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
- 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.
E2622 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $388.75 to $438.67 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| 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.
| State | Non-rural | Rural |
|---|---|---|
| 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
| State | Non-rural | Rural |
|---|---|---|
| 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.
| State | Non-rural | Rural |
|---|---|---|
| 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.
| State | Non-rural | Rural |
|---|---|---|
| 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
| State | Non-rural | Rural |
|---|---|---|
| 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.
| State | Non-rural | Rural |
|---|---|---|
| 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.
| State | Non-rural | Rural |
|---|---|---|
| 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
| State | Non-rural | Rural |
|---|---|---|
| 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 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2622 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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