E2386 — Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each
HCPCS Level II E-code · short descriptor: “Foam filled drive wheel tire”
- 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
- 2
- 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.
E2386 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $108.95 to $179.47 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $159.45 | — |
| AL | $132.13 | $160.99 |
| AR | $132.13 | $160.99 |
| AZ | $123.76 | $159.45 |
| CA | $121.81 | $159.45 |
| CO | $129.53 | $160.99 |
| CT | $108.95 | $160.99 |
| DC | $116.38 | $160.99 |
| DE | $116.38 | $160.99 |
| FL | $132.13 | $160.99 |
| GA | $132.13 | $160.99 |
| HI | $159.45 | — |
| IA | $128.00 | $159.45 |
| ID | $129.53 | $159.45 |
| IL | $128.94 | $160.99 |
| IN | $128.94 | $160.99 |
| KS | $128.00 | $159.45 |
| KY | $132.13 | $160.99 |
| LA | $132.13 | $160.99 |
| MA | $108.95 | $160.99 |
| MD | $116.38 | $160.99 |
| ME | $108.95 | $160.99 |
| MI | $128.94 | $160.99 |
| MN | $128.00 | $160.99 |
| MO | $128.00 | $160.99 |
| MS | $132.13 | $160.99 |
| MT | $129.53 | $159.45 |
| NC | $132.13 | $160.99 |
| ND | $128.00 | $159.45 |
| NE | $128.00 | $159.45 |
| NH | $108.95 | $160.99 |
| NJ | $116.38 | $160.99 |
| NM | $123.76 | $160.99 |
| NV | $121.81 | $159.45 |
| NY | $116.38 | $160.99 |
| OH | $128.94 | $160.99 |
| OK | $123.76 | $160.99 |
| OR | $121.81 | $159.45 |
| PA | $116.38 | $160.99 |
| PR | $179.47 | — |
| RI | $108.95 | $160.99 |
| SC | $132.13 | $160.99 |
| SD | $128.00 | $159.45 |
| TN | $132.13 | $160.99 |
| TX | $123.76 | $160.99 |
| UT | $129.53 | $160.99 |
| VA | $132.13 | $160.99 |
| VI | $160.99 | — |
| VT | $108.95 | $160.99 |
| WA | $121.81 | $160.99 |
| WI | $128.94 | $160.99 |
| WV | $132.13 | $160.99 |
| WY | $129.53 | $159.45 |
NU + KE — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $172.62 to $195.55 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $172.62 | — |
| AL | — | $174.39 |
| AR | — | $174.39 |
| AZ | — | $172.62 |
| CA | — | $172.62 |
| CO | — | $174.39 |
| CT | — | $174.39 |
| DC | — | $174.39 |
| DE | — | $174.39 |
| FL | — | $174.39 |
| GA | — | $174.39 |
| HI | $172.62 | — |
| IA | — | $172.62 |
| ID | — | $172.62 |
| IL | — | $174.39 |
| IN | — | $174.39 |
| KS | — | $172.62 |
| KY | — | $174.39 |
| LA | — | $174.39 |
| MA | — | $174.39 |
| MD | — | $174.39 |
| ME | — | $174.39 |
| MI | — | $174.39 |
| MN | — | $174.39 |
| MO | — | $174.39 |
| MS | — | $174.39 |
| MT | — | $172.62 |
| NC | — | $174.39 |
| ND | — | $172.62 |
| NE | — | $172.62 |
| NH | — | $174.39 |
| NJ | — | $174.39 |
| NM | — | $174.39 |
| NV | — | $172.62 |
| NY | — | $174.39 |
| OH | — | $174.39 |
| OK | — | $174.39 |
| OR | — | $172.62 |
| PA | — | $174.39 |
| PR | $195.55 | — |
| RI | — | $174.39 |
| SC | — | $174.39 |
| SD | — | $172.62 |
| TN | — | $174.39 |
| TX | — | $174.39 |
| UT | — | $174.39 |
| VA | — | $174.39 |
| VI | $174.39 | — |
| VT | — | $174.39 |
| WA | — | $174.39 |
| WI | — | $174.39 |
| WV | — | $174.39 |
| WY | — | $172.62 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $181.77 to $221.82 depending on state and rural status.
Former-CBA payment limits: ceiling $184.86 · floor $157.13
| State | Non-rural | Rural |
|---|---|---|
| AK | $181.77 | — |
| AL | $184.86 | — |
| AR | $184.86 | — |
| AZ | $181.77 | — |
| CA | $181.77 | — |
| CO | $184.86 | — |
| CT | $184.86 | — |
| DC | $184.86 | — |
| DE | $184.86 | — |
| FL | $184.86 | — |
| GA | $184.86 | — |
| HI | $181.77 | — |
| IA | $181.77 | — |
| ID | $181.77 | — |
| IL | $184.86 | — |
| IN | $184.86 | — |
| KS | $181.77 | — |
| KY | $184.86 | — |
| LA | $184.86 | — |
| MA | $184.86 | — |
| MD | $184.86 | — |
| ME | $184.86 | — |
| MI | $184.86 | — |
| MN | $184.86 | — |
| MO | $184.86 | — |
| MS | $184.86 | — |
| MT | $181.77 | — |
| NC | $184.86 | — |
| ND | $181.77 | — |
| NE | $181.77 | — |
| NH | $184.86 | — |
| NJ | $184.86 | — |
| NM | $184.86 | — |
| NV | $181.77 | — |
| NY | $184.86 | — |
| OH | $184.86 | — |
| OK | $184.86 | — |
| OR | $181.77 | — |
| PA | $184.86 | — |
| PR | $221.82 | — |
| RI | $184.86 | — |
| SC | $184.86 | — |
| SD | $181.77 | — |
| TN | $184.86 | — |
| TX | $184.86 | — |
| UT | $184.86 | — |
| VA | $184.86 | — |
| VI | $184.86 | — |
| VT | $184.86 | — |
| WA | $184.86 | — |
| WI | $184.86 | — |
| WV | $184.86 | — |
| WY | $181.77 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $10.90 to $17.94 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $15.95 | — |
| AL | $13.21 | $16.10 |
| AR | $13.21 | $16.10 |
| AZ | $12.38 | $15.95 |
| CA | $12.18 | $15.95 |
| CO | $12.96 | $16.10 |
| CT | $10.90 | $16.10 |
| DC | $11.64 | $16.10 |
| DE | $11.64 | $16.10 |
| FL | $13.21 | $16.10 |
| GA | $13.21 | $16.10 |
| HI | $15.95 | — |
| IA | $12.80 | $15.95 |
| ID | $12.96 | $15.95 |
| IL | $12.89 | $16.10 |
| IN | $12.89 | $16.10 |
| KS | $12.80 | $15.95 |
| KY | $13.21 | $16.10 |
| LA | $13.21 | $16.10 |
| MA | $10.90 | $16.10 |
| MD | $11.64 | $16.10 |
| ME | $10.90 | $16.10 |
| MI | $12.89 | $16.10 |
| MN | $12.80 | $16.10 |
| MO | $12.80 | $16.10 |
| MS | $13.21 | $16.10 |
| MT | $12.96 | $15.95 |
| NC | $13.21 | $16.10 |
| ND | $12.80 | $15.95 |
| NE | $12.80 | $15.95 |
| NH | $10.90 | $16.10 |
| NJ | $11.64 | $16.10 |
| NM | $12.38 | $16.10 |
| NV | $12.18 | $15.95 |
| NY | $11.64 | $16.10 |
| OH | $12.89 | $16.10 |
| OK | $12.38 | $16.10 |
| OR | $12.18 | $15.95 |
| PA | $11.64 | $16.10 |
| PR | $17.94 | — |
| RI | $10.90 | $16.10 |
| SC | $13.21 | $16.10 |
| SD | $12.80 | $15.95 |
| TN | $13.21 | $16.10 |
| TX | $12.38 | $16.10 |
| UT | $12.96 | $16.10 |
| VA | $13.21 | $16.10 |
| VI | $16.10 | — |
| VT | $10.90 | $16.10 |
| WA | $12.18 | $16.10 |
| WI | $12.89 | $16.10 |
| WV | $13.21 | $16.10 |
| WY | $12.96 | $15.95 |
RR + KE — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $17.26 to $19.55 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $17.26 | — |
| AL | — | $17.44 |
| AR | — | $17.44 |
| AZ | — | $17.26 |
| CA | — | $17.26 |
| CO | — | $17.44 |
| CT | — | $17.44 |
| DC | — | $17.44 |
| DE | — | $17.44 |
| FL | — | $17.44 |
| GA | — | $17.44 |
| HI | $17.26 | — |
| IA | — | $17.26 |
| ID | — | $17.26 |
| IL | — | $17.44 |
| IN | — | $17.44 |
| KS | — | $17.26 |
| KY | — | $17.44 |
| LA | — | $17.44 |
| MA | — | $17.44 |
| MD | — | $17.44 |
| ME | — | $17.44 |
| MI | — | $17.44 |
| MN | — | $17.44 |
| MO | — | $17.44 |
| MS | — | $17.44 |
| MT | — | $17.26 |
| NC | — | $17.44 |
| ND | — | $17.26 |
| NE | — | $17.26 |
| NH | — | $17.44 |
| NJ | — | $17.44 |
| NM | — | $17.44 |
| NV | — | $17.26 |
| NY | — | $17.44 |
| OH | — | $17.44 |
| OK | — | $17.44 |
| OR | — | $17.26 |
| PA | — | $17.44 |
| PR | $19.55 | — |
| RI | — | $17.44 |
| SC | — | $17.44 |
| SD | — | $17.26 |
| TN | — | $17.44 |
| TX | — | $17.44 |
| UT | — | $17.44 |
| VA | — | $17.44 |
| VI | $17.44 | — |
| VT | — | $17.44 |
| WA | — | $17.44 |
| WI | — | $17.44 |
| WV | — | $17.44 |
| WY | — | $17.26 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $18.19 to $22.17 depending on state and rural status.
Former-CBA payment limits: ceiling $18.48 · floor $15.71
| State | Non-rural | Rural |
|---|---|---|
| AK | $18.19 | — |
| AL | $18.48 | — |
| AR | $18.48 | — |
| AZ | $18.19 | — |
| CA | $18.19 | — |
| CO | $18.48 | — |
| CT | $18.48 | — |
| DC | $18.48 | — |
| DE | $18.48 | — |
| FL | $18.48 | — |
| GA | $18.48 | — |
| HI | $18.19 | — |
| IA | $18.19 | — |
| ID | $18.19 | — |
| IL | $18.48 | — |
| IN | $18.48 | — |
| KS | $18.19 | — |
| KY | $18.48 | — |
| LA | $18.48 | — |
| MA | $18.48 | — |
| MD | $18.48 | — |
| ME | $18.48 | — |
| MI | $18.48 | — |
| MN | $18.48 | — |
| MO | $18.48 | — |
| MS | $18.48 | — |
| MT | $18.19 | — |
| NC | $18.48 | — |
| ND | $18.19 | — |
| NE | $18.19 | — |
| NH | $18.48 | — |
| NJ | $18.48 | — |
| NM | $18.48 | — |
| NV | $18.19 | — |
| NY | $18.48 | — |
| OH | $18.48 | — |
| OK | $18.48 | — |
| OR | $18.19 | — |
| PA | $18.48 | — |
| PR | $22.17 | — |
| RI | $18.48 | — |
| SC | $18.48 | — |
| SD | $18.19 | — |
| TN | $18.48 | — |
| TX | $18.48 | — |
| UT | $18.48 | — |
| VA | $18.48 | — |
| VI | $18.48 | — |
| VT | $18.48 | — |
| WA | $18.48 | — |
| WI | $18.48 | — |
| WV | $18.48 | — |
| WY | $18.19 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $81.71 to $134.62 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $119.60 | — |
| AL | $99.10 | $120.75 |
| AR | $99.10 | $120.75 |
| AZ | $92.82 | $119.60 |
| CA | $91.36 | $119.60 |
| CO | $97.15 | $120.75 |
| CT | $81.71 | $120.75 |
| DC | $87.29 | $120.75 |
| DE | $87.29 | $120.75 |
| FL | $99.10 | $120.75 |
| GA | $99.10 | $120.75 |
| HI | $119.60 | — |
| IA | $96.00 | $119.60 |
| ID | $97.15 | $119.60 |
| IL | $96.71 | $120.75 |
| IN | $96.71 | $120.75 |
| KS | $96.00 | $119.60 |
| KY | $99.10 | $120.75 |
| LA | $99.10 | $120.75 |
| MA | $81.71 | $120.75 |
| MD | $87.29 | $120.75 |
| ME | $81.71 | $120.75 |
| MI | $96.71 | $120.75 |
| MN | $96.00 | $120.75 |
| MO | $96.00 | $120.75 |
| MS | $99.10 | $120.75 |
| MT | $97.15 | $119.60 |
| NC | $99.10 | $120.75 |
| ND | $96.00 | $119.60 |
| NE | $96.00 | $119.60 |
| NH | $81.71 | $120.75 |
| NJ | $87.29 | $120.75 |
| NM | $92.82 | $120.75 |
| NV | $91.36 | $119.60 |
| NY | $87.29 | $120.75 |
| OH | $96.71 | $120.75 |
| OK | $92.82 | $120.75 |
| OR | $91.36 | $119.60 |
| PA | $87.29 | $120.75 |
| PR | $134.62 | — |
| RI | $81.71 | $120.75 |
| SC | $99.10 | $120.75 |
| SD | $96.00 | $119.60 |
| TN | $99.10 | $120.75 |
| TX | $92.82 | $120.75 |
| UT | $97.15 | $120.75 |
| VA | $99.10 | $120.75 |
| VI | $120.75 | — |
| VT | $81.71 | $120.75 |
| WA | $91.36 | $120.75 |
| WI | $96.71 | $120.75 |
| WV | $99.10 | $120.75 |
| WY | $97.15 | $119.60 |
UE + KE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $129.49 to $146.68 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $129.49 | — |
| AL | — | $130.80 |
| AR | — | $130.80 |
| AZ | — | $129.49 |
| CA | — | $129.49 |
| CO | — | $130.80 |
| CT | — | $130.80 |
| DC | — | $130.80 |
| DE | — | $130.80 |
| FL | — | $130.80 |
| GA | — | $130.80 |
| HI | $129.49 | — |
| IA | — | $129.49 |
| ID | — | $129.49 |
| IL | — | $130.80 |
| IN | — | $130.80 |
| KS | — | $129.49 |
| KY | — | $130.80 |
| LA | — | $130.80 |
| MA | — | $130.80 |
| MD | — | $130.80 |
| ME | — | $130.80 |
| MI | — | $130.80 |
| MN | — | $130.80 |
| MO | — | $130.80 |
| MS | — | $130.80 |
| MT | — | $129.49 |
| NC | — | $130.80 |
| ND | — | $129.49 |
| NE | — | $129.49 |
| NH | — | $130.80 |
| NJ | — | $130.80 |
| NM | — | $130.80 |
| NV | — | $129.49 |
| NY | — | $130.80 |
| OH | — | $130.80 |
| OK | — | $130.80 |
| OR | — | $129.49 |
| PA | — | $130.80 |
| PR | $146.68 | — |
| RI | — | $130.80 |
| SC | — | $130.80 |
| SD | — | $129.49 |
| TN | — | $130.80 |
| TX | — | $130.80 |
| UT | — | $130.80 |
| VA | — | $130.80 |
| VI | $130.80 | — |
| VT | — | $130.80 |
| WA | — | $130.80 |
| WI | — | $130.80 |
| WV | — | $130.80 |
| WY | — | $129.49 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $136.35 to $166.38 depending on state and rural status.
Former-CBA payment limits: ceiling $138.67 · floor $117.87
| State | Non-rural | Rural |
|---|---|---|
| AK | $136.35 | — |
| AL | $138.67 | — |
| AR | $138.67 | — |
| AZ | $136.35 | — |
| CA | $136.35 | — |
| CO | $138.67 | — |
| CT | $138.67 | — |
| DC | $138.67 | — |
| DE | $138.67 | — |
| FL | $138.67 | — |
| GA | $138.67 | — |
| HI | $136.35 | — |
| IA | $136.35 | — |
| ID | $136.35 | — |
| IL | $138.67 | — |
| IN | $138.67 | — |
| KS | $136.35 | — |
| KY | $138.67 | — |
| LA | $138.67 | — |
| MA | $138.67 | — |
| MD | $138.67 | — |
| ME | $138.67 | — |
| MI | $138.67 | — |
| MN | $138.67 | — |
| MO | $138.67 | — |
| MS | $138.67 | — |
| MT | $136.35 | — |
| NC | $138.67 | — |
| ND | $136.35 | — |
| NE | $136.35 | — |
| NH | $138.67 | — |
| NJ | $138.67 | — |
| NM | $138.67 | — |
| NV | $136.35 | — |
| NY | $138.67 | — |
| OH | $138.67 | — |
| OK | $138.67 | — |
| OR | $136.35 | — |
| PA | $138.67 | — |
| PR | $166.38 | — |
| RI | $138.67 | — |
| SC | $138.67 | — |
| SD | $136.35 | — |
| TN | $138.67 | — |
| TX | $138.67 | — |
| UT | $138.67 | — |
| VA | $138.67 | — |
| VI | $138.67 | — |
| VT | $138.67 | — |
| WA | $138.67 | — |
| WI | $138.67 | — |
| WV | $138.67 | — |
| WY | $136.35 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2386 at 2 units 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
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