MyMedi-AI

E2614 — Positioning wheelchair back cushion, posterior, width 22 inches or greater, 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 2026-10-25; 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.

E2614 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $527.46 to $733.82 depending on state and rural status.

StateNon-ruralRural
AK$667.01—
AL$550.27$639.38
AR$550.27$639.38
AZ$546.92$639.38
CA$527.46$639.38
CO$553.99$639.38
CT$591.03$639.38
DC$536.59$639.38
DE$536.59$639.38
FL$550.27$639.38
GA$550.27$639.38
HI$667.01—
IA$542.37$639.38
ID$553.99$639.38
IL$593.54$639.38
IN$593.54$639.38
KS$542.37$639.38
KY$550.27$639.38
LA$550.27$639.38
MA$591.03$639.38
MD$536.59$639.38
ME$591.03$639.38
MI$593.54$639.38
MN$542.37$639.38
MO$542.37$639.38
MS$550.27$639.38
MT$553.99$639.38
NC$550.27$639.38
ND$542.37$639.38
NE$542.37$639.38
NH$591.03$639.38
NJ$536.59$639.38
NM$546.92$639.38
NV$527.46$639.38
NY$536.59$639.38
OH$593.54$639.38
OK$546.92$639.38
OR$527.46$639.38
PA$536.59$639.38
PR$733.82—
RI$591.03$639.38
SC$550.27$639.38
SD$542.37$639.38
TN$550.27$639.38
TX$546.92$639.38
UT$553.99$639.38
VA$550.27$639.38
VI$667.01—
VT$591.03$639.38
WA$527.46$639.38
WI$593.54$639.38
WV$550.27$639.38
WY$553.99$639.38

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $687.82 to $791.95 depending on state and rural status.

StateNon-ruralRural
AK$715.45—
AL—$687.82
AR—$687.82
AZ—$687.82
CA—$687.82
CO—$687.82
CT—$687.82
DC—$687.82
DE—$687.82
FL—$687.82
GA—$687.82
HI$715.45—
IA—$687.82
ID—$687.82
IL—$687.82
IN—$687.82
KS—$687.82
KY—$687.82
LA—$687.82
MA—$687.82
MD—$687.82
ME—$687.82
MI—$687.82
MN—$687.82
MO—$687.82
MS—$687.82
MT—$687.82
NC—$687.82
ND—$687.82
NE—$687.82
NH—$687.82
NJ—$687.82
NM—$687.82
NV—$687.82
NY—$687.82
OH—$687.82
OK—$687.82
OR—$687.82
PA—$687.82
PR$791.95—
RI—$687.82
SC—$687.82
SD—$687.82
TN—$687.82
TX—$687.82
UT—$687.82
VA—$687.82
VI$715.45—
VT—$687.82
WA—$687.82
WI—$687.82
WV—$687.82
WY—$687.82

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $668.14 to $801.75 depending on state and rural status.

Former-CBA payment limits: ceiling $668.14 · floor $567.92

StateNon-ruralRural
AK$668.14—
AL$668.14—
AR$668.14—
AZ$668.14—
CA$668.14—
CO$668.14—
CT$668.14—
DC$668.14—
DE$668.14—
FL$668.14—
GA$668.14—
HI$668.14—
IA$668.14—
ID$668.14—
IL$668.14—
IN$668.14—
KS$668.14—
KY$668.14—
LA$668.14—
MA$668.14—
MD$668.14—
ME$668.14—
MI$668.14—
MN$668.14—
MO$668.14—
MS$668.14—
MT$668.14—
NC$668.14—
ND$668.14—
NE$668.14—
NH$668.14—
NJ$668.14—
NM$668.14—
NV$668.14—
NY$668.14—
OH$668.14—
OK$668.14—
OR$668.14—
PA$668.14—
PR$801.75—
RI$668.14—
SC$668.14—
SD$668.14—
TN$668.14—
TX$668.14—
UT$668.14—
VA$668.14—
VI$668.14—
VT$668.14—
WA$668.14—
WI$668.14—
WV$668.14—
WY$668.14—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $52.75 to $73.37 depending on state and rural status.

StateNon-ruralRural
AK$66.70—
AL$55.03$63.94
AR$55.03$63.94
AZ$54.69$63.94
CA$52.75$63.94
CO$55.40$63.94
CT$59.10$63.94
DC$53.66$63.94
DE$53.66$63.94
FL$55.03$63.94
GA$55.03$63.94
HI$66.70—
IA$54.24$63.94
ID$55.40$63.94
IL$59.35$63.94
IN$59.35$63.94
KS$54.24$63.94
KY$55.03$63.94
LA$55.03$63.94
MA$59.10$63.94
MD$53.66$63.94
ME$59.10$63.94
MI$59.35$63.94
MN$54.24$63.94
MO$54.24$63.94
MS$55.03$63.94
MT$55.40$63.94
NC$55.03$63.94
ND$54.24$63.94
NE$54.24$63.94
NH$59.10$63.94
NJ$53.66$63.94
NM$54.69$63.94
NV$52.75$63.94
NY$53.66$63.94
OH$59.35$63.94
OK$54.69$63.94
OR$52.75$63.94
PA$53.66$63.94
PR$73.37—
RI$59.10$63.94
SC$55.03$63.94
SD$54.24$63.94
TN$55.03$63.94
TX$54.69$63.94
UT$55.40$63.94
VA$55.03$63.94
VI$66.70—
VT$59.10$63.94
WA$52.75$63.94
WI$59.35$63.94
WV$55.03$63.94
WY$55.40$63.94

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $68.78 to $79.18 depending on state and rural status.

StateNon-ruralRural
AK$71.55—
AL—$68.78
AR—$68.78
AZ—$68.78
CA—$68.78
CO—$68.78
CT—$68.78
DC—$68.78
DE—$68.78
FL—$68.78
GA—$68.78
HI$71.55—
IA—$68.78
ID—$68.78
IL—$68.78
IN—$68.78
KS—$68.78
KY—$68.78
LA—$68.78
MA—$68.78
MD—$68.78
ME—$68.78
MI—$68.78
MN—$68.78
MO—$68.78
MS—$68.78
MT—$68.78
NC—$68.78
ND—$68.78
NE—$68.78
NH—$68.78
NJ—$68.78
NM—$68.78
NV—$68.78
NY—$68.78
OH—$68.78
OK—$68.78
OR—$68.78
PA—$68.78
PR$79.18—
RI—$68.78
SC—$68.78
SD—$68.78
TN—$68.78
TX—$68.78
UT—$68.78
VA—$68.78
VI$71.55—
VT—$68.78
WA—$68.78
WI—$68.78
WV—$68.78
WY—$68.78

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $66.81 to $80.17 depending on state and rural status.

Former-CBA payment limits: ceiling $66.81 · floor $56.79

StateNon-ruralRural
AK$66.81—
AL$66.81—
AR$66.81—
AZ$66.81—
CA$66.81—
CO$66.81—
CT$66.81—
DC$66.81—
DE$66.81—
FL$66.81—
GA$66.81—
HI$66.81—
IA$66.81—
ID$66.81—
IL$66.81—
IN$66.81—
KS$66.81—
KY$66.81—
LA$66.81—
MA$66.81—
MD$66.81—
ME$66.81—
MI$66.81—
MN$66.81—
MO$66.81—
MS$66.81—
MT$66.81—
NC$66.81—
ND$66.81—
NE$66.81—
NH$66.81—
NJ$66.81—
NM$66.81—
NV$66.81—
NY$66.81—
OH$66.81—
OK$66.81—
OR$66.81—
PA$66.81—
PR$80.17—
RI$66.81—
SC$66.81—
SD$66.81—
TN$66.81—
TX$66.81—
UT$66.81—
VA$66.81—
VI$66.81—
VT$66.81—
WA$66.81—
WI$66.81—
WV$66.81—
WY$66.81—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $395.59 to $550.38 depending on state and rural status.

StateNon-ruralRural
AK$500.27—
AL$412.71$479.55
AR$412.71$479.55
AZ$410.20$479.55
CA$395.59$479.55
CO$415.50$479.55
CT$443.28$479.55
DC$402.45$479.55
DE$402.45$479.55
FL$412.71$479.55
GA$412.71$479.55
HI$500.27—
IA$406.77$479.55
ID$415.50$479.55
IL$445.16$479.55
IN$445.16$479.55
KS$406.77$479.55
KY$412.71$479.55
LA$412.71$479.55
MA$443.28$479.55
MD$402.45$479.55
ME$443.28$479.55
MI$445.16$479.55
MN$406.77$479.55
MO$406.77$479.55
MS$412.71$479.55
MT$415.50$479.55
NC$412.71$479.55
ND$406.77$479.55
NE$406.77$479.55
NH$443.28$479.55
NJ$402.45$479.55
NM$410.20$479.55
NV$395.59$479.55
NY$402.45$479.55
OH$445.16$479.55
OK$410.20$479.55
OR$395.59$479.55
PA$402.45$479.55
PR$550.38—
RI$443.28$479.55
SC$412.71$479.55
SD$406.77$479.55
TN$412.71$479.55
TX$410.20$479.55
UT$415.50$479.55
VA$412.71$479.55
VI$500.27—
VT$443.28$479.55
WA$395.59$479.55
WI$445.16$479.55
WV$412.71$479.55
WY$415.50$479.55

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $515.88 to $593.98 depending on state and rural status.

StateNon-ruralRural
AK$536.60—
AL—$515.88
AR—$515.88
AZ—$515.88
CA—$515.88
CO—$515.88
CT—$515.88
DC—$515.88
DE—$515.88
FL—$515.88
GA—$515.88
HI$536.60—
IA—$515.88
ID—$515.88
IL—$515.88
IN—$515.88
KS—$515.88
KY—$515.88
LA—$515.88
MA—$515.88
MD—$515.88
ME—$515.88
MI—$515.88
MN—$515.88
MO—$515.88
MS—$515.88
MT—$515.88
NC—$515.88
ND—$515.88
NE—$515.88
NH—$515.88
NJ—$515.88
NM—$515.88
NV—$515.88
NY—$515.88
OH—$515.88
OK—$515.88
OR—$515.88
PA—$515.88
PR$593.98—
RI—$515.88
SC—$515.88
SD—$515.88
TN—$515.88
TX—$515.88
UT—$515.88
VA—$515.88
VI$536.60—
VT—$515.88
WA—$515.88
WI—$515.88
WV—$515.88
WY—$515.88

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $501.13 to $601.35 depending on state and rural status.

Former-CBA payment limits: ceiling $501.13 · floor $425.96

StateNon-ruralRural
AK$501.13—
AL$501.13—
AR$501.13—
AZ$501.13—
CA$501.13—
CO$501.13—
CT$501.13—
DC$501.13—
DE$501.13—
FL$501.13—
GA$501.13—
HI$501.13—
IA$501.13—
ID$501.13—
IL$501.13—
IN$501.13—
KS$501.13—
KY$501.13—
LA$501.13—
MA$501.13—
MD$501.13—
ME$501.13—
MI$501.13—
MN$501.13—
MO$501.13—
MS$501.13—
MT$501.13—
NC$501.13—
ND$501.13—
NE$501.13—
NH$501.13—
NJ$501.13—
NM$501.13—
NV$501.13—
NY$501.13—
OH$501.13—
OK$501.13—
OR$501.13—
PA$501.13—
PR$601.35—
RI$501.13—
SC$501.13—
SD$501.13—
TN$501.13—
TX$501.13—
UT$501.13—
VA$501.13—
VI$501.13—
VT$501.13—
WA$501.13—
WI$501.13—
WV$501.13—
WY$501.13—
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 E2614 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

E2601E2602E2603E2604E2605E2606E2607E2608E2609E2610E2611E2612

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