MyMedi-AI

E2395 — Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

HCPCS Level II E-code · short descriptor: “Caster wheel excludes 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
4
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.

E2395 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $48.71 to $73.50 depending on state and rural status.

StateNon-ruralRural
AK$66.79—
AL$53.46$62.66
AR$53.46$62.66
AZ$52.73$62.66
CA$53.44$62.66
CO$54.74$62.66
CT$48.71$62.66
DC$49.01$62.66
DE$49.01$62.66
FL$53.46$62.66
GA$53.46$62.66
HI$66.79—
IA$54.95$62.66
ID$54.74$62.66
IL$57.40$62.66
IN$57.40$62.66
KS$54.95$62.66
KY$53.46$62.66
LA$53.46$62.66
MA$48.71$62.66
MD$49.01$62.66
ME$48.71$62.66
MI$57.40$62.66
MN$54.95$62.66
MO$54.95$62.66
MS$53.46$62.66
MT$54.74$62.66
NC$53.46$62.66
ND$54.95$62.66
NE$54.95$62.66
NH$48.71$62.66
NJ$49.01$62.66
NM$52.73$62.66
NV$53.44$62.66
NY$49.01$62.66
OH$57.40$62.66
OK$52.73$62.66
OR$53.44$62.66
PA$49.01$62.66
PR$73.50—
RI$48.71$62.66
SC$53.46$62.66
SD$54.95$62.66
TN$53.46$62.66
TX$52.73$62.66
UT$54.74$62.66
VA$53.46$62.66
VI$66.79—
VT$48.71$62.66
WA$53.44$62.66
WI$57.40$62.66
WV$53.46$62.66
WY$54.74$62.66

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $67.52 to $79.32 depending on state and rural status.

StateNon-ruralRural
AK$71.65—
AL—$67.52
AR—$67.52
AZ—$67.52
CA—$67.52
CO—$67.52
CT—$67.52
DC—$67.52
DE—$67.52
FL—$67.52
GA—$67.52
HI$71.65—
IA—$67.52
ID—$67.52
IL—$67.52
IN—$67.52
KS—$67.52
KY—$67.52
LA—$67.52
MA—$67.52
MD—$67.52
ME—$67.52
MI—$67.52
MN—$67.52
MO—$67.52
MS—$67.52
MT—$67.52
NC—$67.52
ND—$67.52
NE—$67.52
NH—$67.52
NJ—$67.52
NM—$67.52
NV—$67.52
NY—$67.52
OH—$67.52
OK—$67.52
OR—$67.52
PA—$67.52
PR$79.32—
RI—$67.52
SC—$67.52
SD—$67.52
TN—$67.52
TX—$67.52
UT—$67.52
VA—$67.52
VI$71.65—
VT—$67.52
WA—$67.52
WI—$67.52
WV—$67.52
WY—$67.52

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $67.00 to $80.40 depending on state and rural status.

Former-CBA payment limits: ceiling $67.00 · floor $56.95

StateNon-ruralRural
AK$67.00—
AL$67.00—
AR$67.00—
AZ$67.00—
CA$67.00—
CO$67.00—
CT$67.00—
DC$67.00—
DE$67.00—
FL$67.00—
GA$67.00—
HI$67.00—
IA$67.00—
ID$67.00—
IL$67.00—
IN$67.00—
KS$67.00—
KY$67.00—
LA$67.00—
MA$67.00—
MD$67.00—
ME$67.00—
MI$67.00—
MN$67.00—
MO$67.00—
MS$67.00—
MT$67.00—
NC$67.00—
ND$67.00—
NE$67.00—
NH$67.00—
NJ$67.00—
NM$67.00—
NV$67.00—
NY$67.00—
OH$67.00—
OK$67.00—
OR$67.00—
PA$67.00—
PR$80.40—
RI$67.00—
SC$67.00—
SD$67.00—
TN$67.00—
TX$67.00—
UT$67.00—
VA$67.00—
VI$67.00—
VT$67.00—
WA$67.00—
WI$67.00—
WV$67.00—
WY$67.00—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $4.87 to $7.35 depending on state and rural status.

StateNon-ruralRural
AK$6.69—
AL$5.35$6.27
AR$5.35$6.27
AZ$5.27$6.27
CA$5.35$6.27
CO$5.47$6.27
CT$4.87$6.27
DC$4.90$6.27
DE$4.90$6.27
FL$5.35$6.27
GA$5.35$6.27
HI$6.69—
IA$5.49$6.27
ID$5.47$6.27
IL$5.74$6.27
IN$5.74$6.27
KS$5.49$6.27
KY$5.35$6.27
LA$5.35$6.27
MA$4.87$6.27
MD$4.90$6.27
ME$4.87$6.27
MI$5.74$6.27
MN$5.49$6.27
MO$5.49$6.27
MS$5.35$6.27
MT$5.47$6.27
NC$5.35$6.27
ND$5.49$6.27
NE$5.49$6.27
NH$4.87$6.27
NJ$4.90$6.27
NM$5.27$6.27
NV$5.35$6.27
NY$4.90$6.27
OH$5.74$6.27
OK$5.27$6.27
OR$5.35$6.27
PA$4.90$6.27
PR$7.35—
RI$4.87$6.27
SC$5.35$6.27
SD$5.49$6.27
TN$5.35$6.27
TX$5.27$6.27
UT$5.47$6.27
VA$5.35$6.27
VI$6.69—
VT$4.87$6.27
WA$5.35$6.27
WI$5.74$6.27
WV$5.35$6.27
WY$5.47$6.27

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $6.76 to $7.93 depending on state and rural status.

StateNon-ruralRural
AK$7.17—
AL—$6.76
AR—$6.76
AZ—$6.76
CA—$6.76
CO—$6.76
CT—$6.76
DC—$6.76
DE—$6.76
FL—$6.76
GA—$6.76
HI$7.17—
IA—$6.76
ID—$6.76
IL—$6.76
IN—$6.76
KS—$6.76
KY—$6.76
LA—$6.76
MA—$6.76
MD—$6.76
ME—$6.76
MI—$6.76
MN—$6.76
MO—$6.76
MS—$6.76
MT—$6.76
NC—$6.76
ND—$6.76
NE—$6.76
NH—$6.76
NJ—$6.76
NM—$6.76
NV—$6.76
NY—$6.76
OH—$6.76
OK—$6.76
OR—$6.76
PA—$6.76
PR$7.93—
RI—$6.76
SC—$6.76
SD—$6.76
TN—$6.76
TX—$6.76
UT—$6.76
VA—$6.76
VI$7.17—
VT—$6.76
WA—$6.76
WI—$6.76
WV—$6.76
WY—$6.76

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $6.71 to $8.02 depending on state and rural status.

Former-CBA payment limits: ceiling $6.71 · floor $5.70

StateNon-ruralRural
AK$6.71—
AL$6.71—
AR$6.71—
AZ$6.71—
CA$6.71—
CO$6.71—
CT$6.71—
DC$6.71—
DE$6.71—
FL$6.71—
GA$6.71—
HI$6.71—
IA$6.71—
ID$6.71—
IL$6.71—
IN$6.71—
KS$6.71—
KY$6.71—
LA$6.71—
MA$6.71—
MD$6.71—
ME$6.71—
MI$6.71—
MN$6.71—
MO$6.71—
MS$6.71—
MT$6.71—
NC$6.71—
ND$6.71—
NE$6.71—
NH$6.71—
NJ$6.71—
NM$6.71—
NV$6.71—
NY$6.71—
OH$6.71—
OK$6.71—
OR$6.71—
PA$6.71—
PR$8.02—
RI$6.71—
SC$6.71—
SD$6.71—
TN$6.71—
TX$6.71—
UT$6.71—
VA$6.71—
VI$6.71—
VT$6.71—
WA$6.71—
WI$6.71—
WV$6.71—
WY$6.71—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $36.53 to $55.13 depending on state and rural status.

StateNon-ruralRural
AK$50.10—
AL$40.09$47.00
AR$40.09$47.00
AZ$39.55$47.00
CA$40.08$47.00
CO$41.06$47.00
CT$36.53$47.00
DC$36.76$47.00
DE$36.76$47.00
FL$40.09$47.00
GA$40.09$47.00
HI$50.10—
IA$41.22$47.00
ID$41.06$47.00
IL$43.05$47.00
IN$43.05$47.00
KS$41.22$47.00
KY$40.09$47.00
LA$40.09$47.00
MA$36.53$47.00
MD$36.76$47.00
ME$36.53$47.00
MI$43.05$47.00
MN$41.22$47.00
MO$41.22$47.00
MS$40.09$47.00
MT$41.06$47.00
NC$40.09$47.00
ND$41.22$47.00
NE$41.22$47.00
NH$36.53$47.00
NJ$36.76$47.00
NM$39.55$47.00
NV$40.08$47.00
NY$36.76$47.00
OH$43.05$47.00
OK$39.55$47.00
OR$40.08$47.00
PA$36.76$47.00
PR$55.13—
RI$36.53$47.00
SC$40.09$47.00
SD$41.22$47.00
TN$40.09$47.00
TX$39.55$47.00
UT$41.06$47.00
VA$40.09$47.00
VI$50.10—
VT$36.53$47.00
WA$40.08$47.00
WI$43.05$47.00
WV$40.09$47.00
WY$41.06$47.00

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $50.65 to $59.50 depending on state and rural status.

StateNon-ruralRural
AK$53.75—
AL—$50.65
AR—$50.65
AZ—$50.65
CA—$50.65
CO—$50.65
CT—$50.65
DC—$50.65
DE—$50.65
FL—$50.65
GA—$50.65
HI$53.75—
IA—$50.65
ID—$50.65
IL—$50.65
IN—$50.65
KS—$50.65
KY—$50.65
LA—$50.65
MA—$50.65
MD—$50.65
ME—$50.65
MI—$50.65
MN—$50.65
MO—$50.65
MS—$50.65
MT—$50.65
NC—$50.65
ND—$50.65
NE—$50.65
NH—$50.65
NJ—$50.65
NM—$50.65
NV—$50.65
NY—$50.65
OH—$50.65
OK—$50.65
OR—$50.65
PA—$50.65
PR$59.50—
RI—$50.65
SC—$50.65
SD—$50.65
TN—$50.65
TX—$50.65
UT—$50.65
VA—$50.65
VI$53.75—
VT—$50.65
WA—$50.65
WI—$50.65
WV—$50.65
WY—$50.65

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $50.25 to $60.33 depending on state and rural status.

Former-CBA payment limits: ceiling $50.25 · floor $42.71

StateNon-ruralRural
AK$50.25—
AL$50.25—
AR$50.25—
AZ$50.25—
CA$50.25—
CO$50.25—
CT$50.25—
DC$50.25—
DE$50.25—
FL$50.25—
GA$50.25—
HI$50.25—
IA$50.25—
ID$50.25—
IL$50.25—
IN$50.25—
KS$50.25—
KY$50.25—
LA$50.25—
MA$50.25—
MD$50.25—
ME$50.25—
MI$50.25—
MN$50.25—
MO$50.25—
MS$50.25—
MT$50.25—
NC$50.25—
ND$50.25—
NE$50.25—
NH$50.25—
NJ$50.25—
NM$50.25—
NV$50.25—
NY$50.25—
OH$50.25—
OK$50.25—
OR$50.25—
PA$50.25—
PR$60.33—
RI$50.25—
SC$50.25—
SD$50.25—
TN$50.25—
TX$50.25—
UT$50.25—
VA$50.25—
VI$50.25—
VT$50.25—
WA$50.25—
WI$50.25—
WV$50.25—
WY$50.25—
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 E2395 at 4 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

CO-50 medical necessityCO-151 frequency/units

Related E-codes

E2301E2310E2311E2312E2313E2321E2322E2323E2324E2325E2326E2327

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