E2624 — Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth
HCPCS Level II E-code · short descriptor: “Adj skin pro/pos cus<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 2026-10-27; 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 2026-10-27; 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.
E2624 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $395.03 to $443.82 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $402.76 | — |
| AL | $395.03 | $402.76 |
| AR | $395.03 | $402.76 |
| AZ | $395.03 | $402.76 |
| CA | $395.03 | $402.76 |
| CO | $395.03 | $402.76 |
| CT | $395.03 | $402.76 |
| DC | $395.03 | $402.76 |
| DE | $395.03 | $402.76 |
| FL | $395.03 | $402.76 |
| GA | $395.03 | $402.76 |
| HI | $402.76 | — |
| IA | $395.03 | $402.76 |
| ID | $395.03 | $402.76 |
| IL | $395.03 | $402.76 |
| IN | $395.03 | $402.76 |
| KS | $395.03 | $402.76 |
| KY | $395.03 | $402.76 |
| LA | $395.03 | $402.76 |
| MA | $395.03 | $402.76 |
| MD | $395.03 | $402.76 |
| ME | $395.03 | $402.76 |
| MI | $395.03 | $402.76 |
| MN | $395.03 | $402.76 |
| MO | $395.03 | $402.76 |
| MS | $395.03 | $402.76 |
| MT | $395.03 | $402.76 |
| NC | $395.03 | $402.76 |
| ND | $395.03 | $402.76 |
| NE | $395.03 | $402.76 |
| NH | $395.03 | $402.76 |
| NJ | $395.03 | $402.76 |
| NM | $395.03 | $402.76 |
| NV | $395.03 | $402.76 |
| NY | $395.03 | $402.76 |
| OH | $395.03 | $402.76 |
| OK | $395.03 | $402.76 |
| OR | $395.03 | $402.76 |
| PA | $395.03 | $402.76 |
| PR | $443.82 | — |
| RI | $395.03 | $402.76 |
| SC | $395.03 | $402.76 |
| SD | $395.03 | $402.76 |
| TN | $395.03 | $402.76 |
| TX | $395.03 | $402.76 |
| UT | $395.03 | $402.76 |
| VA | $395.03 | $402.76 |
| VI | $402.76 | — |
| VT | $395.03 | $402.76 |
| WA | $395.03 | $402.76 |
| WI | $395.03 | $402.76 |
| WV | $395.03 | $402.76 |
| WY | $395.03 | $402.76 |
NU + KE — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $432.53 to $479.53 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $432.53 | — |
| AL | — | $432.53 |
| AR | — | $432.53 |
| AZ | — | $432.53 |
| CA | — | $432.53 |
| CO | — | $432.53 |
| CT | — | $432.53 |
| DC | — | $432.53 |
| DE | — | $432.53 |
| FL | — | $432.53 |
| GA | — | $432.53 |
| HI | $432.53 | — |
| IA | — | $432.53 |
| ID | — | $432.53 |
| IL | — | $432.53 |
| IN | — | $432.53 |
| KS | — | $432.53 |
| KY | — | $432.53 |
| LA | — | $432.53 |
| MA | — | $432.53 |
| MD | — | $432.53 |
| ME | — | $432.53 |
| MI | — | $432.53 |
| MN | — | $432.53 |
| MO | — | $432.53 |
| MS | — | $432.53 |
| MT | — | $432.53 |
| NC | — | $432.53 |
| ND | — | $432.53 |
| NE | — | $432.53 |
| NH | — | $432.53 |
| NJ | — | $432.53 |
| NM | — | $432.53 |
| NV | — | $432.53 |
| NY | — | $432.53 |
| OH | — | $432.53 |
| OK | — | $432.53 |
| OR | — | $432.53 |
| PA | — | $432.53 |
| PR | $479.53 | — |
| RI | — | $432.53 |
| SC | — | $432.53 |
| SD | — | $432.53 |
| TN | — | $432.53 |
| TX | — | $432.53 |
| UT | — | $432.53 |
| VA | — | $432.53 |
| VI | $432.53 | — |
| VT | — | $432.53 |
| WA | — | $432.53 |
| WI | — | $432.53 |
| WV | — | $432.53 |
| WY | — | $432.53 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $410.50 to $492.60 depending on state and rural status.
Former-CBA payment limits: ceiling $410.50 · floor $348.93
| State | Non-rural | Rural |
|---|---|---|
| AK | $410.50 | — |
| AL | $410.50 | — |
| AR | $410.50 | — |
| AZ | $410.50 | — |
| CA | $410.50 | — |
| CO | $410.50 | — |
| CT | $410.50 | — |
| DC | $410.50 | — |
| DE | $410.50 | — |
| FL | $410.50 | — |
| GA | $410.50 | — |
| HI | $410.50 | — |
| IA | $410.50 | — |
| ID | $410.50 | — |
| IL | $410.50 | — |
| IN | $410.50 | — |
| KS | $410.50 | — |
| KY | $410.50 | — |
| LA | $410.50 | — |
| MA | $410.50 | — |
| MD | $410.50 | — |
| ME | $410.50 | — |
| MI | $410.50 | — |
| MN | $410.50 | — |
| MO | $410.50 | — |
| MS | $410.50 | — |
| MT | $410.50 | — |
| NC | $410.50 | — |
| ND | $410.50 | — |
| NE | $410.50 | — |
| NH | $410.50 | — |
| NJ | $410.50 | — |
| NM | $410.50 | — |
| NV | $410.50 | — |
| NY | $410.50 | — |
| OH | $410.50 | — |
| OK | $410.50 | — |
| OR | $410.50 | — |
| PA | $410.50 | — |
| PR | $492.60 | — |
| RI | $410.50 | — |
| SC | $410.50 | — |
| SD | $410.50 | — |
| TN | $410.50 | — |
| TX | $410.50 | — |
| UT | $410.50 | — |
| VA | $410.50 | — |
| VI | $410.50 | — |
| VT | $410.50 | — |
| WA | $410.50 | — |
| WI | $410.50 | — |
| WV | $410.50 | — |
| WY | $410.50 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $39.51 to $44.37 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $40.28 | — |
| AL | $39.51 | $40.28 |
| AR | $39.51 | $40.28 |
| AZ | $39.51 | $40.28 |
| CA | $39.51 | $40.28 |
| CO | $39.51 | $40.28 |
| CT | $39.51 | $40.28 |
| DC | $39.51 | $40.28 |
| DE | $39.51 | $40.28 |
| FL | $39.51 | $40.28 |
| GA | $39.51 | $40.28 |
| HI | $40.28 | — |
| IA | $39.51 | $40.28 |
| ID | $39.51 | $40.28 |
| IL | $39.51 | $40.28 |
| IN | $39.51 | $40.28 |
| KS | $39.51 | $40.28 |
| KY | $39.51 | $40.28 |
| LA | $39.51 | $40.28 |
| MA | $39.51 | $40.28 |
| MD | $39.51 | $40.28 |
| ME | $39.51 | $40.28 |
| MI | $39.51 | $40.28 |
| MN | $39.51 | $40.28 |
| MO | $39.51 | $40.28 |
| MS | $39.51 | $40.28 |
| MT | $39.51 | $40.28 |
| NC | $39.51 | $40.28 |
| ND | $39.51 | $40.28 |
| NE | $39.51 | $40.28 |
| NH | $39.51 | $40.28 |
| NJ | $39.51 | $40.28 |
| NM | $39.51 | $40.28 |
| NV | $39.51 | $40.28 |
| NY | $39.51 | $40.28 |
| OH | $39.51 | $40.28 |
| OK | $39.51 | $40.28 |
| OR | $39.51 | $40.28 |
| PA | $39.51 | $40.28 |
| PR | $44.37 | — |
| RI | $39.51 | $40.28 |
| SC | $39.51 | $40.28 |
| SD | $39.51 | $40.28 |
| TN | $39.51 | $40.28 |
| TX | $39.51 | $40.28 |
| UT | $39.51 | $40.28 |
| VA | $39.51 | $40.28 |
| VI | $40.28 | — |
| VT | $39.51 | $40.28 |
| WA | $39.51 | $40.28 |
| WI | $39.51 | $40.28 |
| WV | $39.51 | $40.28 |
| WY | $39.51 | $40.28 |
RR + KE — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $43.26 to $47.94 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $43.26 | — |
| AL | — | $43.26 |
| AR | — | $43.26 |
| AZ | — | $43.26 |
| CA | — | $43.26 |
| CO | — | $43.26 |
| CT | — | $43.26 |
| DC | — | $43.26 |
| DE | — | $43.26 |
| FL | — | $43.26 |
| GA | — | $43.26 |
| HI | $43.26 | — |
| IA | — | $43.26 |
| ID | — | $43.26 |
| IL | — | $43.26 |
| IN | — | $43.26 |
| KS | — | $43.26 |
| KY | — | $43.26 |
| LA | — | $43.26 |
| MA | — | $43.26 |
| MD | — | $43.26 |
| ME | — | $43.26 |
| MI | — | $43.26 |
| MN | — | $43.26 |
| MO | — | $43.26 |
| MS | — | $43.26 |
| MT | — | $43.26 |
| NC | — | $43.26 |
| ND | — | $43.26 |
| NE | — | $43.26 |
| NH | — | $43.26 |
| NJ | — | $43.26 |
| NM | — | $43.26 |
| NV | — | $43.26 |
| NY | — | $43.26 |
| OH | — | $43.26 |
| OK | — | $43.26 |
| OR | — | $43.26 |
| PA | — | $43.26 |
| PR | $47.94 | — |
| RI | — | $43.26 |
| SC | — | $43.26 |
| SD | — | $43.26 |
| TN | — | $43.26 |
| TX | — | $43.26 |
| UT | — | $43.26 |
| VA | — | $43.26 |
| VI | $43.26 | — |
| VT | — | $43.26 |
| WA | — | $43.26 |
| WI | — | $43.26 |
| WV | — | $43.26 |
| WY | — | $43.26 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $41.07 to $49.24 depending on state and rural status.
Former-CBA payment limits: ceiling $41.07 · floor $34.91
| State | Non-rural | Rural |
|---|---|---|
| AK | $41.07 | — |
| AL | $41.07 | — |
| AR | $41.07 | — |
| AZ | $41.07 | — |
| CA | $41.07 | — |
| CO | $41.07 | — |
| CT | $41.07 | — |
| DC | $41.07 | — |
| DE | $41.07 | — |
| FL | $41.07 | — |
| GA | $41.07 | — |
| HI | $41.07 | — |
| IA | $41.07 | — |
| ID | $41.07 | — |
| IL | $41.07 | — |
| IN | $41.07 | — |
| KS | $41.07 | — |
| KY | $41.07 | — |
| LA | $41.07 | — |
| MA | $41.07 | — |
| MD | $41.07 | — |
| ME | $41.07 | — |
| MI | $41.07 | — |
| MN | $41.07 | — |
| MO | $41.07 | — |
| MS | $41.07 | — |
| MT | $41.07 | — |
| NC | $41.07 | — |
| ND | $41.07 | — |
| NE | $41.07 | — |
| NH | $41.07 | — |
| NJ | $41.07 | — |
| NM | $41.07 | — |
| NV | $41.07 | — |
| NY | $41.07 | — |
| OH | $41.07 | — |
| OK | $41.07 | — |
| OR | $41.07 | — |
| PA | $41.07 | — |
| PR | $49.24 | — |
| RI | $41.07 | — |
| SC | $41.07 | — |
| SD | $41.07 | — |
| TN | $41.07 | — |
| TX | $41.07 | — |
| UT | $41.07 | — |
| VA | $41.07 | — |
| VI | $41.07 | — |
| VT | $41.07 | — |
| WA | $41.07 | — |
| WI | $41.07 | — |
| WV | $41.07 | — |
| WY | $41.07 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $296.28 to $332.87 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $302.09 | — |
| AL | $296.28 | $302.09 |
| AR | $296.28 | $302.09 |
| AZ | $296.28 | $302.09 |
| CA | $296.28 | $302.09 |
| CO | $296.28 | $302.09 |
| CT | $296.28 | $302.09 |
| DC | $296.28 | $302.09 |
| DE | $296.28 | $302.09 |
| FL | $296.28 | $302.09 |
| GA | $296.28 | $302.09 |
| HI | $302.09 | — |
| IA | $296.28 | $302.09 |
| ID | $296.28 | $302.09 |
| IL | $296.28 | $302.09 |
| IN | $296.28 | $302.09 |
| KS | $296.28 | $302.09 |
| KY | $296.28 | $302.09 |
| LA | $296.28 | $302.09 |
| MA | $296.28 | $302.09 |
| MD | $296.28 | $302.09 |
| ME | $296.28 | $302.09 |
| MI | $296.28 | $302.09 |
| MN | $296.28 | $302.09 |
| MO | $296.28 | $302.09 |
| MS | $296.28 | $302.09 |
| MT | $296.28 | $302.09 |
| NC | $296.28 | $302.09 |
| ND | $296.28 | $302.09 |
| NE | $296.28 | $302.09 |
| NH | $296.28 | $302.09 |
| NJ | $296.28 | $302.09 |
| NM | $296.28 | $302.09 |
| NV | $296.28 | $302.09 |
| NY | $296.28 | $302.09 |
| OH | $296.28 | $302.09 |
| OK | $296.28 | $302.09 |
| OR | $296.28 | $302.09 |
| PA | $296.28 | $302.09 |
| PR | $332.87 | — |
| RI | $296.28 | $302.09 |
| SC | $296.28 | $302.09 |
| SD | $296.28 | $302.09 |
| TN | $296.28 | $302.09 |
| TX | $296.28 | $302.09 |
| UT | $296.28 | $302.09 |
| VA | $296.28 | $302.09 |
| VI | $302.09 | — |
| VT | $296.28 | $302.09 |
| WA | $296.28 | $302.09 |
| WI | $296.28 | $302.09 |
| WV | $296.28 | $302.09 |
| WY | $296.28 | $302.09 |
UE + KE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $324.41 to $359.65 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $324.41 | — |
| AL | — | $324.41 |
| AR | — | $324.41 |
| AZ | — | $324.41 |
| CA | — | $324.41 |
| CO | — | $324.41 |
| CT | — | $324.41 |
| DC | — | $324.41 |
| DE | — | $324.41 |
| FL | — | $324.41 |
| GA | — | $324.41 |
| HI | $324.41 | — |
| IA | — | $324.41 |
| ID | — | $324.41 |
| IL | — | $324.41 |
| IN | — | $324.41 |
| KS | — | $324.41 |
| KY | — | $324.41 |
| LA | — | $324.41 |
| MA | — | $324.41 |
| MD | — | $324.41 |
| ME | — | $324.41 |
| MI | — | $324.41 |
| MN | — | $324.41 |
| MO | — | $324.41 |
| MS | — | $324.41 |
| MT | — | $324.41 |
| NC | — | $324.41 |
| ND | — | $324.41 |
| NE | — | $324.41 |
| NH | — | $324.41 |
| NJ | — | $324.41 |
| NM | — | $324.41 |
| NV | — | $324.41 |
| NY | — | $324.41 |
| OH | — | $324.41 |
| OK | — | $324.41 |
| OR | — | $324.41 |
| PA | — | $324.41 |
| PR | $359.65 | — |
| RI | — | $324.41 |
| SC | — | $324.41 |
| SD | — | $324.41 |
| TN | — | $324.41 |
| TX | — | $324.41 |
| UT | — | $324.41 |
| VA | — | $324.41 |
| VI | $324.41 | — |
| VT | — | $324.41 |
| WA | — | $324.41 |
| WI | — | $324.41 |
| WV | — | $324.41 |
| WY | — | $324.41 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $307.90 to $369.45 depending on state and rural status.
Former-CBA payment limits: ceiling $307.90 · floor $261.72
| State | Non-rural | Rural |
|---|---|---|
| AK | $307.90 | — |
| AL | $307.90 | — |
| AR | $307.90 | — |
| AZ | $307.90 | — |
| CA | $307.90 | — |
| CO | $307.90 | — |
| CT | $307.90 | — |
| DC | $307.90 | — |
| DE | $307.90 | — |
| FL | $307.90 | — |
| GA | $307.90 | — |
| HI | $307.90 | — |
| IA | $307.90 | — |
| ID | $307.90 | — |
| IL | $307.90 | — |
| IN | $307.90 | — |
| KS | $307.90 | — |
| KY | $307.90 | — |
| LA | $307.90 | — |
| MA | $307.90 | — |
| MD | $307.90 | — |
| ME | $307.90 | — |
| MI | $307.90 | — |
| MN | $307.90 | — |
| MO | $307.90 | — |
| MS | $307.90 | — |
| MT | $307.90 | — |
| NC | $307.90 | — |
| ND | $307.90 | — |
| NE | $307.90 | — |
| NH | $307.90 | — |
| NJ | $307.90 | — |
| NM | $307.90 | — |
| NV | $307.90 | — |
| NY | $307.90 | — |
| OH | $307.90 | — |
| OK | $307.90 | — |
| OR | $307.90 | — |
| PA | $307.90 | — |
| PR | $369.45 | — |
| RI | $307.90 | — |
| SC | $307.90 | — |
| SD | $307.90 | — |
| TN | $307.90 | — |
| TX | $307.90 | — |
| UT | $307.90 | — |
| VA | $307.90 | — |
| VI | $307.90 | — |
| VT | $307.90 | — |
| WA | $307.90 | — |
| WI | $307.90 | — |
| WV | $307.90 | — |
| WY | $307.90 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2624 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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