E2631 — Wheelchair accessory, addition to mobile arm support, elevating proximal arm
HCPCS Level II E-code · short descriptor: “Elevat proximal arm support”
- 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.
E2631 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $317.30 to $519.25 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $494.32 | — |
| AL | $320.17 | $320.17 |
| AR | $320.17 | $320.17 |
| AZ | $328.70 | $371.14 |
| CA | $317.30 | $371.14 |
| CO | $339.89 | $371.14 |
| CT | $319.59 | $337.09 |
| DC | $340.96 | $371.14 |
| DE | $340.96 | $371.14 |
| FL | $344.90 | $371.14 |
| GA | $344.90 | $371.14 |
| HI | $512.85 | — |
| IA | $317.81 | $371.14 |
| ID | $320.17 | $320.17 |
| IL | $335.19 | $371.14 |
| IN | $335.19 | $371.14 |
| KS | $317.81 | $320.17 |
| KY | $344.90 | $371.14 |
| LA | $344.90 | $371.14 |
| MA | $319.59 | $320.17 |
| MD | $340.96 | $371.14 |
| ME | $319.59 | $320.17 |
| MI | $335.19 | $371.14 |
| MN | $317.81 | $320.17 |
| MO | $317.81 | $320.17 |
| MS | $320.17 | $320.17 |
| MT | $320.17 | $320.17 |
| NC | $344.90 | $371.14 |
| ND | $317.81 | $320.17 |
| NE | $317.81 | $320.17 |
| NH | $319.59 | $371.14 |
| NJ | $340.96 | $371.14 |
| NM | $322.89 | $322.89 |
| NV | $317.30 | $371.14 |
| NY | $340.96 | $371.14 |
| OH | $320.17 | $320.17 |
| OK | $320.17 | $320.17 |
| OR | $317.30 | $320.17 |
| PA | $340.96 | $371.14 |
| PR | $519.25 | — |
| RI | $319.59 | $366.42 |
| SC | $344.90 | $371.14 |
| SD | $317.81 | $320.17 |
| TN | $344.90 | $371.14 |
| TX | $328.70 | $371.14 |
| UT | $339.89 | $371.14 |
| VA | $344.90 | $371.14 |
| VI | $376.67 | — |
| VT | $319.59 | $350.55 |
| WA | $317.30 | $345.58 |
| WI | $335.19 | $371.14 |
| WV | $320.17 | $320.17 |
| WY | $320.17 | $320.17 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $320.19 to $583.32 depending on state and rural status.
Former-CBA payment limits: ceiling $376.69 · floor $320.19
| State | Non-rural | Rural |
|---|---|---|
| AK | $533.46 | — |
| AL | $320.19 | — |
| AR | $320.19 | — |
| AZ | $376.69 | — |
| CA | $376.69 | — |
| CO | $376.69 | — |
| CT | $337.10 | — |
| DC | $376.69 | — |
| DE | $376.69 | — |
| FL | $376.69 | — |
| GA | $376.69 | — |
| HI | $570.51 | — |
| IA | $376.69 | — |
| ID | $320.19 | — |
| IL | $376.69 | — |
| IN | $376.69 | — |
| KS | $320.19 | — |
| KY | $376.69 | — |
| LA | $376.69 | — |
| MA | $320.19 | — |
| MD | $376.69 | — |
| ME | $320.19 | — |
| MI | $376.69 | — |
| MN | $320.19 | — |
| MO | $320.19 | — |
| MS | $320.19 | — |
| MT | $320.19 | — |
| NC | $376.69 | — |
| ND | $320.19 | — |
| NE | $320.19 | — |
| NH | $376.69 | — |
| NJ | $376.69 | — |
| NM | $322.87 | — |
| NV | $376.69 | — |
| NY | $376.69 | — |
| OH | $320.19 | — |
| OK | $320.19 | — |
| OR | $320.19 | — |
| PA | $376.69 | — |
| PR | $583.32 | — |
| RI | $367.24 | — |
| SC | $376.69 | — |
| SD | $320.19 | — |
| TN | $376.69 | — |
| TX | $376.69 | — |
| UT | $376.69 | — |
| VA | $376.69 | — |
| VI | $376.69 | — |
| VT | $350.53 | — |
| WA | $345.58 | — |
| WI | $376.69 | — |
| WV | $320.19 | — |
| WY | $320.19 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $31.73 to $51.93 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $49.44 | — |
| AL | $32.02 | $32.02 |
| AR | $32.02 | $32.02 |
| AZ | $32.87 | $37.12 |
| CA | $31.73 | $37.12 |
| CO | $33.99 | $37.12 |
| CT | $31.96 | $33.72 |
| DC | $34.10 | $37.12 |
| DE | $34.10 | $37.12 |
| FL | $34.49 | $37.12 |
| GA | $34.49 | $37.12 |
| HI | $51.29 | — |
| IA | $31.78 | $37.12 |
| ID | $32.02 | $32.02 |
| IL | $33.52 | $37.12 |
| IN | $33.52 | $37.12 |
| KS | $31.78 | $32.02 |
| KY | $34.49 | $37.12 |
| LA | $34.49 | $37.12 |
| MA | $31.96 | $32.02 |
| MD | $34.10 | $37.12 |
| ME | $31.96 | $32.02 |
| MI | $33.52 | $37.12 |
| MN | $31.78 | $32.02 |
| MO | $31.78 | $32.02 |
| MS | $32.02 | $32.02 |
| MT | $32.02 | $32.02 |
| NC | $34.49 | $37.12 |
| ND | $31.78 | $32.02 |
| NE | $31.78 | $32.02 |
| NH | $31.96 | $37.12 |
| NJ | $34.10 | $37.12 |
| NM | $32.30 | $32.30 |
| NV | $31.73 | $37.12 |
| NY | $34.10 | $37.12 |
| OH | $32.02 | $32.02 |
| OK | $32.02 | $32.02 |
| OR | $31.73 | $32.02 |
| PA | $34.10 | $37.12 |
| PR | $51.93 | — |
| RI | $31.96 | $36.64 |
| SC | $34.49 | $37.12 |
| SD | $31.78 | $32.02 |
| TN | $34.49 | $37.12 |
| TX | $32.87 | $37.12 |
| UT | $33.99 | $37.12 |
| VA | $34.49 | $37.12 |
| VI | $37.67 | — |
| VT | $31.96 | $35.05 |
| WA | $31.73 | $34.55 |
| WI | $33.52 | $37.12 |
| WV | $32.02 | $32.02 |
| WY | $32.02 | $32.02 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $31.99 to $58.35 depending on state and rural status.
Former-CBA payment limits: ceiling $37.64 · floor $31.99
| State | Non-rural | Rural |
|---|---|---|
| AK | $53.35 | — |
| AL | $31.99 | — |
| AR | $31.99 | — |
| AZ | $37.64 | — |
| CA | $37.64 | — |
| CO | $37.64 | — |
| CT | $33.70 | — |
| DC | $37.64 | — |
| DE | $37.64 | — |
| FL | $37.64 | — |
| GA | $37.64 | — |
| HI | $57.04 | — |
| IA | $37.64 | — |
| ID | $31.99 | — |
| IL | $37.64 | — |
| IN | $37.64 | — |
| KS | $31.99 | — |
| KY | $37.64 | — |
| LA | $37.64 | — |
| MA | $31.99 | — |
| MD | $37.64 | — |
| ME | $31.99 | — |
| MI | $37.64 | — |
| MN | $31.99 | — |
| MO | $31.99 | — |
| MS | $31.99 | — |
| MT | $31.99 | — |
| NC | $37.64 | — |
| ND | $31.99 | — |
| NE | $31.99 | — |
| NH | $37.64 | — |
| NJ | $37.64 | — |
| NM | $32.30 | — |
| NV | $37.64 | — |
| NY | $37.64 | — |
| OH | $31.99 | — |
| OK | $31.99 | — |
| OR | $31.99 | — |
| PA | $37.64 | — |
| PR | $58.35 | — |
| RI | $36.73 | — |
| SC | $37.64 | — |
| SD | $31.99 | — |
| TN | $37.64 | — |
| TX | $37.64 | — |
| UT | $37.64 | — |
| VA | $37.64 | — |
| VI | $37.64 | — |
| VT | $35.06 | — |
| WA | $34.56 | — |
| WI | $37.64 | — |
| WV | $31.99 | — |
| WY | $31.99 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $237.98 to $389.45 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $370.76 | — |
| AL | $240.13 | $240.13 |
| AR | $240.13 | $240.13 |
| AZ | $246.53 | $278.35 |
| CA | $237.98 | $278.35 |
| CO | $254.93 | $278.35 |
| CT | $239.70 | $252.81 |
| DC | $255.72 | $278.35 |
| DE | $255.72 | $278.35 |
| FL | $258.68 | $278.35 |
| GA | $258.68 | $278.35 |
| HI | $384.61 | — |
| IA | $238.36 | $278.35 |
| ID | $240.13 | $240.13 |
| IL | $251.39 | $278.35 |
| IN | $251.39 | $278.35 |
| KS | $238.36 | $240.13 |
| KY | $258.68 | $278.35 |
| LA | $258.68 | $278.35 |
| MA | $239.70 | $240.13 |
| MD | $255.72 | $278.35 |
| ME | $239.70 | $240.13 |
| MI | $251.39 | $278.35 |
| MN | $238.36 | $240.13 |
| MO | $238.36 | $240.13 |
| MS | $240.13 | $240.13 |
| MT | $240.13 | $240.13 |
| NC | $258.68 | $278.35 |
| ND | $238.36 | $240.13 |
| NE | $238.36 | $240.13 |
| NH | $239.70 | $278.35 |
| NJ | $255.72 | $278.35 |
| NM | $242.17 | $242.17 |
| NV | $237.98 | $278.35 |
| NY | $255.72 | $278.35 |
| OH | $240.13 | $240.13 |
| OK | $240.13 | $240.13 |
| OR | $237.98 | $240.13 |
| PA | $255.72 | $278.35 |
| PR | $389.45 | — |
| RI | $239.70 | $274.82 |
| SC | $258.68 | $278.35 |
| SD | $238.36 | $240.13 |
| TN | $258.68 | $278.35 |
| TX | $246.53 | $278.35 |
| UT | $254.93 | $278.35 |
| VA | $258.68 | $278.35 |
| VI | $282.50 | — |
| VT | $239.70 | $262.93 |
| WA | $237.98 | $259.23 |
| WI | $251.39 | $278.35 |
| WV | $240.13 | $240.13 |
| WY | $240.13 | $240.13 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $240.12 to $437.52 depending on state and rural status.
Former-CBA payment limits: ceiling $282.49 · floor $240.12
| State | Non-rural | Rural |
|---|---|---|
| AK | $400.12 | — |
| AL | $240.12 | — |
| AR | $240.12 | — |
| AZ | $282.49 | — |
| CA | $282.49 | — |
| CO | $282.49 | — |
| CT | $252.80 | — |
| DC | $282.49 | — |
| DE | $282.49 | — |
| FL | $282.49 | — |
| GA | $282.49 | — |
| HI | $427.82 | — |
| IA | $282.49 | — |
| ID | $240.12 | — |
| IL | $282.49 | — |
| IN | $282.49 | — |
| KS | $240.12 | — |
| KY | $282.49 | — |
| LA | $282.49 | — |
| MA | $240.12 | — |
| MD | $282.49 | — |
| ME | $240.12 | — |
| MI | $282.49 | — |
| MN | $240.12 | — |
| MO | $240.12 | — |
| MS | $240.12 | — |
| MT | $240.12 | — |
| NC | $282.49 | — |
| ND | $240.12 | — |
| NE | $240.12 | — |
| NH | $282.49 | — |
| NJ | $282.49 | — |
| NM | $242.18 | — |
| NV | $282.49 | — |
| NY | $282.49 | — |
| OH | $240.12 | — |
| OK | $240.12 | — |
| OR | $240.12 | — |
| PA | $282.49 | — |
| PR | $437.52 | — |
| RI | $275.43 | — |
| SC | $282.49 | — |
| SD | $240.12 | — |
| TN | $282.49 | — |
| TX | $282.49 | — |
| UT | $282.49 | — |
| VA | $282.49 | — |
| VI | $282.49 | — |
| VT | $262.94 | — |
| WA | $259.23 | — |
| WI | $282.49 | — |
| WV | $240.12 | — |
| WY | $240.12 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2631 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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