E2626 — Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable
HCPCS Level II E-code · short descriptor: “Seo mobile arm sup att to wc”
- 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
- 2
- 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.
E2626 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $750.55 to $1221.40 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $993.81 | — |
| AL | $768.67 | $847.48 |
| AR | $752.41 | $752.41 |
| AZ | $756.09 | $874.46 |
| CA | $750.55 | $874.46 |
| CO | $799.68 | $874.46 |
| CT | $842.75 | $874.46 |
| DC | $773.04 | $874.46 |
| DE | $773.04 | $874.46 |
| FL | $768.67 | $874.46 |
| GA | $768.67 | $874.46 |
| HI | $1030.99 | — |
| IA | $793.57 | $874.46 |
| ID | $799.68 | $874.46 |
| IL | $795.38 | $874.46 |
| IN | $752.41 | $752.41 |
| KS | $793.57 | $801.32 |
| KY | $768.67 | $874.46 |
| LA | $752.41 | $752.41 |
| MA | $842.75 | $874.46 |
| MD | $773.04 | $869.20 |
| ME | $842.75 | $874.46 |
| MI | $795.38 | $874.46 |
| MN | $793.57 | $874.46 |
| MO | $793.57 | $801.32 |
| MS | $768.67 | $874.46 |
| MT | $799.68 | $864.55 |
| NC | $768.67 | $874.46 |
| ND | $752.41 | $752.41 |
| NE | $793.57 | $801.32 |
| NH | $842.75 | $874.46 |
| NJ | $773.04 | $874.46 |
| NM | $756.09 | $862.27 |
| NV | $750.55 | $874.46 |
| NY | $773.04 | $874.46 |
| OH | $795.38 | $868.32 |
| OK | $756.09 | $874.46 |
| OR | $750.55 | $874.46 |
| PA | $773.04 | $874.46 |
| PR | $1221.40 | — |
| RI | $842.75 | $874.46 |
| SC | $752.41 | $752.41 |
| SD | $752.41 | $752.41 |
| TN | $768.67 | $874.46 |
| TX | $756.09 | $822.50 |
| UT | $799.68 | $874.46 |
| VA | $768.67 | $837.87 |
| VI | $885.19 | — |
| VT | $842.75 | $874.46 |
| WA | $750.55 | $874.46 |
| WI | $795.38 | $868.32 |
| WV | $768.67 | $868.32 |
| WY | $752.41 | $752.41 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $752.43 to $1527.73 depending on state and rural status.
Former-CBA payment limits: ceiling $885.21 · floor $752.43
| State | Non-rural | Rural |
|---|---|---|
| AK | $1072.53 | — |
| AL | $847.46 | — |
| AR | $752.43 | — |
| AZ | $885.21 | — |
| CA | $885.21 | — |
| CO | $885.21 | — |
| CT | $885.21 | — |
| DC | $885.21 | — |
| DE | $885.21 | — |
| FL | $885.21 | — |
| GA | $885.21 | — |
| HI | $1146.92 | — |
| IA | $885.21 | — |
| ID | $885.21 | — |
| IL | $885.21 | — |
| IN | $752.43 | — |
| KS | $801.33 | — |
| KY | $885.21 | — |
| LA | $752.43 | — |
| MA | $885.21 | — |
| MD | $874.69 | — |
| ME | $885.21 | — |
| MI | $885.21 | — |
| MN | $885.21 | — |
| MO | $801.33 | — |
| MS | $885.21 | — |
| MT | $865.37 | — |
| NC | $885.21 | — |
| ND | $752.43 | — |
| NE | $801.33 | — |
| NH | $885.21 | — |
| NJ | $885.21 | — |
| NM | $862.27 | — |
| NV | $885.21 | — |
| NY | $885.21 | — |
| OH | $872.91 | — |
| OK | $885.21 | — |
| OR | $885.21 | — |
| PA | $885.21 | — |
| PR | $1527.73 | — |
| RI | $885.21 | — |
| SC | $752.43 | — |
| SD | $752.43 | — |
| TN | $885.21 | — |
| TX | $822.52 | — |
| UT | $885.21 | — |
| VA | $837.88 | — |
| VI | $885.21 | — |
| VT | $885.21 | — |
| WA | $885.21 | — |
| WI | $872.91 | — |
| WV | $872.91 | — |
| WY | $752.43 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $75.06 to $122.15 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $99.37 | — |
| AL | $76.87 | $84.78 |
| AR | $75.21 | $75.21 |
| AZ | $75.61 | $87.43 |
| CA | $75.06 | $87.43 |
| CO | $79.97 | $87.43 |
| CT | $84.28 | $87.43 |
| DC | $77.30 | $87.43 |
| DE | $77.30 | $87.43 |
| FL | $76.87 | $87.43 |
| GA | $76.87 | $87.43 |
| HI | $103.10 | — |
| IA | $79.36 | $87.43 |
| ID | $79.97 | $87.43 |
| IL | $79.54 | $87.43 |
| IN | $75.21 | $75.21 |
| KS | $79.36 | $80.12 |
| KY | $76.87 | $87.43 |
| LA | $75.21 | $75.21 |
| MA | $84.28 | $87.43 |
| MD | $77.30 | $86.93 |
| ME | $84.28 | $87.43 |
| MI | $79.54 | $87.43 |
| MN | $79.36 | $87.43 |
| MO | $79.36 | $80.12 |
| MS | $76.87 | $87.43 |
| MT | $79.97 | $86.46 |
| NC | $76.87 | $87.43 |
| ND | $75.21 | $75.21 |
| NE | $79.36 | $80.12 |
| NH | $84.28 | $87.43 |
| NJ | $77.30 | $87.43 |
| NM | $75.61 | $86.26 |
| NV | $75.06 | $87.43 |
| NY | $77.30 | $87.43 |
| OH | $79.54 | $86.84 |
| OK | $75.61 | $87.43 |
| OR | $75.06 | $87.43 |
| PA | $77.30 | $87.43 |
| PR | $122.15 | — |
| RI | $84.28 | $87.43 |
| SC | $75.21 | $75.21 |
| SD | $75.21 | $75.21 |
| TN | $76.87 | $87.43 |
| TX | $75.61 | $82.28 |
| UT | $79.97 | $87.43 |
| VA | $76.87 | $83.82 |
| VI | $88.49 | — |
| VT | $84.28 | $87.43 |
| WA | $75.06 | $87.43 |
| WI | $79.54 | $86.84 |
| WV | $76.87 | $86.84 |
| WY | $75.21 | $75.21 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $75.22 to $152.79 depending on state and rural status.
Former-CBA payment limits: ceiling $88.49 · floor $75.22
| State | Non-rural | Rural |
|---|---|---|
| AK | $107.22 | — |
| AL | $84.79 | — |
| AR | $75.22 | — |
| AZ | $88.49 | — |
| CA | $88.49 | — |
| CO | $88.49 | — |
| CT | $88.49 | — |
| DC | $88.49 | — |
| DE | $88.49 | — |
| FL | $88.49 | — |
| GA | $88.49 | — |
| HI | $114.69 | — |
| IA | $88.49 | — |
| ID | $88.49 | — |
| IL | $88.49 | — |
| IN | $75.22 | — |
| KS | $80.12 | — |
| KY | $88.49 | — |
| LA | $75.22 | — |
| MA | $88.49 | — |
| MD | $87.48 | — |
| ME | $88.49 | — |
| MI | $88.49 | — |
| MN | $88.49 | — |
| MO | $80.12 | — |
| MS | $88.49 | — |
| MT | $86.53 | — |
| NC | $88.49 | — |
| ND | $75.22 | — |
| NE | $80.12 | — |
| NH | $88.49 | — |
| NJ | $88.49 | — |
| NM | $86.25 | — |
| NV | $88.49 | — |
| NY | $88.49 | — |
| OH | $87.30 | — |
| OK | $88.49 | — |
| OR | $88.49 | — |
| PA | $88.49 | — |
| PR | $152.79 | — |
| RI | $88.49 | — |
| SC | $75.22 | — |
| SD | $75.22 | — |
| TN | $88.49 | — |
| TX | $82.27 | — |
| UT | $88.49 | — |
| VA | $83.82 | — |
| VI | $88.49 | — |
| VT | $88.49 | — |
| WA | $88.49 | — |
| WI | $87.30 | — |
| WV | $87.30 | — |
| WY | $75.22 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $562.92 to $916.06 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $745.35 | — |
| AL | $576.50 | $635.61 |
| AR | $564.25 | $564.25 |
| AZ | $567.07 | $655.81 |
| CA | $562.92 | $655.81 |
| CO | $599.76 | $655.81 |
| CT | $632.06 | $655.81 |
| DC | $579.78 | $655.81 |
| DE | $579.78 | $655.81 |
| FL | $576.50 | $655.81 |
| GA | $576.50 | $655.81 |
| HI | $773.23 | — |
| IA | $595.18 | $655.81 |
| ID | $599.76 | $655.81 |
| IL | $596.54 | $655.81 |
| IN | $564.25 | $564.25 |
| KS | $595.18 | $601.02 |
| KY | $576.50 | $655.81 |
| LA | $564.25 | $564.25 |
| MA | $632.06 | $655.81 |
| MD | $579.78 | $651.89 |
| ME | $632.06 | $655.81 |
| MI | $596.54 | $655.81 |
| MN | $595.18 | $655.81 |
| MO | $595.18 | $601.02 |
| MS | $576.50 | $655.81 |
| MT | $599.76 | $648.42 |
| NC | $576.50 | $655.81 |
| ND | $564.25 | $564.25 |
| NE | $595.18 | $601.02 |
| NH | $632.06 | $655.81 |
| NJ | $579.78 | $655.81 |
| NM | $567.07 | $646.70 |
| NV | $562.92 | $655.81 |
| NY | $579.78 | $655.81 |
| OH | $596.54 | $651.22 |
| OK | $567.07 | $655.81 |
| OR | $562.92 | $655.81 |
| PA | $579.78 | $655.81 |
| PR | $916.06 | — |
| RI | $632.06 | $655.81 |
| SC | $564.25 | $564.25 |
| SD | $564.25 | $564.25 |
| TN | $576.50 | $655.81 |
| TX | $567.07 | $616.92 |
| UT | $599.76 | $655.81 |
| VA | $576.50 | $628.42 |
| VI | $663.82 | — |
| VT | $632.06 | $655.81 |
| WA | $562.92 | $655.81 |
| WI | $596.54 | $651.22 |
| WV | $576.50 | $651.22 |
| WY | $564.25 | $564.25 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $564.25 to $1145.82 depending on state and rural status.
Former-CBA payment limits: ceiling $663.82 · floor $564.25
| State | Non-rural | Rural |
|---|---|---|
| AK | $804.38 | — |
| AL | $635.62 | — |
| AR | $564.25 | — |
| AZ | $663.82 | — |
| CA | $663.82 | — |
| CO | $663.82 | — |
| CT | $663.82 | — |
| DC | $663.82 | — |
| DE | $663.82 | — |
| FL | $663.82 | — |
| GA | $663.82 | — |
| HI | $860.14 | — |
| IA | $663.82 | — |
| ID | $663.82 | — |
| IL | $663.82 | — |
| IN | $564.25 | — |
| KS | $601.02 | — |
| KY | $663.82 | — |
| LA | $564.25 | — |
| MA | $663.82 | — |
| MD | $655.99 | — |
| ME | $663.82 | — |
| MI | $663.82 | — |
| MN | $663.82 | — |
| MO | $601.02 | — |
| MS | $663.82 | — |
| MT | $649.04 | — |
| NC | $663.82 | — |
| ND | $564.25 | — |
| NE | $601.02 | — |
| NH | $663.82 | — |
| NJ | $663.82 | — |
| NM | $646.71 | — |
| NV | $663.82 | — |
| NY | $663.82 | — |
| OH | $654.64 | — |
| OK | $663.82 | — |
| OR | $663.82 | — |
| PA | $663.82 | — |
| PR | $1145.82 | — |
| RI | $663.82 | — |
| SC | $564.25 | — |
| SD | $564.25 | — |
| TN | $663.82 | — |
| TX | $616.95 | — |
| UT | $663.82 | — |
| VA | $628.41 | — |
| VI | $663.82 | — |
| VT | $663.82 | — |
| WA | $663.82 | — |
| WI | $654.64 | — |
| WV | $654.64 | — |
| WY | $564.25 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2626 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.
Common denial codes to watch
Related E-codes
Bill E2626 with confidence
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