E2625 — Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth
HCPCS Level II E-code · short descriptor: “Adj skin pro/pos wc cus>=22”
- 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.
E2625 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $488.89 to $556.25 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $504.27 | — |
| AL | $488.89 | $504.27 |
| AR | $488.89 | $504.27 |
| AZ | $488.89 | $504.27 |
| CA | $488.89 | $504.27 |
| CO | $488.89 | $504.27 |
| CT | $488.89 | $504.27 |
| DC | $488.89 | $504.27 |
| DE | $488.89 | $504.27 |
| FL | $488.89 | $504.27 |
| GA | $488.89 | $504.27 |
| HI | $504.27 | — |
| IA | $488.89 | $504.27 |
| ID | $488.89 | $504.27 |
| IL | $488.89 | $504.27 |
| IN | $488.89 | $504.27 |
| KS | $488.89 | $504.27 |
| KY | $488.89 | $504.27 |
| LA | $488.89 | $504.27 |
| MA | $488.89 | $504.27 |
| MD | $488.89 | $504.27 |
| ME | $488.89 | $504.27 |
| MI | $488.89 | $504.27 |
| MN | $488.89 | $504.27 |
| MO | $488.89 | $504.27 |
| MS | $488.89 | $504.27 |
| MT | $488.89 | $504.27 |
| NC | $488.89 | $504.27 |
| ND | $488.89 | $504.27 |
| NE | $488.89 | $504.27 |
| NH | $488.89 | $504.27 |
| NJ | $488.89 | $504.27 |
| NM | $488.89 | $504.27 |
| NV | $488.89 | $504.27 |
| NY | $488.89 | $504.27 |
| OH | $488.89 | $504.27 |
| OK | $488.89 | $504.27 |
| OR | $488.89 | $504.27 |
| PA | $488.89 | $504.27 |
| PR | $556.25 | — |
| RI | $488.89 | $504.27 |
| SC | $488.89 | $504.27 |
| SD | $488.89 | $504.27 |
| TN | $488.89 | $504.27 |
| TX | $488.89 | $504.27 |
| UT | $488.89 | $504.27 |
| VA | $488.89 | $504.27 |
| VI | $504.27 | — |
| VT | $488.89 | $504.27 |
| WA | $488.89 | $504.27 |
| WI | $488.89 | $504.27 |
| WV | $488.89 | $504.27 |
| WY | $488.89 | $504.27 |
NU + KE — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $541.95 to $601.46 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $541.95 | — |
| AL | — | $541.95 |
| AR | — | $541.95 |
| AZ | — | $541.95 |
| CA | — | $541.95 |
| CO | — | $541.95 |
| CT | — | $541.95 |
| DC | — | $541.95 |
| DE | — | $541.95 |
| FL | — | $541.95 |
| GA | — | $541.95 |
| HI | $541.95 | — |
| IA | — | $541.95 |
| ID | — | $541.95 |
| IL | — | $541.95 |
| IN | — | $541.95 |
| KS | — | $541.95 |
| KY | — | $541.95 |
| LA | — | $541.95 |
| MA | — | $541.95 |
| MD | — | $541.95 |
| ME | — | $541.95 |
| MI | — | $541.95 |
| MN | — | $541.95 |
| MO | — | $541.95 |
| MS | — | $541.95 |
| MT | — | $541.95 |
| NC | — | $541.95 |
| ND | — | $541.95 |
| NE | — | $541.95 |
| NH | — | $541.95 |
| NJ | — | $541.95 |
| NM | — | $541.95 |
| NV | — | $541.95 |
| NY | — | $541.95 |
| OH | — | $541.95 |
| OK | — | $541.95 |
| OR | — | $541.95 |
| PA | — | $541.95 |
| PR | $601.46 | — |
| RI | — | $541.95 |
| SC | — | $541.95 |
| SD | — | $541.95 |
| TN | — | $541.95 |
| TX | — | $541.95 |
| UT | — | $541.95 |
| VA | — | $541.95 |
| VI | $541.95 | — |
| VT | — | $541.95 |
| WA | — | $541.95 |
| WI | — | $541.95 |
| WV | — | $541.95 |
| WY | — | $541.95 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $519.67 to $623.63 depending on state and rural status.
Former-CBA payment limits: ceiling $519.67 · floor $441.72
| State | Non-rural | Rural |
|---|---|---|
| AK | $519.67 | — |
| AL | $519.67 | — |
| AR | $519.67 | — |
| AZ | $519.67 | — |
| CA | $519.67 | — |
| CO | $519.67 | — |
| CT | $519.67 | — |
| DC | $519.67 | — |
| DE | $519.67 | — |
| FL | $519.67 | — |
| GA | $519.67 | — |
| HI | $519.67 | — |
| IA | $519.67 | — |
| ID | $519.67 | — |
| IL | $519.67 | — |
| IN | $519.67 | — |
| KS | $519.67 | — |
| KY | $519.67 | — |
| LA | $519.67 | — |
| MA | $519.67 | — |
| MD | $519.67 | — |
| ME | $519.67 | — |
| MI | $519.67 | — |
| MN | $519.67 | — |
| MO | $519.67 | — |
| MS | $519.67 | — |
| MT | $519.67 | — |
| NC | $519.67 | — |
| ND | $519.67 | — |
| NE | $519.67 | — |
| NH | $519.67 | — |
| NJ | $519.67 | — |
| NM | $519.67 | — |
| NV | $519.67 | — |
| NY | $519.67 | — |
| OH | $519.67 | — |
| OK | $519.67 | — |
| OR | $519.67 | — |
| PA | $519.67 | — |
| PR | $623.63 | — |
| RI | $519.67 | — |
| SC | $519.67 | — |
| SD | $519.67 | — |
| TN | $519.67 | — |
| TX | $519.67 | — |
| UT | $519.67 | — |
| VA | $519.67 | — |
| VI | $519.67 | — |
| VT | $519.67 | — |
| WA | $519.67 | — |
| WI | $519.67 | — |
| WV | $519.67 | — |
| WY | $519.67 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $48.89 to $55.63 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $50.42 | — |
| AL | $48.89 | $50.42 |
| AR | $48.89 | $50.42 |
| AZ | $48.89 | $50.42 |
| CA | $48.89 | $50.42 |
| CO | $48.89 | $50.42 |
| CT | $48.89 | $50.42 |
| DC | $48.89 | $50.42 |
| DE | $48.89 | $50.42 |
| FL | $48.89 | $50.42 |
| GA | $48.89 | $50.42 |
| HI | $50.42 | — |
| IA | $48.89 | $50.42 |
| ID | $48.89 | $50.42 |
| IL | $48.89 | $50.42 |
| IN | $48.89 | $50.42 |
| KS | $48.89 | $50.42 |
| KY | $48.89 | $50.42 |
| LA | $48.89 | $50.42 |
| MA | $48.89 | $50.42 |
| MD | $48.89 | $50.42 |
| ME | $48.89 | $50.42 |
| MI | $48.89 | $50.42 |
| MN | $48.89 | $50.42 |
| MO | $48.89 | $50.42 |
| MS | $48.89 | $50.42 |
| MT | $48.89 | $50.42 |
| NC | $48.89 | $50.42 |
| ND | $48.89 | $50.42 |
| NE | $48.89 | $50.42 |
| NH | $48.89 | $50.42 |
| NJ | $48.89 | $50.42 |
| NM | $48.89 | $50.42 |
| NV | $48.89 | $50.42 |
| NY | $48.89 | $50.42 |
| OH | $48.89 | $50.42 |
| OK | $48.89 | $50.42 |
| OR | $48.89 | $50.42 |
| PA | $48.89 | $50.42 |
| PR | $55.63 | — |
| RI | $48.89 | $50.42 |
| SC | $48.89 | $50.42 |
| SD | $48.89 | $50.42 |
| TN | $48.89 | $50.42 |
| TX | $48.89 | $50.42 |
| UT | $48.89 | $50.42 |
| VA | $48.89 | $50.42 |
| VI | $50.42 | — |
| VT | $48.89 | $50.42 |
| WA | $48.89 | $50.42 |
| WI | $48.89 | $50.42 |
| WV | $48.89 | $50.42 |
| WY | $48.89 | $50.42 |
RR + KE — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $54.19 to $60.15 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $54.19 | — |
| AL | — | $54.19 |
| AR | — | $54.19 |
| AZ | — | $54.19 |
| CA | — | $54.19 |
| CO | — | $54.19 |
| CT | — | $54.19 |
| DC | — | $54.19 |
| DE | — | $54.19 |
| FL | — | $54.19 |
| GA | — | $54.19 |
| HI | $54.19 | — |
| IA | — | $54.19 |
| ID | — | $54.19 |
| IL | — | $54.19 |
| IN | — | $54.19 |
| KS | — | $54.19 |
| KY | — | $54.19 |
| LA | — | $54.19 |
| MA | — | $54.19 |
| MD | — | $54.19 |
| ME | — | $54.19 |
| MI | — | $54.19 |
| MN | — | $54.19 |
| MO | — | $54.19 |
| MS | — | $54.19 |
| MT | — | $54.19 |
| NC | — | $54.19 |
| ND | — | $54.19 |
| NE | — | $54.19 |
| NH | — | $54.19 |
| NJ | — | $54.19 |
| NM | — | $54.19 |
| NV | — | $54.19 |
| NY | — | $54.19 |
| OH | — | $54.19 |
| OK | — | $54.19 |
| OR | — | $54.19 |
| PA | — | $54.19 |
| PR | $60.15 | — |
| RI | — | $54.19 |
| SC | — | $54.19 |
| SD | — | $54.19 |
| TN | — | $54.19 |
| TX | — | $54.19 |
| UT | — | $54.19 |
| VA | — | $54.19 |
| VI | $54.19 | — |
| VT | — | $54.19 |
| WA | — | $54.19 |
| WI | — | $54.19 |
| WV | — | $54.19 |
| WY | — | $54.19 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $51.94 to $62.36 depending on state and rural status.
Former-CBA payment limits: ceiling $51.94 · floor $44.15
| State | Non-rural | Rural |
|---|---|---|
| AK | $51.94 | — |
| AL | $51.94 | — |
| AR | $51.94 | — |
| AZ | $51.94 | — |
| CA | $51.94 | — |
| CO | $51.94 | — |
| CT | $51.94 | — |
| DC | $51.94 | — |
| DE | $51.94 | — |
| FL | $51.94 | — |
| GA | $51.94 | — |
| HI | $51.94 | — |
| IA | $51.94 | — |
| ID | $51.94 | — |
| IL | $51.94 | — |
| IN | $51.94 | — |
| KS | $51.94 | — |
| KY | $51.94 | — |
| LA | $51.94 | — |
| MA | $51.94 | — |
| MD | $51.94 | — |
| ME | $51.94 | — |
| MI | $51.94 | — |
| MN | $51.94 | — |
| MO | $51.94 | — |
| MS | $51.94 | — |
| MT | $51.94 | — |
| NC | $51.94 | — |
| ND | $51.94 | — |
| NE | $51.94 | — |
| NH | $51.94 | — |
| NJ | $51.94 | — |
| NM | $51.94 | — |
| NV | $51.94 | — |
| NY | $51.94 | — |
| OH | $51.94 | — |
| OK | $51.94 | — |
| OR | $51.94 | — |
| PA | $51.94 | — |
| PR | $62.36 | — |
| RI | $51.94 | — |
| SC | $51.94 | — |
| SD | $51.94 | — |
| TN | $51.94 | — |
| TX | $51.94 | — |
| UT | $51.94 | — |
| VA | $51.94 | — |
| VI | $51.94 | — |
| VT | $51.94 | — |
| WA | $51.94 | — |
| WI | $51.94 | — |
| WV | $51.94 | — |
| WY | $51.94 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $366.67 to $417.18 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $378.20 | — |
| AL | $366.67 | $378.20 |
| AR | $366.67 | $378.20 |
| AZ | $366.67 | $378.20 |
| CA | $366.67 | $378.20 |
| CO | $366.67 | $378.20 |
| CT | $366.67 | $378.20 |
| DC | $366.67 | $378.20 |
| DE | $366.67 | $378.20 |
| FL | $366.67 | $378.20 |
| GA | $366.67 | $378.20 |
| HI | $378.20 | — |
| IA | $366.67 | $378.20 |
| ID | $366.67 | $378.20 |
| IL | $366.67 | $378.20 |
| IN | $366.67 | $378.20 |
| KS | $366.67 | $378.20 |
| KY | $366.67 | $378.20 |
| LA | $366.67 | $378.20 |
| MA | $366.67 | $378.20 |
| MD | $366.67 | $378.20 |
| ME | $366.67 | $378.20 |
| MI | $366.67 | $378.20 |
| MN | $366.67 | $378.20 |
| MO | $366.67 | $378.20 |
| MS | $366.67 | $378.20 |
| MT | $366.67 | $378.20 |
| NC | $366.67 | $378.20 |
| ND | $366.67 | $378.20 |
| NE | $366.67 | $378.20 |
| NH | $366.67 | $378.20 |
| NJ | $366.67 | $378.20 |
| NM | $366.67 | $378.20 |
| NV | $366.67 | $378.20 |
| NY | $366.67 | $378.20 |
| OH | $366.67 | $378.20 |
| OK | $366.67 | $378.20 |
| OR | $366.67 | $378.20 |
| PA | $366.67 | $378.20 |
| PR | $417.18 | — |
| RI | $366.67 | $378.20 |
| SC | $366.67 | $378.20 |
| SD | $366.67 | $378.20 |
| TN | $366.67 | $378.20 |
| TX | $366.67 | $378.20 |
| UT | $366.67 | $378.20 |
| VA | $366.67 | $378.20 |
| VI | $378.20 | — |
| VT | $366.67 | $378.20 |
| WA | $366.67 | $378.20 |
| WI | $366.67 | $378.20 |
| WV | $366.67 | $378.20 |
| WY | $366.67 | $378.20 |
UE + KE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $406.46 to $451.09 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $406.46 | — |
| AL | — | $406.46 |
| AR | — | $406.46 |
| AZ | — | $406.46 |
| CA | — | $406.46 |
| CO | — | $406.46 |
| CT | — | $406.46 |
| DC | — | $406.46 |
| DE | — | $406.46 |
| FL | — | $406.46 |
| GA | — | $406.46 |
| HI | $406.46 | — |
| IA | — | $406.46 |
| ID | — | $406.46 |
| IL | — | $406.46 |
| IN | — | $406.46 |
| KS | — | $406.46 |
| KY | — | $406.46 |
| LA | — | $406.46 |
| MA | — | $406.46 |
| MD | — | $406.46 |
| ME | — | $406.46 |
| MI | — | $406.46 |
| MN | — | $406.46 |
| MO | — | $406.46 |
| MS | — | $406.46 |
| MT | — | $406.46 |
| NC | — | $406.46 |
| ND | — | $406.46 |
| NE | — | $406.46 |
| NH | — | $406.46 |
| NJ | — | $406.46 |
| NM | — | $406.46 |
| NV | — | $406.46 |
| NY | — | $406.46 |
| OH | — | $406.46 |
| OK | — | $406.46 |
| OR | — | $406.46 |
| PA | — | $406.46 |
| PR | $451.09 | — |
| RI | — | $406.46 |
| SC | — | $406.46 |
| SD | — | $406.46 |
| TN | — | $406.46 |
| TX | — | $406.46 |
| UT | — | $406.46 |
| VA | — | $406.46 |
| VI | $406.46 | — |
| VT | — | $406.46 |
| WA | — | $406.46 |
| WI | — | $406.46 |
| WV | — | $406.46 |
| WY | — | $406.46 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $389.76 to $467.70 depending on state and rural status.
Former-CBA payment limits: ceiling $389.76 · floor $331.30
| State | Non-rural | Rural |
|---|---|---|
| AK | $389.76 | — |
| AL | $389.76 | — |
| AR | $389.76 | — |
| AZ | $389.76 | — |
| CA | $389.76 | — |
| CO | $389.76 | — |
| CT | $389.76 | — |
| DC | $389.76 | — |
| DE | $389.76 | — |
| FL | $389.76 | — |
| GA | $389.76 | — |
| HI | $389.76 | — |
| IA | $389.76 | — |
| ID | $389.76 | — |
| IL | $389.76 | — |
| IN | $389.76 | — |
| KS | $389.76 | — |
| KY | $389.76 | — |
| LA | $389.76 | — |
| MA | $389.76 | — |
| MD | $389.76 | — |
| ME | $389.76 | — |
| MI | $389.76 | — |
| MN | $389.76 | — |
| MO | $389.76 | — |
| MS | $389.76 | — |
| MT | $389.76 | — |
| NC | $389.76 | — |
| ND | $389.76 | — |
| NE | $389.76 | — |
| NH | $389.76 | — |
| NJ | $389.76 | — |
| NM | $389.76 | — |
| NV | $389.76 | — |
| NY | $389.76 | — |
| OH | $389.76 | — |
| OK | $389.76 | — |
| OR | $389.76 | — |
| PA | $389.76 | — |
| PR | $467.70 | — |
| RI | $389.76 | — |
| SC | $389.76 | — |
| SD | $389.76 | — |
| TN | $389.76 | — |
| TX | $389.76 | — |
| UT | $389.76 | — |
| VA | $389.76 | — |
| VI | $389.76 | — |
| VT | $389.76 | — |
| WA | $389.76 | — |
| WI | $389.76 | — |
| WV | $389.76 | — |
| WY | $389.76 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2625 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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