MyMedi-AI

E2375 — Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only

HCPCS Level II E-code · short descriptor: “Non-expandable controller”

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.

E2375 Medicare fee schedule (October 2026)

RR — Monthly rental Capped rental

Medicare allowable ranges from $77.11 to $110.31 depending on state and rural status.

StateNon-ruralRural
AK$105.04—
AL$84.05$97.80
AR$84.05$97.80
AZ$80.33$97.80
CA$77.11$97.80
CO$81.25$97.80
CT$83.61$97.80
DC$80.40$97.80
DE$80.40$97.80
FL$84.05$97.80
GA$84.05$97.80
HI$105.04—
IA$82.77$97.80
ID$81.25$97.80
IL$83.89$97.80
IN$83.89$97.80
KS$82.77$97.80
KY$84.05$97.80
LA$84.05$97.80
MA$83.61$97.80
MD$80.40$97.80
ME$83.61$97.80
MI$83.89$97.80
MN$82.77$97.80
MO$82.77$97.80
MS$84.05$97.80
MT$81.25$97.80
NC$84.05$97.80
ND$82.77$97.80
NE$82.77$97.80
NH$83.61$97.80
NJ$80.40$97.80
NM$80.33$97.80
NV$77.11$97.80
NY$80.40$97.80
OH$83.89$97.80
OK$80.33$97.80
OR$77.11$97.80
PA$80.40$97.80
PR$110.31—
RI$83.61$97.80
SC$84.05$97.80
SD$82.77$97.80
TN$84.05$97.80
TX$80.33$97.80
UT$81.25$97.80
VA$84.05$97.80
VI$105.04—
VT$83.61$97.80
WA$77.11$97.80
WI$83.89$97.80
WV$84.05$97.80
WY$81.25$97.80

RR + KE — Monthly rental Capped rental

Medicare allowable ranges from $105.43 to $118.70 depending on state and rural status.

StateNon-ruralRural
AK$112.66—
AL—$105.43
AR—$105.43
AZ—$105.43
CA—$105.43
CO—$105.43
CT—$105.43
DC—$105.43
DE—$105.43
FL—$105.43
GA—$105.43
HI$112.66—
IA—$105.43
ID—$105.43
IL—$105.43
IN—$105.43
KS—$105.43
KY—$105.43
LA—$105.43
MA—$105.43
MD—$105.43
ME—$105.43
MI—$105.43
MN—$105.43
MO—$105.43
MS—$105.43
MT—$105.43
NC—$105.43
ND—$105.43
NE—$105.43
NH—$105.43
NJ—$105.43
NM—$105.43
NV—$105.43
NY—$105.43
OH—$105.43
OK—$105.43
OR—$105.43
PA—$105.43
PR$118.70—
RI—$105.43
SC—$105.43
SD—$105.43
TN—$105.43
TX—$105.43
UT—$105.43
VA—$105.43
VI$112.66—
VT—$105.43
WA—$105.43
WI—$105.43
WV—$105.43
WY—$105.43

RR + KU — Monthly rental Capped rental

Medicare allowable ranges from $105.18 to $115.73 depending on state and rural status.

Former-CBA payment limits: ceiling $105.18 · floor $89.40

StateNon-ruralRural
AK$105.18—
AL$105.18—
AR$105.18—
AZ$105.18—
CA$105.18—
CO$105.18—
CT$105.18—
DC$105.18—
DE$105.18—
FL$105.18—
GA$105.18—
HI$105.18—
IA$105.18—
ID$105.18—
IL$105.18—
IN$105.18—
KS$105.18—
KY$105.18—
LA$105.18—
MA$105.18—
MD$105.18—
ME$105.18—
MI$105.18—
MN$105.18—
MO$105.18—
MS$105.18—
MT$105.18—
NC$105.18—
ND$105.18—
NE$105.18—
NH$105.18—
NJ$105.18—
NM$105.18—
NV$105.18—
NY$105.18—
OH$105.18—
OK$105.18—
OR$105.18—
PA$105.18—
PR$115.73—
RI$105.18—
SC$105.18—
SD$105.18—
TN$105.18—
TX$105.18—
UT$105.18—
VA$105.18—
VI$105.18—
VT$105.18—
WA$105.18—
WI$105.18—
WV$105.18—
WY$105.18—
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 E2375 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

E2301E2310E2311E2312E2313E2321E2322E2323E2324E2325E2326E2327

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