E2612 — General use wheelchair back cushion, width 22 inches or greater, 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.
E2612 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $346.44 to $570.08 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $518.18 | — |
| AL | $388.52 | $463.99 |
| AR | $388.52 | $463.99 |
| AZ | $365.15 | $463.99 |
| CA | $368.01 | $463.99 |
| CO | $377.88 | $463.99 |
| CT | $349.38 | $463.99 |
| DC | $346.44 | $463.99 |
| DE | $346.44 | $463.99 |
| FL | $388.52 | $463.99 |
| GA | $388.52 | $463.99 |
| HI | $518.18 | — |
| IA | $381.56 | $463.99 |
| ID | $377.88 | $463.99 |
| IL | $377.44 | $463.99 |
| IN | $377.44 | $463.99 |
| KS | $381.56 | $463.99 |
| KY | $388.52 | $463.99 |
| LA | $388.52 | $463.99 |
| MA | $349.38 | $463.99 |
| MD | $346.44 | $463.99 |
| ME | $349.38 | $463.99 |
| MI | $377.44 | $463.99 |
| MN | $381.56 | $463.99 |
| MO | $381.56 | $463.99 |
| MS | $388.52 | $463.99 |
| MT | $377.88 | $463.99 |
| NC | $388.52 | $463.99 |
| ND | $381.56 | $463.99 |
| NE | $381.56 | $463.99 |
| NH | $349.38 | $463.99 |
| NJ | $346.44 | $463.99 |
| NM | $365.15 | $463.99 |
| NV | $368.01 | $463.99 |
| NY | $346.44 | $463.99 |
| OH | $377.44 | $463.99 |
| OK | $365.15 | $463.99 |
| OR | $368.01 | $463.99 |
| PA | $346.44 | $463.99 |
| PR | $570.08 | — |
| RI | $349.38 | $463.99 |
| SC | $388.52 | $463.99 |
| SD | $381.56 | $463.99 |
| TN | $388.52 | $463.99 |
| TX | $365.15 | $463.99 |
| UT | $377.88 | $463.99 |
| VA | $388.52 | $463.99 |
| VI | $518.18 | — |
| VT | $349.38 | $463.99 |
| WA | $368.01 | $463.99 |
| WI | $377.44 | $463.99 |
| WV | $388.52 | $463.99 |
| WY | $377.88 | $463.99 |
NU + KE — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $501.62 to $615.23 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $555.81 | — |
| AL | — | $501.62 |
| AR | — | $501.62 |
| AZ | — | $501.62 |
| CA | — | $501.62 |
| CO | — | $501.62 |
| CT | — | $501.62 |
| DC | — | $501.62 |
| DE | — | $501.62 |
| FL | — | $501.62 |
| GA | — | $501.62 |
| HI | $555.81 | — |
| IA | — | $501.62 |
| ID | — | $501.62 |
| IL | — | $501.62 |
| IN | — | $501.62 |
| KS | — | $501.62 |
| KY | — | $501.62 |
| LA | — | $501.62 |
| MA | — | $501.62 |
| MD | — | $501.62 |
| ME | — | $501.62 |
| MI | — | $501.62 |
| MN | — | $501.62 |
| MO | — | $501.62 |
| MS | — | $501.62 |
| MT | — | $501.62 |
| NC | — | $501.62 |
| ND | — | $501.62 |
| NE | — | $501.62 |
| NH | — | $501.62 |
| NJ | — | $501.62 |
| NM | — | $501.62 |
| NV | — | $501.62 |
| NY | — | $501.62 |
| OH | — | $501.62 |
| OK | — | $501.62 |
| OR | — | $501.62 |
| PA | — | $501.62 |
| PR | $615.23 | — |
| RI | — | $501.62 |
| SC | — | $501.62 |
| SD | — | $501.62 |
| TN | — | $501.62 |
| TX | — | $501.62 |
| UT | — | $501.62 |
| VA | — | $501.62 |
| VI | $555.81 | — |
| VT | — | $501.62 |
| WA | — | $501.62 |
| WI | — | $501.62 |
| WV | — | $501.62 |
| WY | — | $501.62 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $519.02 to $622.81 depending on state and rural status.
Former-CBA payment limits: ceiling $519.02 · floor $441.17
| State | Non-rural | Rural |
|---|---|---|
| AK | $519.02 | — |
| AL | $519.02 | — |
| AR | $519.02 | — |
| AZ | $519.02 | — |
| CA | $519.02 | — |
| CO | $519.02 | — |
| CT | $519.02 | — |
| DC | $519.02 | — |
| DE | $519.02 | — |
| FL | $519.02 | — |
| GA | $519.02 | — |
| HI | $519.02 | — |
| IA | $519.02 | — |
| ID | $519.02 | — |
| IL | $519.02 | — |
| IN | $519.02 | — |
| KS | $519.02 | — |
| KY | $519.02 | — |
| LA | $519.02 | — |
| MA | $519.02 | — |
| MD | $519.02 | — |
| ME | $519.02 | — |
| MI | $519.02 | — |
| MN | $519.02 | — |
| MO | $519.02 | — |
| MS | $519.02 | — |
| MT | $519.02 | — |
| NC | $519.02 | — |
| ND | $519.02 | — |
| NE | $519.02 | — |
| NH | $519.02 | — |
| NJ | $519.02 | — |
| NM | $519.02 | — |
| NV | $519.02 | — |
| NY | $519.02 | — |
| OH | $519.02 | — |
| OK | $519.02 | — |
| OR | $519.02 | — |
| PA | $519.02 | — |
| PR | $622.81 | — |
| RI | $519.02 | — |
| SC | $519.02 | — |
| SD | $519.02 | — |
| TN | $519.02 | — |
| TX | $519.02 | — |
| UT | $519.02 | — |
| VA | $519.02 | — |
| VI | $519.02 | — |
| VT | $519.02 | — |
| WA | $519.02 | — |
| WI | $519.02 | — |
| WV | $519.02 | — |
| WY | $519.02 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $34.65 to $57.00 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $51.82 | — |
| AL | $38.85 | $46.40 |
| AR | $38.85 | $46.40 |
| AZ | $36.52 | $46.40 |
| CA | $36.80 | $46.40 |
| CO | $37.79 | $46.40 |
| CT | $34.94 | $46.40 |
| DC | $34.65 | $46.40 |
| DE | $34.65 | $46.40 |
| FL | $38.85 | $46.40 |
| GA | $38.85 | $46.40 |
| HI | $51.82 | — |
| IA | $38.16 | $46.40 |
| ID | $37.79 | $46.40 |
| IL | $37.75 | $46.40 |
| IN | $37.75 | $46.40 |
| KS | $38.16 | $46.40 |
| KY | $38.85 | $46.40 |
| LA | $38.85 | $46.40 |
| MA | $34.94 | $46.40 |
| MD | $34.65 | $46.40 |
| ME | $34.94 | $46.40 |
| MI | $37.75 | $46.40 |
| MN | $38.16 | $46.40 |
| MO | $38.16 | $46.40 |
| MS | $38.85 | $46.40 |
| MT | $37.79 | $46.40 |
| NC | $38.85 | $46.40 |
| ND | $38.16 | $46.40 |
| NE | $38.16 | $46.40 |
| NH | $34.94 | $46.40 |
| NJ | $34.65 | $46.40 |
| NM | $36.52 | $46.40 |
| NV | $36.80 | $46.40 |
| NY | $34.65 | $46.40 |
| OH | $37.75 | $46.40 |
| OK | $36.52 | $46.40 |
| OR | $36.80 | $46.40 |
| PA | $34.65 | $46.40 |
| PR | $57.00 | — |
| RI | $34.94 | $46.40 |
| SC | $38.85 | $46.40 |
| SD | $38.16 | $46.40 |
| TN | $38.85 | $46.40 |
| TX | $36.52 | $46.40 |
| UT | $37.79 | $46.40 |
| VA | $38.85 | $46.40 |
| VI | $51.82 | — |
| VT | $34.94 | $46.40 |
| WA | $36.80 | $46.40 |
| WI | $37.75 | $46.40 |
| WV | $38.85 | $46.40 |
| WY | $37.79 | $46.40 |
RR + KE — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $50.16 to $61.52 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $55.58 | — |
| AL | — | $50.16 |
| AR | — | $50.16 |
| AZ | — | $50.16 |
| CA | — | $50.16 |
| CO | — | $50.16 |
| CT | — | $50.16 |
| DC | — | $50.16 |
| DE | — | $50.16 |
| FL | — | $50.16 |
| GA | — | $50.16 |
| HI | $55.58 | — |
| IA | — | $50.16 |
| ID | — | $50.16 |
| IL | — | $50.16 |
| IN | — | $50.16 |
| KS | — | $50.16 |
| KY | — | $50.16 |
| LA | — | $50.16 |
| MA | — | $50.16 |
| MD | — | $50.16 |
| ME | — | $50.16 |
| MI | — | $50.16 |
| MN | — | $50.16 |
| MO | — | $50.16 |
| MS | — | $50.16 |
| MT | — | $50.16 |
| NC | — | $50.16 |
| ND | — | $50.16 |
| NE | — | $50.16 |
| NH | — | $50.16 |
| NJ | — | $50.16 |
| NM | — | $50.16 |
| NV | — | $50.16 |
| NY | — | $50.16 |
| OH | — | $50.16 |
| OK | — | $50.16 |
| OR | — | $50.16 |
| PA | — | $50.16 |
| PR | $61.52 | — |
| RI | — | $50.16 |
| SC | — | $50.16 |
| SD | — | $50.16 |
| TN | — | $50.16 |
| TX | — | $50.16 |
| UT | — | $50.16 |
| VA | — | $50.16 |
| VI | $55.58 | — |
| VT | — | $50.16 |
| WA | — | $50.16 |
| WI | — | $50.16 |
| WV | — | $50.16 |
| WY | — | $50.16 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $51.90 to $62.27 depending on state and rural status.
Former-CBA payment limits: ceiling $51.90 · floor $44.12
| State | Non-rural | Rural |
|---|---|---|
| AK | $51.90 | — |
| AL | $51.90 | — |
| AR | $51.90 | — |
| AZ | $51.90 | — |
| CA | $51.90 | — |
| CO | $51.90 | — |
| CT | $51.90 | — |
| DC | $51.90 | — |
| DE | $51.90 | — |
| FL | $51.90 | — |
| GA | $51.90 | — |
| HI | $51.90 | — |
| IA | $51.90 | — |
| ID | $51.90 | — |
| IL | $51.90 | — |
| IN | $51.90 | — |
| KS | $51.90 | — |
| KY | $51.90 | — |
| LA | $51.90 | — |
| MA | $51.90 | — |
| MD | $51.90 | — |
| ME | $51.90 | — |
| MI | $51.90 | — |
| MN | $51.90 | — |
| MO | $51.90 | — |
| MS | $51.90 | — |
| MT | $51.90 | — |
| NC | $51.90 | — |
| ND | $51.90 | — |
| NE | $51.90 | — |
| NH | $51.90 | — |
| NJ | $51.90 | — |
| NM | $51.90 | — |
| NV | $51.90 | — |
| NY | $51.90 | — |
| OH | $51.90 | — |
| OK | $51.90 | — |
| OR | $51.90 | — |
| PA | $51.90 | — |
| PR | $62.27 | — |
| RI | $51.90 | — |
| SC | $51.90 | — |
| SD | $51.90 | — |
| TN | $51.90 | — |
| TX | $51.90 | — |
| UT | $51.90 | — |
| VA | $51.90 | — |
| VI | $51.90 | — |
| VT | $51.90 | — |
| WA | $51.90 | — |
| WI | $51.90 | — |
| WV | $51.90 | — |
| WY | $51.90 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $259.83 to $427.58 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $388.63 | — |
| AL | $291.40 | $347.99 |
| AR | $291.40 | $347.99 |
| AZ | $273.87 | $347.99 |
| CA | $276.01 | $347.99 |
| CO | $283.41 | $347.99 |
| CT | $262.04 | $347.99 |
| DC | $259.83 | $347.99 |
| DE | $259.83 | $347.99 |
| FL | $291.40 | $347.99 |
| GA | $291.40 | $347.99 |
| HI | $388.63 | — |
| IA | $286.17 | $347.99 |
| ID | $283.41 | $347.99 |
| IL | $283.08 | $347.99 |
| IN | $283.08 | $347.99 |
| KS | $286.17 | $347.99 |
| KY | $291.40 | $347.99 |
| LA | $291.40 | $347.99 |
| MA | $262.04 | $347.99 |
| MD | $259.83 | $347.99 |
| ME | $262.04 | $347.99 |
| MI | $283.08 | $347.99 |
| MN | $286.17 | $347.99 |
| MO | $286.17 | $347.99 |
| MS | $291.40 | $347.99 |
| MT | $283.41 | $347.99 |
| NC | $291.40 | $347.99 |
| ND | $286.17 | $347.99 |
| NE | $286.17 | $347.99 |
| NH | $262.04 | $347.99 |
| NJ | $259.83 | $347.99 |
| NM | $273.87 | $347.99 |
| NV | $276.01 | $347.99 |
| NY | $259.83 | $347.99 |
| OH | $283.08 | $347.99 |
| OK | $273.87 | $347.99 |
| OR | $276.01 | $347.99 |
| PA | $259.83 | $347.99 |
| PR | $427.58 | — |
| RI | $262.04 | $347.99 |
| SC | $291.40 | $347.99 |
| SD | $286.17 | $347.99 |
| TN | $291.40 | $347.99 |
| TX | $273.87 | $347.99 |
| UT | $283.41 | $347.99 |
| VA | $291.40 | $347.99 |
| VI | $388.63 | — |
| VT | $262.04 | $347.99 |
| WA | $276.01 | $347.99 |
| WI | $283.08 | $347.99 |
| WV | $291.40 | $347.99 |
| WY | $283.41 | $347.99 |
UE + KE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $376.21 to $461.44 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $416.86 | — |
| AL | — | $376.21 |
| AR | — | $376.21 |
| AZ | — | $376.21 |
| CA | — | $376.21 |
| CO | — | $376.21 |
| CT | — | $376.21 |
| DC | — | $376.21 |
| DE | — | $376.21 |
| FL | — | $376.21 |
| GA | — | $376.21 |
| HI | $416.86 | — |
| IA | — | $376.21 |
| ID | — | $376.21 |
| IL | — | $376.21 |
| IN | — | $376.21 |
| KS | — | $376.21 |
| KY | — | $376.21 |
| LA | — | $376.21 |
| MA | — | $376.21 |
| MD | — | $376.21 |
| ME | — | $376.21 |
| MI | — | $376.21 |
| MN | — | $376.21 |
| MO | — | $376.21 |
| MS | — | $376.21 |
| MT | — | $376.21 |
| NC | — | $376.21 |
| ND | — | $376.21 |
| NE | — | $376.21 |
| NH | — | $376.21 |
| NJ | — | $376.21 |
| NM | — | $376.21 |
| NV | — | $376.21 |
| NY | — | $376.21 |
| OH | — | $376.21 |
| OK | — | $376.21 |
| OR | — | $376.21 |
| PA | — | $376.21 |
| PR | $461.44 | — |
| RI | — | $376.21 |
| SC | — | $376.21 |
| SD | — | $376.21 |
| TN | — | $376.21 |
| TX | — | $376.21 |
| UT | — | $376.21 |
| VA | — | $376.21 |
| VI | $416.86 | — |
| VT | — | $376.21 |
| WA | — | $376.21 |
| WI | — | $376.21 |
| WV | — | $376.21 |
| WY | — | $376.21 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $389.23 to $467.14 depending on state and rural status.
Former-CBA payment limits: ceiling $389.23 · floor $330.85
| State | Non-rural | Rural |
|---|---|---|
| AK | $389.23 | — |
| AL | $389.23 | — |
| AR | $389.23 | — |
| AZ | $389.23 | — |
| CA | $389.23 | — |
| CO | $389.23 | — |
| CT | $389.23 | — |
| DC | $389.23 | — |
| DE | $389.23 | — |
| FL | $389.23 | — |
| GA | $389.23 | — |
| HI | $389.23 | — |
| IA | $389.23 | — |
| ID | $389.23 | — |
| IL | $389.23 | — |
| IN | $389.23 | — |
| KS | $389.23 | — |
| KY | $389.23 | — |
| LA | $389.23 | — |
| MA | $389.23 | — |
| MD | $389.23 | — |
| ME | $389.23 | — |
| MI | $389.23 | — |
| MN | $389.23 | — |
| MO | $389.23 | — |
| MS | $389.23 | — |
| MT | $389.23 | — |
| NC | $389.23 | — |
| ND | $389.23 | — |
| NE | $389.23 | — |
| NH | $389.23 | — |
| NJ | $389.23 | — |
| NM | $389.23 | — |
| NV | $389.23 | — |
| NY | $389.23 | — |
| OH | $389.23 | — |
| OK | $389.23 | — |
| OR | $389.23 | — |
| PA | $389.23 | — |
| PR | $467.14 | — |
| RI | $389.23 | — |
| SC | $389.23 | — |
| SD | $389.23 | — |
| TN | $389.23 | — |
| TX | $389.23 | — |
| UT | $389.23 | — |
| VA | $389.23 | — |
| VI | $389.23 | — |
| VT | $389.23 | — |
| WA | $389.23 | — |
| WI | $389.23 | — |
| WV | $389.23 | — |
| WY | $389.23 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2612 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
Related E-codes
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