MyMedi-AI

E2620 — Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware

HCPCS Level II E-code · short descriptor: “Wc planar 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.

E2620 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $428.59 to $656.64 depending on state and rural status.

StateNon-ruralRural
AK$589.37—
AL$478.01$589.37
AR$478.01$589.37
AZ$463.38$589.37
CA$447.62$589.37
CO$474.59$589.37
CT$428.59$589.37
DC$431.96$589.37
DE$431.96$589.37
FL$478.01$589.37
GA$478.01$589.37
HI$589.37—
IA$466.66$589.37
ID$474.59$589.37
IL$471.41$589.37
IN$471.41$589.37
KS$466.66$589.37
KY$478.01$589.37
LA$478.01$589.37
MA$428.59$589.37
MD$431.96$589.37
ME$428.59$589.37
MI$471.41$589.37
MN$466.66$589.37
MO$466.66$589.37
MS$478.01$589.37
MT$474.59$589.37
NC$478.01$589.37
ND$466.66$589.37
NE$466.66$589.37
NH$428.59$589.37
NJ$431.96$589.37
NM$463.38$589.37
NV$447.62$589.37
NY$431.96$589.37
OH$471.41$589.37
OK$463.38$589.37
OR$447.62$589.37
PA$431.96$589.37
PR$656.64—
RI$428.59$589.37
SC$478.01$589.37
SD$466.66$589.37
TN$478.01$589.37
TX$463.38$589.37
UT$474.59$589.37
VA$478.01$589.37
VI$589.37—
VT$428.59$589.37
WA$447.62$589.37
WI$471.41$589.37
WV$478.01$589.37
WY$474.59$589.37

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $638.15 to $715.17 depending on state and rural status.

StateNon-ruralRural
AK$638.15—
AL—$638.15
AR—$638.15
AZ—$638.15
CA—$638.15
CO—$638.15
CT—$638.15
DC—$638.15
DE—$638.15
FL—$638.15
GA—$638.15
HI$638.15—
IA—$638.15
ID—$638.15
IL—$638.15
IN—$638.15
KS—$638.15
KY—$638.15
LA—$638.15
MA—$638.15
MD—$638.15
ME—$638.15
MI—$638.15
MN—$638.15
MO—$638.15
MS—$638.15
MT—$638.15
NC—$638.15
ND—$638.15
NE—$638.15
NH—$638.15
NJ—$638.15
NM—$638.15
NV—$638.15
NY—$638.15
OH—$638.15
OK—$638.15
OR—$638.15
PA—$638.15
PR$715.17—
RI—$638.15
SC—$638.15
SD—$638.15
TN—$638.15
TX—$638.15
UT—$638.15
VA—$638.15
VI$638.15—
VT—$638.15
WA—$638.15
WI—$638.15
WV—$638.15
WY—$638.15

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $672.73 to $807.29 depending on state and rural status.

Former-CBA payment limits: ceiling $672.73 · floor $571.82

StateNon-ruralRural
AK$672.73—
AL$672.73—
AR$672.73—
AZ$672.73—
CA$672.73—
CO$672.73—
CT$672.73—
DC$672.73—
DE$672.73—
FL$672.73—
GA$672.73—
HI$672.73—
IA$672.73—
ID$672.73—
IL$672.73—
IN$672.73—
KS$672.73—
KY$672.73—
LA$672.73—
MA$672.73—
MD$672.73—
ME$672.73—
MI$672.73—
MN$672.73—
MO$672.73—
MS$672.73—
MT$672.73—
NC$672.73—
ND$672.73—
NE$672.73—
NH$672.73—
NJ$672.73—
NM$672.73—
NV$672.73—
NY$672.73—
OH$672.73—
OK$672.73—
OR$672.73—
PA$672.73—
PR$807.29—
RI$672.73—
SC$672.73—
SD$672.73—
TN$672.73—
TX$672.73—
UT$672.73—
VA$672.73—
VI$672.73—
VT$672.73—
WA$672.73—
WI$672.73—
WV$672.73—
WY$672.73—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $42.86 to $65.67 depending on state and rural status.

StateNon-ruralRural
AK$58.94—
AL$47.80$58.94
AR$47.80$58.94
AZ$46.34$58.94
CA$44.76$58.94
CO$47.46$58.94
CT$42.86$58.94
DC$43.20$58.94
DE$43.20$58.94
FL$47.80$58.94
GA$47.80$58.94
HI$58.94—
IA$46.67$58.94
ID$47.46$58.94
IL$47.14$58.94
IN$47.14$58.94
KS$46.67$58.94
KY$47.80$58.94
LA$47.80$58.94
MA$42.86$58.94
MD$43.20$58.94
ME$42.86$58.94
MI$47.14$58.94
MN$46.67$58.94
MO$46.67$58.94
MS$47.80$58.94
MT$47.46$58.94
NC$47.80$58.94
ND$46.67$58.94
NE$46.67$58.94
NH$42.86$58.94
NJ$43.20$58.94
NM$46.34$58.94
NV$44.76$58.94
NY$43.20$58.94
OH$47.14$58.94
OK$46.34$58.94
OR$44.76$58.94
PA$43.20$58.94
PR$65.67—
RI$42.86$58.94
SC$47.80$58.94
SD$46.67$58.94
TN$47.80$58.94
TX$46.34$58.94
UT$47.46$58.94
VA$47.80$58.94
VI$58.94—
VT$42.86$58.94
WA$44.76$58.94
WI$47.14$58.94
WV$47.80$58.94
WY$47.46$58.94

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $63.82 to $71.53 depending on state and rural status.

StateNon-ruralRural
AK$63.82—
AL—$63.82
AR—$63.82
AZ—$63.82
CA—$63.82
CO—$63.82
CT—$63.82
DC—$63.82
DE—$63.82
FL—$63.82
GA—$63.82
HI$63.82—
IA—$63.82
ID—$63.82
IL—$63.82
IN—$63.82
KS—$63.82
KY—$63.82
LA—$63.82
MA—$63.82
MD—$63.82
ME—$63.82
MI—$63.82
MN—$63.82
MO—$63.82
MS—$63.82
MT—$63.82
NC—$63.82
ND—$63.82
NE—$63.82
NH—$63.82
NJ—$63.82
NM—$63.82
NV—$63.82
NY—$63.82
OH—$63.82
OK—$63.82
OR—$63.82
PA—$63.82
PR$71.53—
RI—$63.82
SC—$63.82
SD—$63.82
TN—$63.82
TX—$63.82
UT—$63.82
VA—$63.82
VI$63.82—
VT—$63.82
WA—$63.82
WI—$63.82
WV—$63.82
WY—$63.82

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $67.29 to $80.75 depending on state and rural status.

Former-CBA payment limits: ceiling $67.29 · floor $57.20

StateNon-ruralRural
AK$67.29—
AL$67.29—
AR$67.29—
AZ$67.29—
CA$67.29—
CO$67.29—
CT$67.29—
DC$67.29—
DE$67.29—
FL$67.29—
GA$67.29—
HI$67.29—
IA$67.29—
ID$67.29—
IL$67.29—
IN$67.29—
KS$67.29—
KY$67.29—
LA$67.29—
MA$67.29—
MD$67.29—
ME$67.29—
MI$67.29—
MN$67.29—
MO$67.29—
MS$67.29—
MT$67.29—
NC$67.29—
ND$67.29—
NE$67.29—
NH$67.29—
NJ$67.29—
NM$67.29—
NV$67.29—
NY$67.29—
OH$67.29—
OK$67.29—
OR$67.29—
PA$67.29—
PR$80.75—
RI$67.29—
SC$67.29—
SD$67.29—
TN$67.29—
TX$67.29—
UT$67.29—
VA$67.29—
VI$67.29—
VT$67.29—
WA$67.29—
WI$67.29—
WV$67.29—
WY$67.29—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $321.45 to $492.50 depending on state and rural status.

StateNon-ruralRural
AK$442.04—
AL$358.51$442.04
AR$358.51$442.04
AZ$347.53$442.04
CA$335.71$442.04
CO$355.94$442.04
CT$321.45$442.04
DC$323.97$442.04
DE$323.97$442.04
FL$358.51$442.04
GA$358.51$442.04
HI$442.04—
IA$350.00$442.04
ID$355.94$442.04
IL$353.56$442.04
IN$353.56$442.04
KS$350.00$442.04
KY$358.51$442.04
LA$358.51$442.04
MA$321.45$442.04
MD$323.97$442.04
ME$321.45$442.04
MI$353.56$442.04
MN$350.00$442.04
MO$350.00$442.04
MS$358.51$442.04
MT$355.94$442.04
NC$358.51$442.04
ND$350.00$442.04
NE$350.00$442.04
NH$321.45$442.04
NJ$323.97$442.04
NM$347.53$442.04
NV$335.71$442.04
NY$323.97$442.04
OH$353.56$442.04
OK$347.53$442.04
OR$335.71$442.04
PA$323.97$442.04
PR$492.50—
RI$321.45$442.04
SC$358.51$442.04
SD$350.00$442.04
TN$358.51$442.04
TX$347.53$442.04
UT$355.94$442.04
VA$358.51$442.04
VI$442.04—
VT$321.45$442.04
WA$335.71$442.04
WI$353.56$442.04
WV$358.51$442.04
WY$355.94$442.04

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $478.62 to $536.40 depending on state and rural status.

StateNon-ruralRural
AK$478.62—
AL—$478.62
AR—$478.62
AZ—$478.62
CA—$478.62
CO—$478.62
CT—$478.62
DC—$478.62
DE—$478.62
FL—$478.62
GA—$478.62
HI$478.62—
IA—$478.62
ID—$478.62
IL—$478.62
IN—$478.62
KS—$478.62
KY—$478.62
LA—$478.62
MA—$478.62
MD—$478.62
ME—$478.62
MI—$478.62
MN—$478.62
MO—$478.62
MS—$478.62
MT—$478.62
NC—$478.62
ND—$478.62
NE—$478.62
NH—$478.62
NJ—$478.62
NM—$478.62
NV—$478.62
NY—$478.62
OH—$478.62
OK—$478.62
OR—$478.62
PA—$478.62
PR$536.40—
RI—$478.62
SC—$478.62
SD—$478.62
TN—$478.62
TX—$478.62
UT—$478.62
VA—$478.62
VI$478.62—
VT—$478.62
WA—$478.62
WI—$478.62
WV—$478.62
WY—$478.62

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $504.58 to $605.49 depending on state and rural status.

Former-CBA payment limits: ceiling $504.58 · floor $428.89

StateNon-ruralRural
AK$504.58—
AL$504.58—
AR$504.58—
AZ$504.58—
CA$504.58—
CO$504.58—
CT$504.58—
DC$504.58—
DE$504.58—
FL$504.58—
GA$504.58—
HI$504.58—
IA$504.58—
ID$504.58—
IL$504.58—
IN$504.58—
KS$504.58—
KY$504.58—
LA$504.58—
MA$504.58—
MD$504.58—
ME$504.58—
MI$504.58—
MN$504.58—
MO$504.58—
MS$504.58—
MT$504.58—
NC$504.58—
ND$504.58—
NE$504.58—
NH$504.58—
NJ$504.58—
NM$504.58—
NV$504.58—
NY$504.58—
OH$504.58—
OK$504.58—
OR$504.58—
PA$504.58—
PR$605.49—
RI$504.58—
SC$504.58—
SD$504.58—
TN$504.58—
TX$504.58—
UT$504.58—
VA$504.58—
VI$504.58—
VT$504.58—
WA$504.58—
WI$504.58—
WV$504.58—
WY$504.58—
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 E2620 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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