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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
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.

E2386 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $108.95 to $179.47 depending on state and rural status.

StateNon-ruralRural
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.

StateNon-ruralRural
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

StateNon-ruralRural
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.

StateNon-ruralRural
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.

StateNon-ruralRural
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

StateNon-ruralRural
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.

StateNon-ruralRural
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.

StateNon-ruralRural
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

StateNon-ruralRural
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
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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