107.10 |
| AZ | $87.22 | $107.10 |
| CA | $86.60 | $107.10 |
| CO | $90.14 | $107.10 |
| CT | $86.20 | $107.10 |
| DC | $82.59 | $107.10 |
| DE | $82.59 | $107.10 |
| FL | $92.13 | $107.10 |
| GA | $92.13 | $107.10 |
| HI | $115.72 | — |
| IA | $91.97 | $107.10 |
| ID | $90.14 | $107.10 |
| IL | $93.88 | $107.10 |
| IN | $93.88 | $107.10 |
| KS | $91.97 | $107.10 |
| KY | $92.13 | $107.10 |
| LA | $92.13 | $107.10 |
| MA | $86.20 | $107.10 |
| MD | $82.59 | $107.10 |
| ME | $86.20 | $107.10 |
| MI | $93.88 | $107.10 |
| MN | $91.97 | $107.10 |
| MO | $91.97 | $107.10 |
| MS | $92.13 | $107.10 |
| MT | $90.14 | $107.10 |
| NC | $92.13 | $107.10 |
| ND | $91.97 | $107.10 |
| NE | $91.97 | $107.10 |
| NH | $86.20 | $107.10 |
| NJ | $82.59 | $107.10 |
| NM | $87.22 | $107.10 |
| NV | $86.60 | $107.10 |
| NY | $82.59 | $107.10 |
| OH | $93.88 | $107.10 |
| OK | $87.22 | $107.10 |
| OR | $86.60 | $107.10 |
| PA | $82.59 | $107.10 |
| PR | $127.31 | — |
| RI | $86.20 | $107.10 |
| SC | $92.13 | $107.10 |
| SD | $91.97 | $107.10 |
| TN | $92.13 | $107.10 |
| TX | $87.22 | $107.10 |
| UT | $90.14 | $107.10 |
| VA | $92.13 | $107.10 |
| VI | $115.72 | — |
| VT | $86.20 | $107.10 |
| WA | $86.60 | $107.10 |
| WI | $93.88 | $107.10 |
| WV | $92.13 | $107.10 |
| WY | $90.14 | $107.10 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $115.93 to $139.14 depending on state and rural status.
Former-CBA payment limits: ceiling $115.93 · floor $98.54
| State | Non-rural | Rural |
|---|---|---|
| AK | $115.93 | — |
| AL | $115.93 | — |
| AR | $115.93 | — |
| AZ | $115.93 | — |
| CA | $115.93 | — |
| CO | $115.93 | — |
| CT | $115.93 | — |
| DC | $115.93 | — |
| DE | $115.93 | — |
| FL | $115.93 | — |
| GA | $115.93 | — |
| HI | $115.93 | — |
| IA | $115.93 | — |
| ID | $115.93 | — |
| IL | $115.93 | — |
| IN | $115.93 | — |
| KS | $115.93 | — |
| KY | $115.93 | — |
| LA | $115.93 | — |
| MA | $115.93 | — |
| MD | $115.93 | — |
| ME | $115.93 | — |
| MI | $115.93 | — |
| MN | $115.93 | — |
| MO | $115.93 | — |
| MS | $115.93 | — |
| MT | $115.93 | — |
| NC | $115.93 | — |
| ND | $115.93 | — |
| NE | $115.93 | — |
| NH | $115.93 | — |
| NJ | $115.93 | — |
| NM | $115.93 | — |
| NV | $115.93 | — |
| NY | $115.93 | — |
| OH | $115.93 | — |
| OK | $115.93 | — |
| OR | $115.93 | — |
| PA | $115.93 | — |
| PR | $139.14 | — |
| RI | $115.93 | — |
| SC | $115.93 | — |
| SD | $115.93 | — |
| TN | $115.93 | — |
| TX | $115.93 | — |
| UT | $115.93 | — |
| VA | $115.93 | — |
| VI | $115.93 | — |
| VT | $115.93 | — |
| WA | $115.93 | — |
| WI | $115.93 | — |
| WV | $115.93 | — |
| WY | $115.93 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $619.42 to $954.80 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $867.85 | — |
| AL | $691.01 | $803.22 |
| AR | $691.01 | $803.22 |
| AZ | $654.16 | $803.22 |
| CA | $649.52 | $803.22 |
| CO | $676.03 | $803.22 |
| CT | $646.49 | $803.22 |
| DC | $619.42 | $803.22 |
| DE | $619.42 | $803.22 |
| FL | $691.01 | $803.22 |
| GA | $691.01 | $803.22 |
| HI | $867.85 | — |
| IA | $689.78 | $803.22 |
| ID | $676.03 | $803.22 |
| IL | $704.08 | $803.22 |
| IN | $704.08 | $803.22 |
| KS | $689.78 | $803.22 |
| KY | $691.01 | $803.22 |
| LA | $691.01 | $803.22 |
| MA | $646.49 | $803.22 |
| MD | $619.42 | $803.22 |
| ME | $646.49 | $803.22 |
| MI | $704.08 | $803.22 |
| MN | $689.78 | $803.22 |
| MO | $689.78 | $803.22 |
| MS | $691.01 | $803.22 |
| MT | $676.03 | $803.22 |
| NC | $691.01 | $803.22 |
| ND | $689.78 | $803.22 |
| NE | $689.78 | $803.22 |
| NH | $646.49 | $803.22 |
| NJ | $619.42 | $803.22 |
| NM | $654.16 | $803.22 |
| NV | $649.52 | $803.22 |
| NY | $619.42 | $803.22 |
| OH | $704.08 | $803.22 |
| OK | $654.16 | $803.22 |
| OR | $649.52 | $803.22 |
| PA | $619.42 | $803.22 |
| PR | $954.80 | — |
| RI | $646.49 | $803.22 |
| SC | $691.01 | $803.22 |
| SD | $689.78 | $803.22 |
| TN | $691.01 | $803.22 |
| TX | $654.16 | $803.22 |
| UT | $676.03 | $803.22 |
| VA | $691.01 | $803.22 |
| VI | $867.85 | — |
| VT | $646.49 | $803.22 |
| WA | $649.52 | $803.22 |
| WI | $704.08 | $803.22 |
| WV | $691.01 | $803.22 |
| WY | $676.03 | $803.22 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $869.41 to $1043.30 depending on state and rural status.
Former-CBA payment limits: ceiling $869.41 · floor $739.00
| State | Non-rural | Rural |
|---|---|---|
| AK | $869.41 | — |
| AL | $869.41 | — |
| AR | $869.41 | — |
| AZ | $869.41 | — |
| CA | $869.41 | — |
| CO | $869.41 | — |
| CT | $869.41 | — |
| DC | $869.41 | — |
| DE | $869.41 | — |
| FL | $869.41 | — |
| GA | $869.41 | — |
| HI | $869.41 | — |
| IA | $869.41 | — |
| ID | $869.41 | — |
| IL | $869.41 | — |
| IN | $869.41 | — |
| KS | $869.41 | — |
| KY | $869.41 | — |
| LA | $869.41 | — |
| MA | $869.41 | — |
| MD | $869.41 | — |
| ME | $869.41 | — |
| MI | $869.41 | — |
| MN | $869.41 | — |
| MO | $869.41 | — |
| MS | $869.41 | — |
| MT | $869.41 | — |
| NC | $869.41 | — |
| ND | $869.41 | — |
| NE | $869.41 | — |
| NH | $869.41 | — |
| NJ | $869.41 | — |
| NM | $869.41 | — |
| NV | $869.41 | — |
| NY | $869.41 | — |
| OH | $869.41 | — |
| OK | $869.41 | — |
| OR | $869.41 | — |
| PA | $869.41 | — |
| PR | $1043.30 | — |
| RI | $869.41 | — |
| SC | $869.41 | — |
| SD | $869.41 | — |
| TN | $869.41 | — |
| TX | $869.41 | — |
| UT | $869.41 | — |
| VA | $869.41 | — |
| VI | $869.41 | — |
| VT | $869.41 | — |
| WA | $869.41 | — |
| WI | $869.41 | — |
| WV | $869.41 | — |
| WY | $869.41 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2204 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 E2204 with confidence
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