E2613 — Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware
HCPCS Level II E-code · short descriptor: “Position back cush wd <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.
E2613 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $354.05 to $496.59 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $448.32 | — |
| AL | $382.76 | $448.32 |
| AR | $382.76 | $448.32 |
| AZ | $371.06 | $448.32 |
| CA | $354.05 | $448.32 |
| CO | $389.71 | $448.32 |
| CT | $370.49 | $448.32 |
| DC | $355.77 | $448.32 |
| DE | $355.77 | $448.32 |
| FL | $382.76 | $448.32 |
| GA | $382.76 | $448.32 |
| HI | $448.32 | — |
| IA | $386.30 | $448.32 |
| ID | $389.71 | $448.32 |
| IL | $386.32 | $448.32 |
| IN | $386.32 | $448.32 |
| KS | $386.30 | $448.32 |
| KY | $382.76 | $448.32 |
| LA | $382.76 | $448.32 |
| MA | $370.49 | $448.32 |
| MD | $355.77 | $448.32 |
| ME | $370.49 | $448.32 |
| MI | $386.32 | $448.32 |
| MN | $386.30 | $448.32 |
| MO | $386.30 | $448.32 |
| MS | $382.76 | $448.32 |
| MT | $389.71 | $448.32 |
| NC | $382.76 | $448.32 |
| ND | $386.30 | $448.32 |
| NE | $386.30 | $448.32 |
| NH | $370.49 | $448.32 |
| NJ | $355.77 | $448.32 |
| NM | $371.06 | $448.32 |
| NV | $354.05 | $448.32 |
| NY | $355.77 | $448.32 |
| OH | $386.32 | $448.32 |
| OK | $371.06 | $448.32 |
| OR | $354.05 | $448.32 |
| PA | $355.77 | $448.32 |
| PR | $496.59 | — |
| RI | $370.49 | $448.32 |
| SC | $382.76 | $448.32 |
| SD | $386.30 | $448.32 |
| TN | $382.76 | $448.32 |
| TX | $371.06 | $448.32 |
| UT | $389.71 | $448.32 |
| VA | $382.76 | $448.32 |
| VI | $448.32 | — |
| VT | $370.49 | $448.32 |
| WA | $354.05 | $448.32 |
| WI | $386.32 | $448.32 |
| WV | $382.76 | $448.32 |
| WY | $389.71 | $448.32 |
NU + KE — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $483.32 to $538.59 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $483.32 | — |
| AL | — | $483.32 |
| AR | — | $483.32 |
| AZ | — | $483.32 |
| CA | — | $483.32 |
| CO | — | $483.32 |
| CT | — | $483.32 |
| DC | — | $483.32 |
| DE | — | $483.32 |
| FL | — | $483.32 |
| GA | — | $483.32 |
| HI | $483.32 | — |
| IA | — | $483.32 |
| ID | — | $483.32 |
| IL | — | $483.32 |
| IN | — | $483.32 |
| KS | — | $483.32 |
| KY | — | $483.32 |
| LA | — | $483.32 |
| MA | — | $483.32 |
| MD | — | $483.32 |
| ME | — | $483.32 |
| MI | — | $483.32 |
| MN | — | $483.32 |
| MO | — | $483.32 |
| MS | — | $483.32 |
| MT | — | $483.32 |
| NC | — | $483.32 |
| ND | — | $483.32 |
| NE | — | $483.32 |
| NH | — | $483.32 |
| NJ | — | $483.32 |
| NM | — | $483.32 |
| NV | — | $483.32 |
| NY | — | $483.32 |
| OH | — | $483.32 |
| OK | — | $483.32 |
| OR | — | $483.32 |
| PA | — | $483.32 |
| PR | $538.59 | — |
| RI | — | $483.32 |
| SC | — | $483.32 |
| SD | — | $483.32 |
| TN | — | $483.32 |
| TX | — | $483.32 |
| UT | — | $483.32 |
| VA | — | $483.32 |
| VI | $483.32 | — |
| VT | — | $483.32 |
| WA | — | $483.32 |
| WI | — | $483.32 |
| WV | — | $483.32 |
| WY | — | $483.32 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $482.79 to $579.33 depending on state and rural status.
Former-CBA payment limits: ceiling $482.79 · floor $410.37
| State | Non-rural | Rural |
|---|---|---|
| AK | $482.79 | — |
| AL | $482.79 | — |
| AR | $482.79 | — |
| AZ | $482.79 | — |
| CA | $482.79 | — |
| CO | $482.79 | — |
| CT | $482.79 | — |
| DC | $482.79 | — |
| DE | $482.79 | — |
| FL | $482.79 | — |
| GA | $482.79 | — |
| HI | $482.79 | — |
| IA | $482.79 | — |
| ID | $482.79 | — |
| IL | $482.79 | — |
| IN | $482.79 | — |
| KS | $482.79 | — |
| KY | $482.79 | — |
| LA | $482.79 | — |
| MA | $482.79 | — |
| MD | $482.79 | — |
| ME | $482.79 | — |
| MI | $482.79 | — |
| MN | $482.79 | — |
| MO | $482.79 | — |
| MS | $482.79 | — |
| MT | $482.79 | — |
| NC | $482.79 | — |
| ND | $482.79 | — |
| NE | $482.79 | — |
| NH | $482.79 | — |
| NJ | $482.79 | — |
| NM | $482.79 | — |
| NV | $482.79 | — |
| NY | $482.79 | — |
| OH | $482.79 | — |
| OK | $482.79 | — |
| OR | $482.79 | — |
| PA | $482.79 | — |
| PR | $579.33 | — |
| RI | $482.79 | — |
| SC | $482.79 | — |
| SD | $482.79 | — |
| TN | $482.79 | — |
| TX | $482.79 | — |
| UT | $482.79 | — |
| VA | $482.79 | — |
| VI | $482.79 | — |
| VT | $482.79 | — |
| WA | $482.79 | — |
| WI | $482.79 | — |
| WV | $482.79 | — |
| WY | $482.79 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $35.41 to $49.66 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $44.84 | — |
| AL | $38.28 | $44.84 |
| AR | $38.28 | $44.84 |
| AZ | $37.11 | $44.84 |
| CA | $35.41 | $44.84 |
| CO | $38.97 | $44.84 |
| CT | $37.05 | $44.84 |
| DC | $35.58 | $44.84 |
| DE | $35.58 | $44.84 |
| FL | $38.28 | $44.84 |
| GA | $38.28 | $44.84 |
| HI | $44.84 | — |
| IA | $38.63 | $44.84 |
| ID | $38.97 | $44.84 |
| IL | $38.63 | $44.84 |
| IN | $38.63 | $44.84 |
| KS | $38.63 | $44.84 |
| KY | $38.28 | $44.84 |
| LA | $38.28 | $44.84 |
| MA | $37.05 | $44.84 |
| MD | $35.58 | $44.84 |
| ME | $37.05 | $44.84 |
| MI | $38.63 | $44.84 |
| MN | $38.63 | $44.84 |
| MO | $38.63 | $44.84 |
| MS | $38.28 | $44.84 |
| MT | $38.97 | $44.84 |
| NC | $38.28 | $44.84 |
| ND | $38.63 | $44.84 |
| NE | $38.63 | $44.84 |
| NH | $37.05 | $44.84 |
| NJ | $35.58 | $44.84 |
| NM | $37.11 | $44.84 |
| NV | $35.41 | $44.84 |
| NY | $35.58 | $44.84 |
| OH | $38.63 | $44.84 |
| OK | $37.11 | $44.84 |
| OR | $35.41 | $44.84 |
| PA | $35.58 | $44.84 |
| PR | $49.66 | — |
| RI | $37.05 | $44.84 |
| SC | $38.28 | $44.84 |
| SD | $38.63 | $44.84 |
| TN | $38.28 | $44.84 |
| TX | $37.11 | $44.84 |
| UT | $38.97 | $44.84 |
| VA | $38.28 | $44.84 |
| VI | $44.84 | — |
| VT | $37.05 | $44.84 |
| WA | $35.41 | $44.84 |
| WI | $38.63 | $44.84 |
| WV | $38.28 | $44.84 |
| WY | $38.97 | $44.84 |
RR + KE — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $48.34 to $53.86 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $48.34 | — |
| AL | — | $48.34 |
| AR | — | $48.34 |
| AZ | — | $48.34 |
| CA | — | $48.34 |
| CO | — | $48.34 |
| CT | — | $48.34 |
| DC | — | $48.34 |
| DE | — | $48.34 |
| FL | — | $48.34 |
| GA | — | $48.34 |
| HI | $48.34 | — |
| IA | — | $48.34 |
| ID | — | $48.34 |
| IL | — | $48.34 |
| IN | — | $48.34 |
| KS | — | $48.34 |
| KY | — | $48.34 |
| LA | — | $48.34 |
| MA | — | $48.34 |
| MD | — | $48.34 |
| ME | — | $48.34 |
| MI | — | $48.34 |
| MN | — | $48.34 |
| MO | — | $48.34 |
| MS | — | $48.34 |
| MT | — | $48.34 |
| NC | — | $48.34 |
| ND | — | $48.34 |
| NE | — | $48.34 |
| NH | — | $48.34 |
| NJ | — | $48.34 |
| NM | — | $48.34 |
| NV | — | $48.34 |
| NY | — | $48.34 |
| OH | — | $48.34 |
| OK | — | $48.34 |
| OR | — | $48.34 |
| PA | — | $48.34 |
| PR | $53.86 | — |
| RI | — | $48.34 |
| SC | — | $48.34 |
| SD | — | $48.34 |
| TN | — | $48.34 |
| TX | — | $48.34 |
| UT | — | $48.34 |
| VA | — | $48.34 |
| VI | $48.34 | — |
| VT | — | $48.34 |
| WA | — | $48.34 |
| WI | — | $48.34 |
| WV | — | $48.34 |
| WY | — | $48.34 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $48.29 to $57.93 depending on state and rural status.
Former-CBA payment limits: ceiling $48.29 · floor $41.05
| State | Non-rural | Rural |
|---|---|---|
| AK | $48.29 | — |
| AL | $48.29 | — |
| AR | $48.29 | — |
| AZ | $48.29 | — |
| CA | $48.29 | — |
| CO | $48.29 | — |
| CT | $48.29 | — |
| DC | $48.29 | — |
| DE | $48.29 | — |
| FL | $48.29 | — |
| GA | $48.29 | — |
| HI | $48.29 | — |
| IA | $48.29 | — |
| ID | $48.29 | — |
| IL | $48.29 | — |
| IN | $48.29 | — |
| KS | $48.29 | — |
| KY | $48.29 | — |
| LA | $48.29 | — |
| MA | $48.29 | — |
| MD | $48.29 | — |
| ME | $48.29 | — |
| MI | $48.29 | — |
| MN | $48.29 | — |
| MO | $48.29 | — |
| MS | $48.29 | — |
| MT | $48.29 | — |
| NC | $48.29 | — |
| ND | $48.29 | — |
| NE | $48.29 | — |
| NH | $48.29 | — |
| NJ | $48.29 | — |
| NM | $48.29 | — |
| NV | $48.29 | — |
| NY | $48.29 | — |
| OH | $48.29 | — |
| OK | $48.29 | — |
| OR | $48.29 | — |
| PA | $48.29 | — |
| PR | $57.93 | — |
| RI | $48.29 | — |
| SC | $48.29 | — |
| SD | $48.29 | — |
| TN | $48.29 | — |
| TX | $48.29 | — |
| UT | $48.29 | — |
| VA | $48.29 | — |
| VI | $48.29 | — |
| VT | $48.29 | — |
| WA | $48.29 | — |
| WI | $48.29 | — |
| WV | $48.29 | — |
| WY | $48.29 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $265.54 to $372.45 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $336.24 | — |
| AL | $287.07 | $336.24 |
| AR | $287.07 | $336.24 |
| AZ | $278.30 | $336.24 |
| CA | $265.54 | $336.24 |
| CO | $292.28 | $336.24 |
| CT | $277.87 | $336.24 |
| DC | $266.83 | $336.24 |
| DE | $266.83 | $336.24 |
| FL | $287.07 | $336.24 |
| GA | $287.07 | $336.24 |
| HI | $336.24 | — |
| IA | $289.73 | $336.24 |
| ID | $292.28 | $336.24 |
| IL | $289.74 | $336.24 |
| IN | $289.74 | $336.24 |
| KS | $289.73 | $336.24 |
| KY | $287.07 | $336.24 |
| LA | $287.07 | $336.24 |
| MA | $277.87 | $336.24 |
| MD | $266.83 | $336.24 |
| ME | $277.87 | $336.24 |
| MI | $289.74 | $336.24 |
| MN | $289.73 | $336.24 |
| MO | $289.73 | $336.24 |
| MS | $287.07 | $336.24 |
| MT | $292.28 | $336.24 |
| NC | $287.07 | $336.24 |
| ND | $289.73 | $336.24 |
| NE | $289.73 | $336.24 |
| NH | $277.87 | $336.24 |
| NJ | $266.83 | $336.24 |
| NM | $278.30 | $336.24 |
| NV | $265.54 | $336.24 |
| NY | $266.83 | $336.24 |
| OH | $289.74 | $336.24 |
| OK | $278.30 | $336.24 |
| OR | $265.54 | $336.24 |
| PA | $266.83 | $336.24 |
| PR | $372.45 | — |
| RI | $277.87 | $336.24 |
| SC | $287.07 | $336.24 |
| SD | $289.73 | $336.24 |
| TN | $287.07 | $336.24 |
| TX | $278.30 | $336.24 |
| UT | $292.28 | $336.24 |
| VA | $287.07 | $336.24 |
| VI | $336.24 | — |
| VT | $277.87 | $336.24 |
| WA | $265.54 | $336.24 |
| WI | $289.74 | $336.24 |
| WV | $287.07 | $336.24 |
| WY | $292.28 | $336.24 |
UE + KE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $362.49 to $403.95 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $362.49 | — |
| AL | — | $362.49 |
| AR | — | $362.49 |
| AZ | — | $362.49 |
| CA | — | $362.49 |
| CO | — | $362.49 |
| CT | — | $362.49 |
| DC | — | $362.49 |
| DE | — | $362.49 |
| FL | — | $362.49 |
| GA | — | $362.49 |
| HI | $362.49 | — |
| IA | — | $362.49 |
| ID | — | $362.49 |
| IL | — | $362.49 |
| IN | — | $362.49 |
| KS | — | $362.49 |
| KY | — | $362.49 |
| LA | — | $362.49 |
| MA | — | $362.49 |
| MD | — | $362.49 |
| ME | — | $362.49 |
| MI | — | $362.49 |
| MN | — | $362.49 |
| MO | — | $362.49 |
| MS | — | $362.49 |
| MT | — | $362.49 |
| NC | — | $362.49 |
| ND | — | $362.49 |
| NE | — | $362.49 |
| NH | — | $362.49 |
| NJ | — | $362.49 |
| NM | — | $362.49 |
| NV | — | $362.49 |
| NY | — | $362.49 |
| OH | — | $362.49 |
| OK | — | $362.49 |
| OR | — | $362.49 |
| PA | — | $362.49 |
| PR | $403.95 | — |
| RI | — | $362.49 |
| SC | — | $362.49 |
| SD | — | $362.49 |
| TN | — | $362.49 |
| TX | — | $362.49 |
| UT | — | $362.49 |
| VA | — | $362.49 |
| VI | $362.49 | — |
| VT | — | $362.49 |
| WA | — | $362.49 |
| WI | — | $362.49 |
| WV | — | $362.49 |
| WY | — | $362.49 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $362.08 to $434.50 depending on state and rural status.
Former-CBA payment limits: ceiling $362.08 · floor $307.77
| State | Non-rural | Rural |
|---|---|---|
| AK | $362.08 | — |
| AL | $362.08 | — |
| AR | $362.08 | — |
| AZ | $362.08 | — |
| CA | $362.08 | — |
| CO | $362.08 | — |
| CT | $362.08 | — |
| DC | $362.08 | — |
| DE | $362.08 | — |
| FL | $362.08 | — |
| GA | $362.08 | — |
| HI | $362.08 | — |
| IA | $362.08 | — |
| ID | $362.08 | — |
| IL | $362.08 | — |
| IN | $362.08 | — |
| KS | $362.08 | — |
| KY | $362.08 | — |
| LA | $362.08 | — |
| MA | $362.08 | — |
| MD | $362.08 | — |
| ME | $362.08 | — |
| MI | $362.08 | — |
| MN | $362.08 | — |
| MO | $362.08 | — |
| MS | $362.08 | — |
| MT | $362.08 | — |
| NC | $362.08 | — |
| ND | $362.08 | — |
| NE | $362.08 | — |
| NH | $362.08 | — |
| NJ | $362.08 | — |
| NM | $362.08 | — |
| NV | $362.08 | — |
| NY | $362.08 | — |
| OH | $362.08 | — |
| OK | $362.08 | — |
| OR | $362.08 | — |
| PA | $362.08 | — |
| PR | $434.50 | — |
| RI | $362.08 | — |
| SC | $362.08 | — |
| SD | $362.08 | — |
| TN | $362.08 | — |
| TX | $362.08 | — |
| UT | $362.08 | — |
| VA | $362.08 | — |
| VI | $362.08 | — |
| VT | $362.08 | — |
| WA | $362.08 | — |
| WI | $362.08 | — |
| WV | $362.08 | — |
| WY | $362.08 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2613 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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