MyMedi-AI

E2621 — Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, 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.

E2621 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $521.07 to $775.13 depending on state and rural status.

StateNon-ruralRural
AK$704.51—
AL$558.37$652.67
AR$558.37$652.67
AZ$545.31$652.67
CA$522.52$652.67
CO$539.84$652.67
CT$537.33$652.67
DC$521.07$652.67
DE$521.07$652.67
FL$558.37$652.67
GA$558.37$652.67
HI$704.51—
IA$547.05$652.67
ID$539.84$652.67
IL$569.54$652.67
IN$569.54$652.67
KS$547.05$652.67
KY$558.37$652.67
LA$558.37$652.67
MA$537.33$652.67
MD$521.07$652.67
ME$537.33$652.67
MI$569.54$652.67
MN$547.05$652.67
MO$547.05$652.67
MS$558.37$652.67
MT$539.84$652.67
NC$558.37$652.67
ND$547.05$652.67
NE$547.05$652.67
NH$537.33$652.67
NJ$521.07$652.67
NM$545.31$652.67
NV$522.52$652.67
NY$521.07$652.67
OH$569.54$652.67
OK$545.31$652.67
OR$522.52$652.67
PA$521.07$652.67
PR$775.13—
RI$537.33$652.67
SC$558.37$652.67
SD$547.05$652.67
TN$558.37$652.67
TX$545.31$652.67
UT$539.84$652.67
VA$558.37$652.67
VI$704.51—
VT$537.33$652.67
WA$522.52$652.67
WI$569.54$652.67
WV$558.37$652.67
WY$539.84$652.67

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $703.86 to $836.56 depending on state and rural status.

StateNon-ruralRural
AK$755.70—
AL—$703.86
AR—$703.86
AZ—$703.86
CA—$703.86
CO—$703.86
CT—$703.86
DC—$703.86
DE—$703.86
FL—$703.86
GA—$703.86
HI$755.70—
IA—$703.86
ID—$703.86
IL—$703.86
IN—$703.86
KS—$703.86
KY—$703.86
LA—$703.86
MA—$703.86
MD—$703.86
ME—$703.86
MI—$703.86
MN—$703.86
MO—$703.86
MS—$703.86
MT—$703.86
NC—$703.86
ND—$703.86
NE—$703.86
NH—$703.86
NJ—$703.86
NM—$703.86
NV—$703.86
NY—$703.86
OH—$703.86
OK—$703.86
OR—$703.86
PA—$703.86
PR$836.56—
RI—$703.86
SC—$703.86
SD—$703.86
TN—$703.86
TX—$703.86
UT—$703.86
VA—$703.86
VI$755.70—
VT—$703.86
WA—$703.86
WI—$703.86
WV—$703.86
WY—$703.86

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $705.99 to $847.24 depending on state and rural status.

Former-CBA payment limits: ceiling $705.99 · floor $600.09

StateNon-ruralRural
AK$705.99—
AL$705.99—
AR$705.99—
AZ$705.99—
CA$705.99—
CO$705.99—
CT$705.99—
DC$705.99—
DE$705.99—
FL$705.99—
GA$705.99—
HI$705.99—
IA$705.99—
ID$705.99—
IL$705.99—
IN$705.99—
KS$705.99—
KY$705.99—
LA$705.99—
MA$705.99—
MD$705.99—
ME$705.99—
MI$705.99—
MN$705.99—
MO$705.99—
MS$705.99—
MT$705.99—
NC$705.99—
ND$705.99—
NE$705.99—
NH$705.99—
NJ$705.99—
NM$705.99—
NV$705.99—
NY$705.99—
OH$705.99—
OK$705.99—
OR$705.99—
PA$705.99—
PR$847.24—
RI$705.99—
SC$705.99—
SD$705.99—
TN$705.99—
TX$705.99—
UT$705.99—
VA$705.99—
VI$705.99—
VT$705.99—
WA$705.99—
WI$705.99—
WV$705.99—
WY$705.99—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $52.10 to $77.52 depending on state and rural status.

StateNon-ruralRural
AK$70.45—
AL$55.84$65.27
AR$55.84$65.27
AZ$54.53$65.27
CA$52.25$65.27
CO$53.99$65.27
CT$53.73$65.27
DC$52.10$65.27
DE$52.10$65.27
FL$55.84$65.27
GA$55.84$65.27
HI$70.45—
IA$54.70$65.27
ID$53.99$65.27
IL$56.96$65.27
IN$56.96$65.27
KS$54.70$65.27
KY$55.84$65.27
LA$55.84$65.27
MA$53.73$65.27
MD$52.10$65.27
ME$53.73$65.27
MI$56.96$65.27
MN$54.70$65.27
MO$54.70$65.27
MS$55.84$65.27
MT$53.99$65.27
NC$55.84$65.27
ND$54.70$65.27
NE$54.70$65.27
NH$53.73$65.27
NJ$52.10$65.27
NM$54.53$65.27
NV$52.25$65.27
NY$52.10$65.27
OH$56.96$65.27
OK$54.53$65.27
OR$52.25$65.27
PA$52.10$65.27
PR$77.52—
RI$53.73$65.27
SC$55.84$65.27
SD$54.70$65.27
TN$55.84$65.27
TX$54.53$65.27
UT$53.99$65.27
VA$55.84$65.27
VI$70.45—
VT$53.73$65.27
WA$52.25$65.27
WI$56.96$65.27
WV$55.84$65.27
WY$53.99$65.27

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $70.39 to $83.66 depending on state and rural status.

StateNon-ruralRural
AK$75.57—
AL—$70.39
AR—$70.39
AZ—$70.39
CA—$70.39
CO—$70.39
CT—$70.39
DC—$70.39
DE—$70.39
FL—$70.39
GA—$70.39
HI$75.57—
IA—$70.39
ID—$70.39
IL—$70.39
IN—$70.39
KS—$70.39
KY—$70.39
LA—$70.39
MA—$70.39
MD—$70.39
ME—$70.39
MI—$70.39
MN—$70.39
MO—$70.39
MS—$70.39
MT—$70.39
NC—$70.39
ND—$70.39
NE—$70.39
NH—$70.39
NJ—$70.39
NM—$70.39
NV—$70.39
NY—$70.39
OH—$70.39
OK—$70.39
OR—$70.39
PA—$70.39
PR$83.66—
RI—$70.39
SC—$70.39
SD—$70.39
TN—$70.39
TX—$70.39
UT—$70.39
VA—$70.39
VI$75.57—
VT—$70.39
WA—$70.39
WI—$70.39
WV—$70.39
WY—$70.39

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $70.59 to $84.75 depending on state and rural status.

Former-CBA payment limits: ceiling $70.59 · floor $60.00

StateNon-ruralRural
AK$70.59—
AL$70.59—
AR$70.59—
AZ$70.59—
CA$70.59—
CO$70.59—
CT$70.59—
DC$70.59—
DE$70.59—
FL$70.59—
GA$70.59—
HI$70.59—
IA$70.59—
ID$70.59—
IL$70.59—
IN$70.59—
KS$70.59—
KY$70.59—
LA$70.59—
MA$70.59—
MD$70.59—
ME$70.59—
MI$70.59—
MN$70.59—
MO$70.59—
MS$70.59—
MT$70.59—
NC$70.59—
ND$70.59—
NE$70.59—
NH$70.59—
NJ$70.59—
NM$70.59—
NV$70.59—
NY$70.59—
OH$70.59—
OK$70.59—
OR$70.59—
PA$70.59—
PR$84.75—
RI$70.59—
SC$70.59—
SD$70.59—
TN$70.59—
TX$70.59—
UT$70.59—
VA$70.59—
VI$70.59—
VT$70.59—
WA$70.59—
WI$70.59—
WV$70.59—
WY$70.59—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $390.80 to $581.35 depending on state and rural status.

StateNon-ruralRural
AK$528.38—
AL$418.78$489.50
AR$418.78$489.50
AZ$408.98$489.50
CA$391.89$489.50
CO$404.88$489.50
CT$403.00$489.50
DC$390.80$489.50
DE$390.80$489.50
FL$418.78$489.50
GA$418.78$489.50
HI$528.38—
IA$410.29$489.50
ID$404.88$489.50
IL$427.16$489.50
IN$427.16$489.50
KS$410.29$489.50
KY$418.78$489.50
LA$418.78$489.50
MA$403.00$489.50
MD$390.80$489.50
ME$403.00$489.50
MI$427.16$489.50
MN$410.29$489.50
MO$410.29$489.50
MS$418.78$489.50
MT$404.88$489.50
NC$418.78$489.50
ND$410.29$489.50
NE$410.29$489.50
NH$403.00$489.50
NJ$390.80$489.50
NM$408.98$489.50
NV$391.89$489.50
NY$390.80$489.50
OH$427.16$489.50
OK$408.98$489.50
OR$391.89$489.50
PA$390.80$489.50
PR$581.35—
RI$403.00$489.50
SC$418.78$489.50
SD$410.29$489.50
TN$418.78$489.50
TX$408.98$489.50
UT$404.88$489.50
VA$418.78$489.50
VI$528.38—
VT$403.00$489.50
WA$391.89$489.50
WI$427.16$489.50
WV$418.78$489.50
WY$404.88$489.50

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $527.89 to $627.41 depending on state and rural status.

StateNon-ruralRural
AK$566.77—
AL—$527.89
AR—$527.89
AZ—$527.89
CA—$527.89
CO—$527.89
CT—$527.89
DC—$527.89
DE—$527.89
FL—$527.89
GA—$527.89
HI$566.77—
IA—$527.89
ID—$527.89
IL—$527.89
IN—$527.89
KS—$527.89
KY—$527.89
LA—$527.89
MA—$527.89
MD—$527.89
ME—$527.89
MI—$527.89
MN—$527.89
MO—$527.89
MS—$527.89
MT—$527.89
NC—$527.89
ND—$527.89
NE—$527.89
NH—$527.89
NJ—$527.89
NM—$527.89
NV—$527.89
NY—$527.89
OH—$527.89
OK—$527.89
OR—$527.89
PA—$527.89
PR$627.41—
RI—$527.89
SC—$527.89
SD—$527.89
TN—$527.89
TX—$527.89
UT—$527.89
VA—$527.89
VI$566.77—
VT—$527.89
WA—$527.89
WI—$527.89
WV—$527.89
WY—$527.89

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $529.51 to $635.43 depending on state and rural status.

Former-CBA payment limits: ceiling $529.51 · floor $450.08

StateNon-ruralRural
AK$529.51—
AL$529.51—
AR$529.51—
AZ$529.51—
CA$529.51—
CO$529.51—
CT$529.51—
DC$529.51—
DE$529.51—
FL$529.51—
GA$529.51—
HI$529.51—
IA$529.51—
ID$529.51—
IL$529.51—
IN$529.51—
KS$529.51—
KY$529.51—
LA$529.51—
MA$529.51—
MD$529.51—
ME$529.51—
MI$529.51—
MN$529.51—
MO$529.51—
MS$529.51—
MT$529.51—
NC$529.51—
ND$529.51—
NE$529.51—
NH$529.51—
NJ$529.51—
NM$529.51—
NV$529.51—
NY$529.51—
OH$529.51—
OK$529.51—
OR$529.51—
PA$529.51—
PR$635.43—
RI$529.51—
SC$529.51—
SD$529.51—
TN$529.51—
TX$529.51—
UT$529.51—
VA$529.51—
VI$529.51—
VT$529.51—
WA$529.51—
WI$529.51—
WV$529.51—
WY$529.51—
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 E2621 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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