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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
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.

E2204 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $825.89 to $1273.06 depending on state and rural status.

StateNon-ruralRural
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

StateNon-ruralRural
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.

StateNon-ruralRural
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

StateNon-ruralRural
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.

StateNon-ruralRural
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

StateNon-ruralRural
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
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.

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Related E-codes

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