E2627 — Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type
HCPCS Level II E-code · short descriptor: “Arm supp att to wc rancho ty”
- 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 2026-10-26; 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.
E2627 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $1160.59 to $2293.32 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $2210.63 | — |
| AL | $1189.35 | $1200.60 |
| AR | $1189.35 | $1200.60 |
| AZ | $1216.08 | $1372.34 |
| CA | $1189.55 | $1372.34 |
| CO | $1276.24 | $1372.34 |
| CT | $1325.65 | $1372.34 |
| DC | $1179.67 | $1372.34 |
| DE | $1179.67 | $1372.34 |
| FL | $1189.35 | $1372.34 |
| GA | $1189.35 | $1372.34 |
| HI | $2293.32 | — |
| IA | $1176.18 | $1372.34 |
| ID | $1276.24 | $1372.34 |
| IL | $1160.59 | $1200.60 |
| IN | $1160.59 | $1200.60 |
| KS | $1176.18 | $1200.60 |
| KY | $1189.35 | $1372.34 |
| LA | $1189.35 | $1200.60 |
| MA | $1325.65 | $1372.34 |
| MD | $1179.67 | $1200.60 |
| ME | $1325.65 | $1372.34 |
| MI | $1160.59 | $1372.34 |
| MN | $1176.18 | $1200.60 |
| MO | $1176.18 | $1200.60 |
| MS | $1189.35 | $1200.60 |
| MT | $1276.24 | $1372.34 |
| NC | $1189.35 | $1372.34 |
| ND | $1176.18 | $1200.60 |
| NE | $1176.18 | $1200.60 |
| NH | $1325.65 | $1372.34 |
| NJ | $1179.67 | $1372.34 |
| NM | $1216.08 | $1372.34 |
| NV | $1189.55 | $1372.34 |
| NY | $1179.67 | $1200.60 |
| OH | $1160.59 | $1200.60 |
| OK | $1216.08 | $1372.34 |
| OR | $1189.55 | $1372.34 |
| PA | $1179.67 | $1372.34 |
| PR | $1509.21 | — |
| RI | $1325.65 | $1372.34 |
| SC | $1189.35 | $1200.60 |
| SD | $1176.18 | $1200.60 |
| TN | $1189.35 | $1372.34 |
| TX | $1216.08 | $1372.34 |
| UT | $1276.24 | $1372.34 |
| VA | $1189.35 | $1200.60 |
| VI | $1200.60 | — |
| VT | $1325.65 | $1372.34 |
| WA | $1189.55 | $1372.34 |
| WI | $1160.59 | $1200.60 |
| WV | $1189.35 | $1200.60 |
| WY | $1200.60 | $1200.60 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $1200.62 to $2551.15 depending on state and rural status.
Former-CBA payment limits: ceiling $1412.49 · floor $1200.62
| State | Non-rural | Rural |
|---|---|---|
| AK | $2385.76 | — |
| AL | $1200.62 | — |
| AR | $1200.62 | — |
| AZ | $1412.49 | — |
| CA | $1412.49 | — |
| CO | $1412.49 | — |
| CT | $1412.49 | — |
| DC | $1412.49 | — |
| DE | $1412.49 | — |
| FL | $1412.49 | — |
| GA | $1412.49 | — |
| HI | $2551.15 | — |
| IA | $1412.49 | — |
| ID | $1412.49 | — |
| IL | $1200.62 | — |
| IN | $1200.62 | — |
| KS | $1200.62 | — |
| KY | $1412.49 | — |
| LA | $1200.62 | — |
| MA | $1412.49 | — |
| MD | $1200.62 | — |
| ME | $1412.49 | — |
| MI | $1412.49 | — |
| MN | $1200.62 | — |
| MO | $1200.62 | — |
| MS | $1200.62 | — |
| MT | $1412.49 | — |
| NC | $1412.49 | — |
| ND | $1200.62 | — |
| NE | $1200.62 | — |
| NH | $1412.49 | — |
| NJ | $1412.49 | — |
| NM | $1412.49 | — |
| NV | $1412.49 | — |
| NY | $1200.62 | — |
| OH | $1200.62 | — |
| OK | $1412.49 | — |
| OR | $1412.49 | — |
| PA | $1412.49 | — |
| PR | $1509.23 | — |
| RI | $1412.49 | — |
| SC | $1200.62 | — |
| SD | $1200.62 | — |
| TN | $1412.49 | — |
| TX | $1412.49 | — |
| UT | $1412.49 | — |
| VA | $1200.62 | — |
| VI | $1200.62 | — |
| VT | $1412.49 | — |
| WA | $1412.49 | — |
| WI | $1200.62 | — |
| WV | $1200.62 | — |
| WY | $1200.62 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $116.06 to $229.33 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $221.07 | — |
| AL | $118.94 | $120.09 |
| AR | $118.94 | $120.09 |
| AZ | $121.61 | $137.25 |
| CA | $118.95 | $137.25 |
| CO | $127.63 | $137.25 |
| CT | $132.56 | $137.25 |
| DC | $117.97 | $137.25 |
| DE | $117.97 | $137.25 |
| FL | $118.94 | $137.25 |
| GA | $118.94 | $137.25 |
| HI | $229.33 | — |
| IA | $117.62 | $137.25 |
| ID | $127.63 | $137.25 |
| IL | $116.06 | $120.09 |
| IN | $116.06 | $120.09 |
| KS | $117.62 | $120.09 |
| KY | $118.94 | $137.25 |
| LA | $118.94 | $120.09 |
| MA | $132.56 | $137.25 |
| MD | $117.97 | $120.09 |
| ME | $132.56 | $137.25 |
| MI | $116.06 | $137.25 |
| MN | $117.62 | $120.09 |
| MO | $117.62 | $120.09 |
| MS | $118.94 | $120.09 |
| MT | $127.63 | $137.25 |
| NC | $118.94 | $137.25 |
| ND | $117.62 | $120.09 |
| NE | $117.62 | $120.09 |
| NH | $132.56 | $137.25 |
| NJ | $117.97 | $137.25 |
| NM | $121.61 | $137.25 |
| NV | $118.95 | $137.25 |
| NY | $117.97 | $120.09 |
| OH | $116.06 | $120.09 |
| OK | $121.61 | $137.25 |
| OR | $118.95 | $137.25 |
| PA | $117.97 | $137.25 |
| PR | $150.95 | — |
| RI | $132.56 | $137.25 |
| SC | $118.94 | $120.09 |
| SD | $117.62 | $120.09 |
| TN | $118.94 | $137.25 |
| TX | $121.61 | $137.25 |
| UT | $127.63 | $137.25 |
| VA | $118.94 | $120.09 |
| VI | $120.09 | — |
| VT | $132.56 | $137.25 |
| WA | $118.95 | $137.25 |
| WI | $116.06 | $120.09 |
| WV | $118.94 | $120.09 |
| WY | $120.09 | $120.09 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $120.11 to $255.14 depending on state and rural status.
Former-CBA payment limits: ceiling $141.30 · floor $120.11
| State | Non-rural | Rural |
|---|---|---|
| AK | $238.59 | — |
| AL | $120.11 | — |
| AR | $120.11 | — |
| AZ | $141.30 | — |
| CA | $141.30 | — |
| CO | $141.30 | — |
| CT | $141.30 | — |
| DC | $141.30 | — |
| DE | $141.30 | — |
| FL | $141.30 | — |
| GA | $141.30 | — |
| HI | $255.14 | — |
| IA | $141.30 | — |
| ID | $141.30 | — |
| IL | $120.11 | — |
| IN | $120.11 | — |
| KS | $120.11 | — |
| KY | $141.30 | — |
| LA | $120.11 | — |
| MA | $141.30 | — |
| MD | $120.11 | — |
| ME | $141.30 | — |
| MI | $141.30 | — |
| MN | $120.11 | — |
| MO | $120.11 | — |
| MS | $120.11 | — |
| MT | $141.30 | — |
| NC | $141.30 | — |
| ND | $120.11 | — |
| NE | $120.11 | — |
| NH | $141.30 | — |
| NJ | $141.30 | — |
| NM | $141.30 | — |
| NV | $141.30 | — |
| NY | $120.11 | — |
| OH | $120.11 | — |
| OK | $141.30 | — |
| OR | $141.30 | — |
| PA | $141.30 | — |
| PR | $150.97 | — |
| RI | $141.30 | — |
| SC | $120.11 | — |
| SD | $120.11 | — |
| TN | $141.30 | — |
| TX | $141.30 | — |
| UT | $141.30 | — |
| VA | $120.11 | — |
| VI | $120.11 | — |
| VT | $141.30 | — |
| WA | $141.30 | — |
| WI | $120.11 | — |
| WV | $120.11 | — |
| WY | $120.11 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $870.44 to $1719.99 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1657.98 | — |
| AL | $892.02 | $900.44 |
| AR | $892.02 | $900.44 |
| AZ | $912.06 | $1029.25 |
| CA | $892.17 | $1029.25 |
| CO | $957.18 | $1029.25 |
| CT | $994.23 | $1029.25 |
| DC | $884.76 | $1029.25 |
| DE | $884.76 | $1029.25 |
| FL | $892.02 | $1029.25 |
| GA | $892.02 | $1029.25 |
| HI | $1719.99 | — |
| IA | $882.13 | $1029.25 |
| ID | $957.18 | $1029.25 |
| IL | $870.44 | $900.44 |
| IN | $870.44 | $900.44 |
| KS | $882.13 | $900.44 |
| KY | $892.02 | $1029.25 |
| LA | $892.02 | $900.44 |
| MA | $994.23 | $1029.25 |
| MD | $884.76 | $900.44 |
| ME | $994.23 | $1029.25 |
| MI | $870.44 | $1029.25 |
| MN | $882.13 | $900.44 |
| MO | $882.13 | $900.44 |
| MS | $892.02 | $900.44 |
| MT | $957.18 | $1029.25 |
| NC | $892.02 | $1029.25 |
| ND | $882.13 | $900.44 |
| NE | $882.13 | $900.44 |
| NH | $994.23 | $1029.25 |
| NJ | $884.76 | $1029.25 |
| NM | $912.06 | $1029.25 |
| NV | $892.17 | $1029.25 |
| NY | $884.76 | $900.44 |
| OH | $870.44 | $900.44 |
| OK | $912.06 | $1029.25 |
| OR | $892.17 | $1029.25 |
| PA | $884.76 | $1029.25 |
| PR | $1131.88 | — |
| RI | $994.23 | $1029.25 |
| SC | $892.02 | $900.44 |
| SD | $882.13 | $900.44 |
| TN | $892.02 | $1029.25 |
| TX | $912.06 | $1029.25 |
| UT | $957.18 | $1029.25 |
| VA | $892.02 | $900.44 |
| VI | $900.44 | — |
| VT | $994.23 | $1029.25 |
| WA | $892.17 | $1029.25 |
| WI | $870.44 | $900.44 |
| WV | $892.02 | $900.44 |
| WY | $900.44 | $900.44 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $900.44 to $1913.34 depending on state and rural status.
Former-CBA payment limits: ceiling $1059.34 · floor $900.44
| State | Non-rural | Rural |
|---|---|---|
| AK | $1789.36 | — |
| AL | $900.44 | — |
| AR | $900.44 | — |
| AZ | $1059.34 | — |
| CA | $1059.34 | — |
| CO | $1059.34 | — |
| CT | $1059.34 | — |
| DC | $1059.34 | — |
| DE | $1059.34 | — |
| FL | $1059.34 | — |
| GA | $1059.34 | — |
| HI | $1913.34 | — |
| IA | $1059.34 | — |
| ID | $1059.34 | — |
| IL | $900.44 | — |
| IN | $900.44 | — |
| KS | $900.44 | — |
| KY | $1059.34 | — |
| LA | $900.44 | — |
| MA | $1059.34 | — |
| MD | $900.44 | — |
| ME | $1059.34 | — |
| MI | $1059.34 | — |
| MN | $900.44 | — |
| MO | $900.44 | — |
| MS | $900.44 | — |
| MT | $1059.34 | — |
| NC | $1059.34 | — |
| ND | $900.44 | — |
| NE | $900.44 | — |
| NH | $1059.34 | — |
| NJ | $1059.34 | — |
| NM | $1059.34 | — |
| NV | $1059.34 | — |
| NY | $900.44 | — |
| OH | $900.44 | — |
| OK | $1059.34 | — |
| OR | $1059.34 | — |
| PA | $1059.34 | — |
| PR | $1131.90 | — |
| RI | $1059.34 | — |
| SC | $900.44 | — |
| SD | $900.44 | — |
| TN | $1059.34 | — |
| TX | $1059.34 | — |
| UT | $1059.34 | — |
| VA | $900.44 | — |
| VI | $900.44 | — |
| VT | $1059.34 | — |
| WA | $1059.34 | — |
| WI | $900.44 | — |
| WV | $900.44 | — |
| WY | $900.44 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2627 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 E2627 with confidence
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