MyMedi-AI

E2611 — General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware

HCPCS Level II E-code · short descriptor: “Gen use back cush wdth <22in”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
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
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 2026-10-26; 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 2026-10-26; 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.

E2611 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $180.01 to $335.00 depending on state and rural status.

StateNon-ruralRural
AK$296.61—
AL$203.62$296.61
AR$203.62$296.61
AZ$184.92$296.61
CA$180.01$296.61
CO$186.16$296.61
CT$194.63$296.61
DC$188.66$296.61
DE$188.66$296.61
FL$203.62$296.61
GA$203.62$296.61
HI$296.61—
IA$184.15$296.61
ID$186.16$296.61
IL$182.27$296.61
IN$182.27$296.61
KS$184.15$296.61
KY$203.62$296.61
LA$203.62$296.61
MA$194.63$296.61
MD$188.66$296.61
ME$194.63$296.61
MI$182.27$296.61
MN$184.15$296.61
MO$184.15$296.61
MS$203.62$296.61
MT$186.16$296.61
NC$203.62$296.61
ND$184.15$296.61
NE$184.15$296.61
NH$194.63$296.61
NJ$188.66$296.61
NM$184.92$296.61
NV$180.01$296.61
NY$188.66$296.61
OH$182.27$296.61
OK$184.92$296.61
OR$180.01$296.61
PA$188.66$296.61
PR$335.00—
RI$194.63$296.61
SC$203.62$296.61
SD$184.15$296.61
TN$203.62$296.61
TX$184.92$296.61
UT$186.16$296.61
VA$203.62$296.61
VI$296.61—
VT$194.63$296.61
WA$180.01$296.61
WI$182.27$296.61
WV$203.62$296.61
WY$186.16$296.61

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $324.42 to $368.38 depending on state and rural status.

StateNon-ruralRural
AK$324.42—
AL—$324.42
AR—$324.42
AZ—$324.42
CA—$324.42
CO—$324.42
CT—$324.42
DC—$324.42
DE—$324.42
FL—$324.42
GA—$324.42
HI$324.42—
IA—$324.42
ID—$324.42
IL—$324.42
IN—$324.42
KS—$324.42
KY—$324.42
LA—$324.42
MA—$324.42
MD—$324.42
ME—$324.42
MI—$324.42
MN—$324.42
MO—$324.42
MS—$324.42
MT—$324.42
NC—$324.42
ND—$324.42
NE—$324.42
NH—$324.42
NJ—$324.42
NM—$324.42
NV—$324.42
NY—$324.42
OH—$324.42
OK—$324.42
OR—$324.42
PA—$324.42
PR$368.38—
RI—$324.42
SC—$324.42
SD—$324.42
TN—$324.42
TX—$324.42
UT—$324.42
VA—$324.42
VI$324.42—
VT—$324.42
WA—$324.42
WI—$324.42
WV—$324.42
WY—$324.42

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $383.68 to $460.46 depending on state and rural status.

Former-CBA payment limits: ceiling $383.68 · floor $326.13

StateNon-ruralRural
AK$383.68—
AL$383.68—
AR$383.68—
AZ$383.68—
CA$383.68—
CO$383.68—
CT$383.68—
DC$383.68—
DE$383.68—
FL$383.68—
GA$383.68—
HI$383.68—
IA$383.68—
ID$383.68—
IL$383.68—
IN$383.68—
KS$383.68—
KY$383.68—
LA$383.68—
MA$383.68—
MD$383.68—
ME$383.68—
MI$383.68—
MN$383.68—
MO$383.68—
MS$383.68—
MT$383.68—
NC$383.68—
ND$383.68—
NE$383.68—
NH$383.68—
NJ$383.68—
NM$383.68—
NV$383.68—
NY$383.68—
OH$383.68—
OK$383.68—
OR$383.68—
PA$383.68—
PR$460.46—
RI$383.68—
SC$383.68—
SD$383.68—
TN$383.68—
TX$383.68—
UT$383.68—
VA$383.68—
VI$383.68—
VT$383.68—
WA$383.68—
WI$383.68—
WV$383.68—
WY$383.68—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $18.00 to $33.50 depending on state and rural status.

StateNon-ruralRural
AK$29.65—
AL$20.36$29.65
AR$20.36$29.65
AZ$18.49$29.65
CA$18.00$29.65
CO$18.62$29.65
CT$19.46$29.65
DC$18.87$29.65
DE$18.87$29.65
FL$20.36$29.65
GA$20.36$29.65
HI$29.65—
IA$18.42$29.65
ID$18.62$29.65
IL$18.23$29.65
IN$18.23$29.65
KS$18.42$29.65
KY$20.36$29.65
LA$20.36$29.65
MA$19.46$29.65
MD$18.87$29.65
ME$19.46$29.65
MI$18.23$29.65
MN$18.42$29.65
MO$18.42$29.65
MS$20.36$29.65
MT$18.62$29.65
NC$20.36$29.65
ND$18.42$29.65
NE$18.42$29.65
NH$19.46$29.65
NJ$18.87$29.65
NM$18.49$29.65
NV$18.00$29.65
NY$18.87$29.65
OH$18.23$29.65
OK$18.49$29.65
OR$18.00$29.65
PA$18.87$29.65
PR$33.50—
RI$19.46$29.65
SC$20.36$29.65
SD$18.42$29.65
TN$20.36$29.65
TX$18.49$29.65
UT$18.62$29.65
VA$20.36$29.65
VI$29.65—
VT$19.46$29.65
WA$18.00$29.65
WI$18.23$29.65
WV$20.36$29.65
WY$18.62$29.65

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $32.43 to $36.84 depending on state and rural status.

StateNon-ruralRural
AK$32.43—
AL—$32.43
AR—$32.43
AZ—$32.43
CA—$32.43
CO—$32.43
CT—$32.43
DC—$32.43
DE—$32.43
FL—$32.43
GA—$32.43
HI$32.43—
IA—$32.43
ID—$32.43
IL—$32.43
IN—$32.43
KS—$32.43
KY—$32.43
LA—$32.43
MA—$32.43
MD—$32.43
ME—$32.43
MI—$32.43
MN—$32.43
MO—$32.43
MS—$32.43
MT—$32.43
NC—$32.43
ND—$32.43
NE—$32.43
NH—$32.43
NJ—$32.43
NM—$32.43
NV—$32.43
NY—$32.43
OH—$32.43
OK—$32.43
OR—$32.43
PA—$32.43
PR$36.84—
RI—$32.43
SC—$32.43
SD—$32.43
TN—$32.43
TX—$32.43
UT—$32.43
VA—$32.43
VI$32.43—
VT—$32.43
WA—$32.43
WI—$32.43
WV—$32.43
WY—$32.43

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $38.35 to $46.06 depending on state and rural status.

Former-CBA payment limits: ceiling $38.35 · floor $32.60

StateNon-ruralRural
AK$38.35—
AL$38.35—
AR$38.35—
AZ$38.35—
CA$38.35—
CO$38.35—
CT$38.35—
DC$38.35—
DE$38.35—
FL$38.35—
GA$38.35—
HI$38.35—
IA$38.35—
ID$38.35—
IL$38.35—
IN$38.35—
KS$38.35—
KY$38.35—
LA$38.35—
MA$38.35—
MD$38.35—
ME$38.35—
MI$38.35—
MN$38.35—
MO$38.35—
MS$38.35—
MT$38.35—
NC$38.35—
ND$38.35—
NE$38.35—
NH$38.35—
NJ$38.35—
NM$38.35—
NV$38.35—
NY$38.35—
OH$38.35—
OK$38.35—
OR$38.35—
PA$38.35—
PR$46.06—
RI$38.35—
SC$38.35—
SD$38.35—
TN$38.35—
TX$38.35—
UT$38.35—
VA$38.35—
VI$38.35—
VT$38.35—
WA$38.35—
WI$38.35—
WV$38.35—
WY$38.35—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $135.01 to $251.24 depending on state and rural status.

StateNon-ruralRural
AK$222.47—
AL$152.72$222.47
AR$152.72$222.47
AZ$138.69$222.47
CA$135.01$222.47
CO$139.62$222.47
CT$145.98$222.47
DC$141.50$222.47
DE$141.50$222.47
FL$152.72$222.47
GA$152.72$222.47
HI$222.47—
IA$138.11$222.47
ID$139.62$222.47
IL$136.70$222.47
IN$136.70$222.47
KS$138.11$222.47
KY$152.72$222.47
LA$152.72$222.47
MA$145.98$222.47
MD$141.50$222.47
ME$145.98$222.47
MI$136.70$222.47
MN$138.11$222.47
MO$138.11$222.47
MS$152.72$222.47
MT$139.62$222.47
NC$152.72$222.47
ND$138.11$222.47
NE$138.11$222.47
NH$145.98$222.47
NJ$141.50$222.47
NM$138.69$222.47
NV$135.01$222.47
NY$141.50$222.47
OH$136.70$222.47
OK$138.69$222.47
OR$135.01$222.47
PA$141.50$222.47
PR$251.24—
RI$145.98$222.47
SC$152.72$222.47
SD$138.11$222.47
TN$152.72$222.47
TX$138.69$222.47
UT$139.62$222.47
VA$152.72$222.47
VI$222.47—
VT$145.98$222.47
WA$135.01$222.47
WI$136.70$222.47
WV$152.72$222.47
WY$139.62$222.47

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $243.34 to $276.28 depending on state and rural status.

StateNon-ruralRural
AK$243.34—
AL—$243.34
AR—$243.34
AZ—$243.34
CA—$243.34
CO—$243.34
CT—$243.34
DC—$243.34
DE—$243.34
FL—$243.34
GA—$243.34
HI$243.34—
IA—$243.34
ID—$243.34
IL—$243.34
IN—$243.34
KS—$243.34
KY—$243.34
LA—$243.34
MA—$243.34
MD—$243.34
ME—$243.34
MI—$243.34
MN—$243.34
MO—$243.34
MS—$243.34
MT—$243.34
NC—$243.34
ND—$243.34
NE—$243.34
NH—$243.34
NJ—$243.34
NM—$243.34
NV—$243.34
NY—$243.34
OH—$243.34
OK—$243.34
OR—$243.34
PA—$243.34
PR$276.28—
RI—$243.34
SC—$243.34
SD—$243.34
TN—$243.34
TX—$243.34
UT—$243.34
VA—$243.34
VI$243.34—
VT—$243.34
WA—$243.34
WI—$243.34
WV—$243.34
WY—$243.34

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $287.77 to $345.32 depending on state and rural status.

Former-CBA payment limits: ceiling $287.77 · floor $244.60

StateNon-ruralRural
AK$287.77—
AL$287.77—
AR$287.77—
AZ$287.77—
CA$287.77—
CO$287.77—
CT$287.77—
DC$287.77—
DE$287.77—
FL$287.77—
GA$287.77—
HI$287.77—
IA$287.77—
ID$287.77—
IL$287.77—
IN$287.77—
KS$287.77—
KY$287.77—
LA$287.77—
MA$287.77—
MD$287.77—
ME$287.77—
MI$287.77—
MN$287.77—
MO$287.77—
MS$287.77—
MT$287.77—
NC$287.77—
ND$287.77—
NE$287.77—
NH$287.77—
NJ$287.77—
NM$287.77—
NV$287.77—
NY$287.77—
OH$287.77—
OK$287.77—
OR$287.77—
PA$287.77—
PR$345.32—
RI$287.77—
SC$287.77—
SD$287.77—
TN$287.77—
TX$287.77—
UT$287.77—
VA$287.77—
VI$287.77—
VT$287.77—
WA$287.77—
WI$287.77—
WV$287.77—
WY$287.77—
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 E2611 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

E2601E2602E2603E2604E2605E2606E2607E2608E2609E2610E2612E2613

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