E2629 — Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)
HCPCS Level II E-code · short descriptor: “Friction dampening arm supp”
- 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.
E2629 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $1143.01 to $1492.97 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1376.43 | — |
| AL | $1144.57 | $1144.57 |
| AR | $1173.01 | $1323.67 |
| AZ | $1175.48 | $1323.67 |
| CA | $1164.06 | $1323.67 |
| CO | $1143.01 | $1144.57 |
| CT | $1230.62 | $1323.67 |
| DC | $1193.19 | $1323.67 |
| DE | $1193.19 | $1323.67 |
| FL | $1173.01 | $1323.67 |
| GA | $1173.01 | $1323.67 |
| HI | $1426.74 | — |
| IA | $1162.19 | $1307.78 |
| ID | $1143.01 | $1323.67 |
| IL | $1223.28 | $1323.67 |
| IN | $1223.28 | $1299.43 |
| KS | $1144.57 | $1144.57 |
| KY | $1173.01 | $1304.82 |
| LA | $1173.01 | $1323.67 |
| MA | $1224.13 | $1224.13 |
| MD | $1193.19 | $1323.67 |
| ME | $1230.62 | $1285.33 |
| MI | $1144.57 | $1144.57 |
| MN | $1162.19 | $1303.79 |
| MO | $1144.57 | $1144.57 |
| MS | $1173.01 | $1323.67 |
| MT | $1143.01 | $1205.29 |
| NC | $1173.01 | $1323.67 |
| ND | $1144.57 | $1144.57 |
| NE | $1144.57 | $1144.57 |
| NH | $1230.62 | $1323.67 |
| NJ | $1193.19 | $1323.67 |
| NM | $1175.48 | $1247.77 |
| NV | $1164.06 | $1323.67 |
| NY | $1193.19 | $1323.67 |
| OH | $1223.28 | $1323.67 |
| OK | $1175.48 | $1299.43 |
| OR | $1164.06 | $1323.67 |
| PA | $1193.19 | $1323.67 |
| PR | $1492.97 | — |
| RI | $1230.62 | $1323.67 |
| SC | $1144.57 | $1144.57 |
| SD | $1144.57 | $1144.57 |
| TN | $1173.01 | $1323.67 |
| TX | $1175.48 | $1257.18 |
| UT | $1143.01 | $1144.57 |
| VA | $1173.01 | $1296.15 |
| VI | $1323.67 | — |
| VT | $1230.62 | $1323.67 |
| WA | $1164.06 | $1323.67 |
| WI | $1223.28 | $1299.43 |
| WV | $1173.01 | $1323.67 |
| WY | $1143.01 | $1144.57 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $1144.58 to $1685.17 depending on state and rural status.
Former-CBA payment limits: ceiling $1346.56 · floor $1144.58
| State | Non-rural | Rural |
|---|---|---|
| AK | $1452.10 | — |
| AL | $1144.58 | — |
| AR | $1346.56 | — |
| AZ | $1346.56 | — |
| CA | $1346.56 | — |
| CO | $1144.58 | — |
| CT | $1346.56 | — |
| DC | $1346.56 | — |
| DE | $1346.56 | — |
| FL | $1346.56 | — |
| GA | $1346.56 | — |
| HI | $1552.71 | — |
| IA | $1314.79 | — |
| ID | $1346.56 | — |
| IL | $1346.56 | — |
| IN | $1299.45 | — |
| KS | $1144.58 | — |
| KY | $1308.85 | — |
| LA | $1346.56 | — |
| MA | $1224.15 | — |
| MD | $1346.56 | — |
| ME | $1285.35 | — |
| MI | $1144.58 | — |
| MN | $1306.83 | — |
| MO | $1144.58 | — |
| MS | $1346.56 | — |
| MT | $1205.30 | — |
| NC | $1346.56 | — |
| ND | $1144.58 | — |
| NE | $1144.58 | — |
| NH | $1346.56 | — |
| NJ | $1346.56 | — |
| NM | $1247.76 | — |
| NV | $1346.56 | — |
| NY | $1346.56 | — |
| OH | $1346.56 | — |
| OK | $1299.45 | — |
| OR | $1346.56 | — |
| PA | $1346.56 | — |
| PR | $1685.17 | — |
| RI | $1346.56 | — |
| SC | $1144.58 | — |
| SD | $1144.58 | — |
| TN | $1346.56 | — |
| TX | $1257.18 | — |
| UT | $1144.58 | — |
| VA | $1296.13 | — |
| VI | $1346.56 | — |
| VT | $1346.56 | — |
| WA | $1346.56 | — |
| WI | $1299.45 | — |
| WV | $1346.56 | — |
| WY | $1144.58 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $114.30 to $149.31 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $137.63 | — |
| AL | $114.44 | $114.44 |
| AR | $117.30 | $132.36 |
| AZ | $117.55 | $132.36 |
| CA | $116.41 | $132.36 |
| CO | $114.30 | $114.44 |
| CT | $123.06 | $132.36 |
| DC | $119.32 | $132.36 |
| DE | $119.32 | $132.36 |
| FL | $117.30 | $132.36 |
| GA | $117.30 | $132.36 |
| HI | $142.69 | — |
| IA | $116.22 | $130.77 |
| ID | $114.30 | $132.36 |
| IL | $122.33 | $132.36 |
| IN | $122.33 | $129.94 |
| KS | $114.44 | $114.44 |
| KY | $117.30 | $130.48 |
| LA | $117.30 | $132.36 |
| MA | $122.40 | $122.40 |
| MD | $119.32 | $132.36 |
| ME | $123.06 | $128.52 |
| MI | $114.44 | $114.44 |
| MN | $116.22 | $130.38 |
| MO | $114.44 | $114.44 |
| MS | $117.30 | $132.36 |
| MT | $114.30 | $120.58 |
| NC | $117.30 | $132.36 |
| ND | $114.44 | $114.44 |
| NE | $114.44 | $114.44 |
| NH | $123.06 | $132.36 |
| NJ | $119.32 | $132.36 |
| NM | $117.55 | $124.78 |
| NV | $116.41 | $132.36 |
| NY | $119.32 | $132.36 |
| OH | $122.33 | $132.36 |
| OK | $117.55 | $129.94 |
| OR | $116.41 | $132.36 |
| PA | $119.32 | $132.36 |
| PR | $149.31 | — |
| RI | $123.06 | $132.36 |
| SC | $114.44 | $114.44 |
| SD | $114.44 | $114.44 |
| TN | $117.30 | $132.36 |
| TX | $117.55 | $125.71 |
| UT | $114.30 | $114.44 |
| VA | $117.30 | $129.60 |
| VI | $132.36 | — |
| VT | $123.06 | $132.36 |
| WA | $116.41 | $132.36 |
| WI | $122.33 | $129.94 |
| WV | $117.30 | $132.36 |
| WY | $114.30 | $114.44 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $114.45 to $168.53 depending on state and rural status.
Former-CBA payment limits: ceiling $134.65 · floor $114.45
| State | Non-rural | Rural |
|---|---|---|
| AK | $145.22 | — |
| AL | $114.45 | — |
| AR | $134.65 | — |
| AZ | $134.65 | — |
| CA | $134.65 | — |
| CO | $114.45 | — |
| CT | $134.65 | — |
| DC | $134.65 | — |
| DE | $134.65 | — |
| FL | $134.65 | — |
| GA | $134.65 | — |
| HI | $155.30 | — |
| IA | $131.47 | — |
| ID | $134.65 | — |
| IL | $134.65 | — |
| IN | $129.94 | — |
| KS | $114.45 | — |
| KY | $130.88 | — |
| LA | $134.65 | — |
| MA | $122.39 | — |
| MD | $134.65 | — |
| ME | $128.51 | — |
| MI | $114.45 | — |
| MN | $130.66 | — |
| MO | $114.45 | — |
| MS | $134.65 | — |
| MT | $120.58 | — |
| NC | $134.65 | — |
| ND | $114.45 | — |
| NE | $114.45 | — |
| NH | $134.65 | — |
| NJ | $134.65 | — |
| NM | $124.79 | — |
| NV | $134.65 | — |
| NY | $134.65 | — |
| OH | $134.65 | — |
| OK | $129.94 | — |
| OR | $134.65 | — |
| PA | $134.65 | — |
| PR | $168.53 | — |
| RI | $134.65 | — |
| SC | $114.45 | — |
| SD | $114.45 | — |
| TN | $134.65 | — |
| TX | $125.70 | — |
| UT | $114.45 | — |
| VA | $129.59 | — |
| VI | $134.65 | — |
| VT | $134.65 | — |
| WA | $134.65 | — |
| WI | $129.94 | — |
| WV | $134.65 | — |
| WY | $114.45 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $857.25 to $1119.72 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1032.31 | — |
| AL | $858.43 | $858.43 |
| AR | $879.76 | $992.75 |
| AZ | $881.61 | $992.75 |
| CA | $873.05 | $992.75 |
| CO | $857.25 | $858.43 |
| CT | $922.97 | $992.75 |
| DC | $894.90 | $992.75 |
| DE | $894.90 | $992.75 |
| FL | $879.76 | $992.75 |
| GA | $879.76 | $992.75 |
| HI | $1070.06 | — |
| IA | $871.65 | $980.83 |
| ID | $857.25 | $992.75 |
| IL | $917.47 | $992.75 |
| IN | $917.47 | $974.59 |
| KS | $858.43 | $858.43 |
| KY | $879.76 | $978.61 |
| LA | $879.76 | $992.75 |
| MA | $918.11 | $918.11 |
| MD | $894.90 | $992.75 |
| ME | $922.97 | $963.96 |
| MI | $858.43 | $858.43 |
| MN | $871.65 | $977.84 |
| MO | $858.43 | $858.43 |
| MS | $879.76 | $992.75 |
| MT | $857.25 | $903.97 |
| NC | $879.76 | $992.75 |
| ND | $858.43 | $858.43 |
| NE | $858.43 | $858.43 |
| NH | $922.97 | $992.75 |
| NJ | $894.90 | $992.75 |
| NM | $881.61 | $935.81 |
| NV | $873.05 | $992.75 |
| NY | $894.90 | $992.75 |
| OH | $917.47 | $992.75 |
| OK | $881.61 | $974.59 |
| OR | $873.05 | $992.75 |
| PA | $894.90 | $992.75 |
| PR | $1119.72 | — |
| RI | $922.97 | $992.75 |
| SC | $858.43 | $858.43 |
| SD | $858.43 | $858.43 |
| TN | $879.76 | $992.75 |
| TX | $881.61 | $942.90 |
| UT | $857.25 | $858.43 |
| VA | $879.76 | $972.06 |
| VI | $992.75 | — |
| VT | $922.97 | $992.75 |
| WA | $873.05 | $992.75 |
| WI | $917.47 | $974.59 |
| WV | $879.76 | $992.75 |
| WY | $857.25 | $858.43 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $858.42 to $1263.85 depending on state and rural status.
Former-CBA payment limits: ceiling $1009.91 · floor $858.42
| State | Non-rural | Rural |
|---|---|---|
| AK | $1089.04 | — |
| AL | $858.42 | — |
| AR | $1009.91 | — |
| AZ | $1009.91 | — |
| CA | $1009.91 | — |
| CO | $858.42 | — |
| CT | $1009.91 | — |
| DC | $1009.91 | — |
| DE | $1009.91 | — |
| FL | $1009.91 | — |
| GA | $1009.91 | — |
| HI | $1164.52 | — |
| IA | $986.09 | — |
| ID | $1009.91 | — |
| IL | $1009.91 | — |
| IN | $974.59 | — |
| KS | $858.42 | — |
| KY | $981.63 | — |
| LA | $1009.91 | — |
| MA | $918.14 | — |
| MD | $1009.91 | — |
| ME | $963.97 | — |
| MI | $858.42 | — |
| MN | $980.11 | — |
| MO | $858.42 | — |
| MS | $1009.91 | — |
| MT | $903.96 | — |
| NC | $1009.91 | — |
| ND | $858.42 | — |
| NE | $858.42 | — |
| NH | $1009.91 | — |
| NJ | $1009.91 | — |
| NM | $935.80 | — |
| NV | $1009.91 | — |
| NY | $1009.91 | — |
| OH | $1009.91 | — |
| OK | $974.59 | — |
| OR | $1009.91 | — |
| PA | $1009.91 | — |
| PR | $1263.85 | — |
| RI | $1009.91 | — |
| SC | $858.42 | — |
| SD | $858.42 | — |
| TN | $1009.91 | — |
| TX | $942.92 | — |
| UT | $858.42 | — |
| VA | $972.06 | — |
| VI | $1009.91 | — |
| VT | $1009.91 | — |
| WA | $1009.91 | — |
| WI | $974.59 | — |
| WV | $1009.91 | — |
| WY | $858.42 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2629 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
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