MyMedi-AI

E2389 — Power wheelchair accessory, foam caster tire, any size, replacement only, each

HCPCS Level II E-code · short descriptor: “Foam caster 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.

E2389 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $33.27 to $35.11 depending on state and rural status.

StateNon-ruralRural
AK$33.44—
AL$33.27$33.44
AR$33.27$33.44
AZ$33.27$33.44
CA$33.27$33.44
CO$33.27$33.44
CT$33.27$33.44
DC$33.27$33.44
DE$33.27$33.44
FL$33.27$33.44
GA$33.27$33.44
HI$33.44—
IA$33.27$33.44
ID$33.27$33.44
IL$33.27$33.44
IN$33.27$33.44
KS$33.27$33.44
KY$33.27$33.44
LA$33.27$33.44
MA$33.27$33.44
MD$33.27$33.44
ME$33.27$33.44
MI$33.27$33.44
MN$33.27$33.44
MO$33.27$33.44
MS$33.27$33.44
MT$33.27$33.44
NC$33.27$33.44
ND$33.27$33.44
NE$33.27$33.44
NH$33.27$33.44
NJ$33.27$33.44
NM$33.27$33.44
NV$33.27$33.44
NY$33.27$33.44
OH$33.27$33.44
OK$33.27$33.44
OR$33.27$33.44
PA$33.27$33.44
PR$35.11—
RI$33.27$33.44
SC$33.27$33.44
SD$33.27$33.44
TN$33.27$33.44
TX$33.27$33.44
UT$33.27$33.44
VA$33.27$33.44
VI$33.44—
VT$33.27$33.44
WA$33.27$33.44
WI$33.27$33.44
WV$33.27$33.44
WY$33.27$33.44

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $35.88 to $37.79 depending on state and rural status.

StateNon-ruralRural
AK$35.88—
AL—$35.88
AR—$35.88
AZ—$35.88
CA—$35.88
CO—$35.88
CT—$35.88
DC—$35.88
DE—$35.88
FL—$35.88
GA—$35.88
HI$35.88—
IA—$35.88
ID—$35.88
IL—$35.88
IN—$35.88
KS—$35.88
KY—$35.88
LA—$35.88
MA—$35.88
MD—$35.88
ME—$35.88
MI—$35.88
MN—$35.88
MO—$35.88
MS—$35.88
MT—$35.88
NC—$35.88
ND—$35.88
NE—$35.88
NH—$35.88
NJ—$35.88
NM—$35.88
NV—$35.88
NY—$35.88
OH—$35.88
OK—$35.88
OR—$35.88
PA—$35.88
PR$37.79—
RI—$35.88
SC—$35.88
SD—$35.88
TN—$35.88
TX—$35.88
UT—$35.88
VA—$35.88
VI$35.88—
VT—$35.88
WA—$35.88
WI—$35.88
WV—$35.88
WY—$35.88

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $33.61 to $36.95 depending on state and rural status.

Former-CBA payment limits: ceiling $33.61 · floor $28.57

StateNon-ruralRural
AK$33.61—
AL$33.61—
AR$33.61—
AZ$33.61—
CA$33.61—
CO$33.61—
CT$33.61—
DC$33.61—
DE$33.61—
FL$33.61—
GA$33.61—
HI$33.61—
IA$33.61—
ID$33.61—
IL$33.61—
IN$33.61—
KS$33.61—
KY$33.61—
LA$33.61—
MA$33.61—
MD$33.61—
ME$33.61—
MI$33.61—
MN$33.61—
MO$33.61—
MS$33.61—
MT$33.61—
NC$33.61—
ND$33.61—
NE$33.61—
NH$33.61—
NJ$33.61—
NM$33.61—
NV$33.61—
NY$33.61—
OH$33.61—
OK$33.61—
OR$33.61—
PA$33.61—
PR$36.95—
RI$33.61—
SC$33.61—
SD$33.61—
TN$33.61—
TX$33.61—
UT$33.61—
VA$33.61—
VI$33.61—
VT$33.61—
WA$33.61—
WI$33.61—
WV$33.61—
WY$33.61—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.33 to $3.53 depending on state and rural status.

StateNon-ruralRural
AK$3.35—
AL$3.33$3.35
AR$3.33$3.35
AZ$3.33$3.35
CA$3.33$3.35
CO$3.33$3.35
CT$3.33$3.35
DC$3.33$3.35
DE$3.33$3.35
FL$3.33$3.35
GA$3.33$3.35
HI$3.35—
IA$3.33$3.35
ID$3.33$3.35
IL$3.33$3.35
IN$3.33$3.35
KS$3.33$3.35
KY$3.33$3.35
LA$3.33$3.35
MA$3.33$3.35
MD$3.33$3.35
ME$3.33$3.35
MI$3.33$3.35
MN$3.33$3.35
MO$3.33$3.35
MS$3.33$3.35
MT$3.33$3.35
NC$3.33$3.35
ND$3.33$3.35
NE$3.33$3.35
NH$3.33$3.35
NJ$3.33$3.35
NM$3.33$3.35
NV$3.33$3.35
NY$3.33$3.35
OH$3.33$3.35
OK$3.33$3.35
OR$3.33$3.35
PA$3.33$3.35
PR$3.53—
RI$3.33$3.35
SC$3.33$3.35
SD$3.33$3.35
TN$3.33$3.35
TX$3.33$3.35
UT$3.33$3.35
VA$3.33$3.35
VI$3.35—
VT$3.33$3.35
WA$3.33$3.35
WI$3.33$3.35
WV$3.33$3.35
WY$3.33$3.35

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.60 to $3.79 depending on state and rural status.

StateNon-ruralRural
AK$3.60—
AL—$3.60
AR—$3.60
AZ—$3.60
CA—$3.60
CO—$3.60
CT—$3.60
DC—$3.60
DE—$3.60
FL—$3.60
GA—$3.60
HI$3.60—
IA—$3.60
ID—$3.60
IL—$3.60
IN—$3.60
KS—$3.60
KY—$3.60
LA—$3.60
MA—$3.60
MD—$3.60
ME—$3.60
MI—$3.60
MN—$3.60
MO—$3.60
MS—$3.60
MT—$3.60
NC—$3.60
ND—$3.60
NE—$3.60
NH—$3.60
NJ—$3.60
NM—$3.60
NV—$3.60
NY—$3.60
OH—$3.60
OK—$3.60
OR—$3.60
PA—$3.60
PR$3.79—
RI—$3.60
SC—$3.60
SD—$3.60
TN—$3.60
TX—$3.60
UT—$3.60
VA—$3.60
VI$3.60—
VT—$3.60
WA—$3.60
WI—$3.60
WV—$3.60
WY—$3.60

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.38 to $3.74 depending on state and rural status.

Former-CBA payment limits: ceiling $3.38 · floor $2.87

StateNon-ruralRural
AK$3.38—
AL$3.38—
AR$3.38—
AZ$3.38—
CA$3.38—
CO$3.38—
CT$3.38—
DC$3.38—
DE$3.38—
FL$3.38—
GA$3.38—
HI$3.38—
IA$3.38—
ID$3.38—
IL$3.38—
IN$3.38—
KS$3.38—
KY$3.38—
LA$3.38—
MA$3.38—
MD$3.38—
ME$3.38—
MI$3.38—
MN$3.38—
MO$3.38—
MS$3.38—
MT$3.38—
NC$3.38—
ND$3.38—
NE$3.38—
NH$3.38—
NJ$3.38—
NM$3.38—
NV$3.38—
NY$3.38—
OH$3.38—
OK$3.38—
OR$3.38—
PA$3.38—
PR$3.74—
RI$3.38—
SC$3.38—
SD$3.38—
TN$3.38—
TX$3.38—
UT$3.38—
VA$3.38—
VI$3.38—
VT$3.38—
WA$3.38—
WI$3.38—
WV$3.38—
WY$3.38—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $24.95 to $26.35 depending on state and rural status.

StateNon-ruralRural
AK$25.07—
AL$24.95$25.07
AR$24.95$25.07
AZ$24.95$25.07
CA$24.95$25.07
CO$24.95$25.07
CT$24.95$25.07
DC$24.95$25.07
DE$24.95$25.07
FL$24.95$25.07
GA$24.95$25.07
HI$25.07—
IA$24.95$25.07
ID$24.95$25.07
IL$24.95$25.07
IN$24.95$25.07
KS$24.95$25.07
KY$24.95$25.07
LA$24.95$25.07
MA$24.95$25.07
MD$24.95$25.07
ME$24.95$25.07
MI$24.95$25.07
MN$24.95$25.07
MO$24.95$25.07
MS$24.95$25.07
MT$24.95$25.07
NC$24.95$25.07
ND$24.95$25.07
NE$24.95$25.07
NH$24.95$25.07
NJ$24.95$25.07
NM$24.95$25.07
NV$24.95$25.07
NY$24.95$25.07
OH$24.95$25.07
OK$24.95$25.07
OR$24.95$25.07
PA$24.95$25.07
PR$26.35—
RI$24.95$25.07
SC$24.95$25.07
SD$24.95$25.07
TN$24.95$25.07
TX$24.95$25.07
UT$24.95$25.07
VA$24.95$25.07
VI$25.07—
VT$24.95$25.07
WA$24.95$25.07
WI$24.95$25.07
WV$24.95$25.07
WY$24.95$25.07

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $26.89 to $28.36 depending on state and rural status.

StateNon-ruralRural
AK$26.89—
AL—$26.89
AR—$26.89
AZ—$26.89
CA—$26.89
CO—$26.89
CT—$26.89
DC—$26.89
DE—$26.89
FL—$26.89
GA—$26.89
HI$26.89—
IA—$26.89
ID—$26.89
IL—$26.89
IN—$26.89
KS—$26.89
KY—$26.89
LA—$26.89
MA—$26.89
MD—$26.89
ME—$26.89
MI—$26.89
MN—$26.89
MO—$26.89
MS—$26.89
MT—$26.89
NC—$26.89
ND—$26.89
NE—$26.89
NH—$26.89
NJ—$26.89
NM—$26.89
NV—$26.89
NY—$26.89
OH—$26.89
OK—$26.89
OR—$26.89
PA—$26.89
PR$28.36—
RI—$26.89
SC—$26.89
SD—$26.89
TN—$26.89
TX—$26.89
UT—$26.89
VA—$26.89
VI$26.89—
VT—$26.89
WA—$26.89
WI—$26.89
WV—$26.89
WY—$26.89

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $25.18 to $27.74 depending on state and rural status.

Former-CBA payment limits: ceiling $25.18 · floor $21.40

StateNon-ruralRural
AK$25.18—
AL$25.18—
AR$25.18—
AZ$25.18—
CA$25.18—
CO$25.18—
CT$25.18—
DC$25.18—
DE$25.18—
FL$25.18—
GA$25.18—
HI$25.18—
IA$25.18—
ID$25.18—
IL$25.18—
IN$25.18—
KS$25.18—
KY$25.18—
LA$25.18—
MA$25.18—
MD$25.18—
ME$25.18—
MI$25.18—
MN$25.18—
MO$25.18—
MS$25.18—
MT$25.18—
NC$25.18—
ND$25.18—
NE$25.18—
NH$25.18—
NJ$25.18—
NM$25.18—
NV$25.18—
NY$25.18—
OH$25.18—
OK$25.18—
OR$25.18—
PA$25.18—
PR$27.74—
RI$25.18—
SC$25.18—
SD$25.18—
TN$25.18—
TX$25.18—
UT$25.18—
VA$25.18—
VI$25.18—
VT$25.18—
WA$25.18—
WI$25.18—
WV$25.18—
WY$25.18—
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.

Common denial codes to watch

CO-50 medical necessity

Related E-codes

E2301E2310E2311E2312E2313E2321E2322E2323E2324E2325E2326E2327

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