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E2622 — Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth

HCPCS Level II E-code · short descriptor: “Adj skin pro w/c cus 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
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

E2622 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $388.75 to $438.67 depending on state and rural status.

StateNon-ruralRural
AK$397.95
AL$388.75$397.95
AR$388.75$397.95
AZ$388.75$397.95
CA$388.75$397.95
CO$388.75$397.95
CT$388.75$397.95
DC$388.75$397.95
DE$388.75$397.95
FL$388.75$397.95
GA$388.75$397.95
HI$397.95
IA$388.75$397.95
ID$388.75$397.95
IL$388.75$397.95
IN$388.75$397.95
KS$388.75$397.95
KY$388.75$397.95
LA$388.75$397.95
MA$388.75$397.95
MD$388.75$397.95
ME$388.75$397.95
MI$388.75$397.95
MN$388.75$397.95
MO$388.75$397.95
MS$388.75$397.95
MT$388.75$397.95
NC$388.75$397.95
ND$388.75$397.95
NE$388.75$397.95
NH$388.75$397.95
NJ$388.75$397.95
NM$388.75$397.95
NV$388.75$397.95
NY$388.75$397.95
OH$388.75$397.95
OK$388.75$397.95
OR$388.75$397.95
PA$388.75$397.95
PR$438.67
RI$388.75$397.95
SC$388.75$397.95
SD$388.75$397.95
TN$388.75$397.95
TX$388.75$397.95
UT$388.75$397.95
VA$388.75$397.95
VI$397.95
VT$388.75$397.95
WA$388.75$397.95
WI$388.75$397.95
WV$388.75$397.95
WY$388.75$397.95

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $427.46 to $474.10 depending on state and rural status.

StateNon-ruralRural
AK$427.46
AL$427.46
AR$427.46
AZ$427.46
CA$427.46
CO$427.46
CT$427.46
DC$427.46
DE$427.46
FL$427.46
GA$427.46
HI$427.46
IA$427.46
ID$427.46
IL$427.46
IN$427.46
KS$427.46
KY$427.46
LA$427.46
MA$427.46
MD$427.46
ME$427.46
MI$427.46
MN$427.46
MO$427.46
MS$427.46
MT$427.46
NC$427.46
ND$427.46
NE$427.46
NH$427.46
NJ$427.46
NM$427.46
NV$427.46
NY$427.46
OH$427.46
OK$427.46
OR$427.46
PA$427.46
PR$474.10
RI$427.46
SC$427.46
SD$427.46
TN$427.46
TX$427.46
UT$427.46
VA$427.46
VI$427.46
VT$427.46
WA$427.46
WI$427.46
WV$427.46
WY$427.46

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $407.15 to $488.60 depending on state and rural status.

Former-CBA payment limits: ceiling $407.15 · floor $346.08

StateNon-ruralRural
AK$407.15
AL$407.15
AR$407.15
AZ$407.15
CA$407.15
CO$407.15
CT$407.15
DC$407.15
DE$407.15
FL$407.15
GA$407.15
HI$407.15
IA$407.15
ID$407.15
IL$407.15
IN$407.15
KS$407.15
KY$407.15
LA$407.15
MA$407.15
MD$407.15
ME$407.15
MI$407.15
MN$407.15
MO$407.15
MS$407.15
MT$407.15
NC$407.15
ND$407.15
NE$407.15
NH$407.15
NJ$407.15
NM$407.15
NV$407.15
NY$407.15
OH$407.15
OK$407.15
OR$407.15
PA$407.15
PR$488.60
RI$407.15
SC$407.15
SD$407.15
TN$407.15
TX$407.15
UT$407.15
VA$407.15
VI$407.15
VT$407.15
WA$407.15
WI$407.15
WV$407.15
WY$407.15

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $38.88 to $43.84 depending on state and rural status.

StateNon-ruralRural
AK$39.80
AL$38.88$39.80
AR$38.88$39.80
AZ$38.88$39.80
CA$38.88$39.80
CO$38.88$39.80
CT$38.88$39.80
DC$38.88$39.80
DE$38.88$39.80
FL$38.88$39.80
GA$38.88$39.80
HI$39.80
IA$38.88$39.80
ID$38.88$39.80
IL$38.88$39.80
IN$38.88$39.80
KS$38.88$39.80
KY$38.88$39.80
LA$38.88$39.80
MA$38.88$39.80
MD$38.88$39.80
ME$38.88$39.80
MI$38.88$39.80
MN$38.88$39.80
MO$38.88$39.80
MS$38.88$39.80
MT$38.88$39.80
NC$38.88$39.80
ND$38.88$39.80
NE$38.88$39.80
NH$38.88$39.80
NJ$38.88$39.80
NM$38.88$39.80
NV$38.88$39.80
NY$38.88$39.80
OH$38.88$39.80
OK$38.88$39.80
OR$38.88$39.80
PA$38.88$39.80
PR$43.84
RI$38.88$39.80
SC$38.88$39.80
SD$38.88$39.80
TN$38.88$39.80
TX$38.88$39.80
UT$38.88$39.80
VA$38.88$39.80
VI$39.80
VT$38.88$39.80
WA$38.88$39.80
WI$38.88$39.80
WV$38.88$39.80
WY$38.88$39.80

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $42.75 to $47.38 depending on state and rural status.

StateNon-ruralRural
AK$42.75
AL$42.75
AR$42.75
AZ$42.75
CA$42.75
CO$42.75
CT$42.75
DC$42.75
DE$42.75
FL$42.75
GA$42.75
HI$42.75
IA$42.75
ID$42.75
IL$42.75
IN$42.75
KS$42.75
KY$42.75
LA$42.75
MA$42.75
MD$42.75
ME$42.75
MI$42.75
MN$42.75
MO$42.75
MS$42.75
MT$42.75
NC$42.75
ND$42.75
NE$42.75
NH$42.75
NJ$42.75
NM$42.75
NV$42.75
NY$42.75
OH$42.75
OK$42.75
OR$42.75
PA$42.75
PR$47.38
RI$42.75
SC$42.75
SD$42.75
TN$42.75
TX$42.75
UT$42.75
VA$42.75
VI$42.75
VT$42.75
WA$42.75
WI$42.75
WV$42.75
WY$42.75

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $40.74 to $48.81 depending on state and rural status.

Former-CBA payment limits: ceiling $40.74 · floor $34.63

StateNon-ruralRural
AK$40.74
AL$40.74
AR$40.74
AZ$40.74
CA$40.74
CO$40.74
CT$40.74
DC$40.74
DE$40.74
FL$40.74
GA$40.74
HI$40.74
IA$40.74
ID$40.74
IL$40.74
IN$40.74
KS$40.74
KY$40.74
LA$40.74
MA$40.74
MD$40.74
ME$40.74
MI$40.74
MN$40.74
MO$40.74
MS$40.74
MT$40.74
NC$40.74
ND$40.74
NE$40.74
NH$40.74
NJ$40.74
NM$40.74
NV$40.74
NY$40.74
OH$40.74
OK$40.74
OR$40.74
PA$40.74
PR$48.81
RI$40.74
SC$40.74
SD$40.74
TN$40.74
TX$40.74
UT$40.74
VA$40.74
VI$40.74
VT$40.74
WA$40.74
WI$40.74
WV$40.74
WY$40.74

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $291.56 to $329.02 depending on state and rural status.

StateNon-ruralRural
AK$298.46
AL$291.56$298.46
AR$291.56$298.46
AZ$291.56$298.46
CA$291.56$298.46
CO$291.56$298.46
CT$291.56$298.46
DC$291.56$298.46
DE$291.56$298.46
FL$291.56$298.46
GA$291.56$298.46
HI$298.46
IA$291.56$298.46
ID$291.56$298.46
IL$291.56$298.46
IN$291.56$298.46
KS$291.56$298.46
KY$291.56$298.46
LA$291.56$298.46
MA$291.56$298.46
MD$291.56$298.46
ME$291.56$298.46
MI$291.56$298.46
MN$291.56$298.46
MO$291.56$298.46
MS$291.56$298.46
MT$291.56$298.46
NC$291.56$298.46
ND$291.56$298.46
NE$291.56$298.46
NH$291.56$298.46
NJ$291.56$298.46
NM$291.56$298.46
NV$291.56$298.46
NY$291.56$298.46
OH$291.56$298.46
OK$291.56$298.46
OR$291.56$298.46
PA$291.56$298.46
PR$329.02
RI$291.56$298.46
SC$291.56$298.46
SD$291.56$298.46
TN$291.56$298.46
TX$291.56$298.46
UT$291.56$298.46
VA$291.56$298.46
VI$298.46
VT$291.56$298.46
WA$291.56$298.46
WI$291.56$298.46
WV$291.56$298.46
WY$291.56$298.46

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $320.60 to $355.58 depending on state and rural status.

StateNon-ruralRural
AK$320.60
AL$320.60
AR$320.60
AZ$320.60
CA$320.60
CO$320.60
CT$320.60
DC$320.60
DE$320.60
FL$320.60
GA$320.60
HI$320.60
IA$320.60
ID$320.60
IL$320.60
IN$320.60
KS$320.60
KY$320.60
LA$320.60
MA$320.60
MD$320.60
ME$320.60
MI$320.60
MN$320.60
MO$320.60
MS$320.60
MT$320.60
NC$320.60
ND$320.60
NE$320.60
NH$320.60
NJ$320.60
NM$320.60
NV$320.60
NY$320.60
OH$320.60
OK$320.60
OR$320.60
PA$320.60
PR$355.58
RI$320.60
SC$320.60
SD$320.60
TN$320.60
TX$320.60
UT$320.60
VA$320.60
VI$320.60
VT$320.60
WA$320.60
WI$320.60
WV$320.60
WY$320.60

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $305.37 to $366.48 depending on state and rural status.

Former-CBA payment limits: ceiling $305.37 · floor $259.56

StateNon-ruralRural
AK$305.37
AL$305.37
AR$305.37
AZ$305.37
CA$305.37
CO$305.37
CT$305.37
DC$305.37
DE$305.37
FL$305.37
GA$305.37
HI$305.37
IA$305.37
ID$305.37
IL$305.37
IN$305.37
KS$305.37
KY$305.37
LA$305.37
MA$305.37
MD$305.37
ME$305.37
MI$305.37
MN$305.37
MO$305.37
MS$305.37
MT$305.37
NC$305.37
ND$305.37
NE$305.37
NH$305.37
NJ$305.37
NM$305.37
NV$305.37
NY$305.37
OH$305.37
OK$305.37
OR$305.37
PA$305.37
PR$366.48
RI$305.37
SC$305.37
SD$305.37
TN$305.37
TX$305.37
UT$305.37
VA$305.37
VI$305.37
VT$305.37
WA$305.37
WI$305.37
WV$305.37
WY$305.37
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. 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.

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