E2628 — Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining
HCPCS Level II E-code · short descriptor: “Mobile arm supports reclinin”
- 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.
E2628 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $903.49 to $1215.75 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1171.94 | — |
| AL | $904.46 | $904.46 |
| AR | $929.28 | $1049.44 |
| AZ | $903.49 | $1049.44 |
| CA | $911.32 | $1049.44 |
| CO | $982.35 | $1049.44 |
| CT | $1008.06 | $1049.44 |
| DC | $938.85 | $1049.44 |
| DE | $938.85 | $1049.44 |
| FL | $929.28 | $1049.44 |
| GA | $929.28 | $1049.44 |
| HI | $1215.75 | — |
| IA | $927.22 | $1049.44 |
| ID | $982.35 | $1049.44 |
| IL | $920.41 | $1049.44 |
| IN | $904.46 | $904.46 |
| KS | $904.46 | $904.46 |
| KY | $929.28 | $941.64 |
| LA | $929.28 | $1049.44 |
| MA | $1008.06 | $1049.44 |
| MD | $938.85 | $1041.48 |
| ME | $1008.06 | $1049.44 |
| MI | $920.41 | $1049.44 |
| MN | $927.22 | $1046.05 |
| MO | $904.46 | $904.46 |
| MS | $929.28 | $1049.44 |
| MT | $963.78 | $963.78 |
| NC | $929.28 | $1045.45 |
| ND | $904.46 | $904.46 |
| NE | $904.46 | $904.46 |
| NH | $1008.06 | $1049.44 |
| NJ | $938.85 | $1049.44 |
| NM | $903.49 | $922.88 |
| NV | $911.32 | $1049.44 |
| NY | $938.85 | $1049.44 |
| OH | $904.46 | $904.46 |
| OK | $903.49 | $1049.44 |
| OR | $911.32 | $1049.44 |
| PA | $938.85 | $1049.44 |
| PR | $1196.93 | — |
| RI | $1008.06 | $1049.44 |
| SC | $904.46 | $904.46 |
| SD | $904.46 | $904.46 |
| TN | $929.28 | $1049.44 |
| TX | $903.49 | $938.07 |
| UT | $982.35 | $1049.44 |
| VA | $929.28 | $983.13 |
| VI | $1064.06 | — |
| VT | $1008.06 | $1049.44 |
| WA | $911.32 | $1026.40 |
| WI | $904.46 | $904.46 |
| WV | $904.46 | $904.46 |
| WY | $904.46 | $904.46 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $904.47 to $1352.43 depending on state and rural status.
Former-CBA payment limits: ceiling $1064.08 · floor $904.47
| State | Non-rural | Rural |
|---|---|---|
| AK | $1264.80 | — |
| AL | $904.47 | — |
| AR | $1064.08 | — |
| AZ | $1064.08 | — |
| CA | $1064.08 | — |
| CO | $1064.08 | — |
| CT | $1064.08 | — |
| DC | $1064.08 | — |
| DE | $1064.08 | — |
| FL | $1064.08 | — |
| GA | $1064.08 | — |
| HI | $1352.43 | — |
| IA | $1064.08 | — |
| ID | $1064.08 | — |
| IL | $1064.08 | — |
| IN | $904.47 | — |
| KS | $904.47 | — |
| KY | $941.66 | — |
| LA | $1064.08 | — |
| MA | $1064.08 | — |
| MD | $1048.13 | — |
| ME | $1064.08 | — |
| MI | $1064.08 | — |
| MN | $1057.30 | — |
| MO | $904.47 | — |
| MS | $1064.08 | — |
| MT | $963.79 | — |
| NC | $1056.07 | — |
| ND | $904.47 | — |
| NE | $904.47 | — |
| NH | $1064.08 | — |
| NJ | $1064.08 | — |
| NM | $922.88 | — |
| NV | $1064.08 | — |
| NY | $1064.08 | — |
| OH | $904.47 | — |
| OK | $1064.08 | — |
| OR | $1064.08 | — |
| PA | $1064.08 | — |
| PR | $1314.79 | — |
| RI | $1064.08 | — |
| SC | $904.47 | — |
| SD | $904.47 | — |
| TN | $1064.08 | — |
| TX | $938.08 | — |
| UT | $1064.08 | — |
| VA | $983.15 | — |
| VI | $1064.08 | — |
| VT | $1064.08 | — |
| WA | $1026.39 | — |
| WI | $904.47 | — |
| WV | $904.47 | — |
| WY | $904.47 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $90.35 to $121.56 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $117.20 | — |
| AL | $90.44 | $90.44 |
| AR | $92.93 | $104.94 |
| AZ | $90.35 | $104.94 |
| CA | $91.13 | $104.94 |
| CO | $98.24 | $104.94 |
| CT | $100.81 | $104.94 |
| DC | $93.89 | $104.94 |
| DE | $93.89 | $104.94 |
| FL | $92.93 | $104.94 |
| GA | $92.93 | $104.94 |
| HI | $121.56 | — |
| IA | $92.72 | $104.94 |
| ID | $98.24 | $104.94 |
| IL | $92.04 | $104.94 |
| IN | $90.44 | $90.44 |
| KS | $90.44 | $90.44 |
| KY | $92.93 | $94.17 |
| LA | $92.93 | $104.94 |
| MA | $100.81 | $104.94 |
| MD | $93.89 | $104.15 |
| ME | $100.81 | $104.94 |
| MI | $92.04 | $104.94 |
| MN | $92.72 | $104.61 |
| MO | $90.44 | $90.44 |
| MS | $92.93 | $104.94 |
| MT | $96.41 | $96.41 |
| NC | $92.93 | $104.56 |
| ND | $90.44 | $90.44 |
| NE | $90.44 | $90.44 |
| NH | $100.81 | $104.94 |
| NJ | $93.89 | $104.94 |
| NM | $90.35 | $92.28 |
| NV | $91.13 | $104.94 |
| NY | $93.89 | $104.94 |
| OH | $90.44 | $90.44 |
| OK | $90.35 | $104.94 |
| OR | $91.13 | $104.94 |
| PA | $93.89 | $104.94 |
| PR | $119.69 | — |
| RI | $100.81 | $104.94 |
| SC | $90.44 | $90.44 |
| SD | $90.44 | $90.44 |
| TN | $92.93 | $104.94 |
| TX | $90.35 | $93.81 |
| UT | $98.24 | $104.94 |
| VA | $92.93 | $98.31 |
| VI | $106.40 | — |
| VT | $100.81 | $104.94 |
| WA | $91.13 | $102.63 |
| WI | $90.44 | $90.44 |
| WV | $90.44 | $90.44 |
| WY | $90.44 | $90.44 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $90.43 to $135.21 depending on state and rural status.
Former-CBA payment limits: ceiling $106.39 · floor $90.43
| State | Non-rural | Rural |
|---|---|---|
| AK | $126.52 | — |
| AL | $90.43 | — |
| AR | $106.39 | — |
| AZ | $106.39 | — |
| CA | $106.39 | — |
| CO | $106.39 | — |
| CT | $106.39 | — |
| DC | $106.39 | — |
| DE | $106.39 | — |
| FL | $106.39 | — |
| GA | $106.39 | — |
| HI | $135.21 | — |
| IA | $106.39 | — |
| ID | $106.39 | — |
| IL | $106.39 | — |
| IN | $90.43 | — |
| KS | $90.43 | — |
| KY | $94.15 | — |
| LA | $106.39 | — |
| MA | $106.39 | — |
| MD | $104.82 | — |
| ME | $106.39 | — |
| MI | $106.39 | — |
| MN | $105.73 | — |
| MO | $90.43 | — |
| MS | $106.39 | — |
| MT | $96.42 | — |
| NC | $105.64 | — |
| ND | $90.43 | — |
| NE | $90.43 | — |
| NH | $106.39 | — |
| NJ | $106.39 | — |
| NM | $92.27 | — |
| NV | $106.39 | — |
| NY | $106.39 | — |
| OH | $90.43 | — |
| OK | $106.39 | — |
| OR | $106.39 | — |
| PA | $106.39 | — |
| PR | $131.47 | — |
| RI | $106.39 | — |
| SC | $90.43 | — |
| SD | $90.43 | — |
| TN | $106.39 | — |
| TX | $93.82 | — |
| UT | $106.39 | — |
| VA | $98.29 | — |
| VI | $106.39 | — |
| VT | $106.39 | — |
| WA | $102.64 | — |
| WI | $90.43 | — |
| WV | $90.43 | — |
| WY | $90.43 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $677.62 to $911.82 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $878.95 | — |
| AL | $678.34 | $678.34 |
| AR | $696.96 | $787.08 |
| AZ | $677.62 | $787.08 |
| CA | $683.49 | $787.08 |
| CO | $736.76 | $787.08 |
| CT | $756.05 | $787.08 |
| DC | $704.14 | $787.08 |
| DE | $704.14 | $787.08 |
| FL | $696.96 | $787.08 |
| GA | $696.96 | $787.08 |
| HI | $911.82 | — |
| IA | $695.41 | $787.08 |
| ID | $736.76 | $787.08 |
| IL | $690.31 | $787.08 |
| IN | $678.34 | $678.34 |
| KS | $678.34 | $678.34 |
| KY | $696.96 | $706.23 |
| LA | $696.96 | $787.08 |
| MA | $756.05 | $787.08 |
| MD | $704.14 | $781.11 |
| ME | $756.05 | $787.08 |
| MI | $690.31 | $787.08 |
| MN | $695.41 | $784.55 |
| MO | $678.34 | $678.34 |
| MS | $696.96 | $787.08 |
| MT | $722.83 | $722.83 |
| NC | $696.96 | $784.10 |
| ND | $678.34 | $678.34 |
| NE | $678.34 | $678.34 |
| NH | $756.05 | $787.08 |
| NJ | $704.14 | $787.08 |
| NM | $677.62 | $692.17 |
| NV | $683.49 | $787.08 |
| NY | $704.14 | $787.08 |
| OH | $678.34 | $678.34 |
| OK | $677.62 | $787.08 |
| OR | $683.49 | $787.08 |
| PA | $704.14 | $787.08 |
| PR | $897.70 | — |
| RI | $756.05 | $787.08 |
| SC | $678.34 | $678.34 |
| SD | $678.34 | $678.34 |
| TN | $696.96 | $787.08 |
| TX | $677.62 | $703.57 |
| UT | $736.76 | $787.08 |
| VA | $696.96 | $737.33 |
| VI | $798.04 | — |
| VT | $756.05 | $787.08 |
| WA | $683.49 | $769.80 |
| WI | $678.34 | $678.34 |
| WV | $678.34 | $678.34 |
| WY | $678.34 | $678.34 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $678.33 to $1014.34 depending on state and rural status.
Former-CBA payment limits: ceiling $798.04 · floor $678.33
| State | Non-rural | Rural |
|---|---|---|
| AK | $948.59 | — |
| AL | $678.33 | — |
| AR | $798.04 | — |
| AZ | $798.04 | — |
| CA | $798.04 | — |
| CO | $798.04 | — |
| CT | $798.04 | — |
| DC | $798.04 | — |
| DE | $798.04 | — |
| FL | $798.04 | — |
| GA | $798.04 | — |
| HI | $1014.34 | — |
| IA | $798.04 | — |
| ID | $798.04 | — |
| IL | $798.04 | — |
| IN | $678.33 | — |
| KS | $678.33 | — |
| KY | $706.24 | — |
| LA | $798.04 | — |
| MA | $798.04 | — |
| MD | $786.10 | — |
| ME | $798.04 | — |
| MI | $798.04 | — |
| MN | $792.99 | — |
| MO | $678.33 | — |
| MS | $798.04 | — |
| MT | $722.85 | — |
| NC | $792.10 | — |
| ND | $678.33 | — |
| NE | $678.33 | — |
| NH | $798.04 | — |
| NJ | $798.04 | — |
| NM | $692.16 | — |
| NV | $798.04 | — |
| NY | $798.04 | — |
| OH | $678.33 | — |
| OK | $798.04 | — |
| OR | $798.04 | — |
| PA | $798.04 | — |
| PR | $986.09 | — |
| RI | $798.04 | — |
| SC | $678.33 | — |
| SD | $678.33 | — |
| TN | $798.04 | — |
| TX | $703.60 | — |
| UT | $798.04 | — |
| VA | $737.32 | — |
| VI | $798.04 | — |
| VT | $798.04 | — |
| WA | $769.80 | — |
| WI | $678.33 | — |
| WV | $678.33 | — |
| WY | $678.33 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2628 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 E2628 with confidence
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