E2633 — Wheelchair accessory, addition to mobile arm support, supinator
HCPCS Level II E-code · short descriptor: “Mobile arm support supinator”
- 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.
E2633 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $167.66 to $296.74 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $197.12 | — |
| AL | $168.05 | $172.68 |
| AR | $168.05 | $172.68 |
| AZ | $172.96 | $196.46 |
| CA | $169.54 | $196.12 |
| CO | $176.43 | $196.46 |
| CT | $184.71 | $196.46 |
| DC | $173.93 | $196.46 |
| DE | $173.93 | $196.46 |
| FL | $168.05 | $194.60 |
| GA | $168.05 | $196.46 |
| HI | $204.23 | — |
| IA | $167.66 | $196.46 |
| ID | $176.43 | $196.46 |
| IL | $171.92 | $196.46 |
| IN | $171.92 | $196.46 |
| KS | $167.66 | $172.68 |
| KY | $168.05 | $190.66 |
| LA | $168.05 | $191.52 |
| MA | $184.71 | $196.46 |
| MD | $173.93 | $196.46 |
| ME | $184.71 | $196.46 |
| MI | $171.92 | $195.23 |
| MN | $167.66 | $172.68 |
| MO | $167.66 | $172.68 |
| MS | $168.05 | $172.68 |
| MT | $172.68 | $172.68 |
| NC | $168.05 | $172.68 |
| ND | $167.66 | $172.68 |
| NE | $167.66 | $172.68 |
| NH | $184.71 | $196.46 |
| NJ | $173.93 | $196.46 |
| NM | $172.96 | $194.24 |
| NV | $169.54 | $196.46 |
| NY | $173.93 | $196.46 |
| OH | $171.92 | $172.68 |
| OK | $172.96 | $196.46 |
| OR | $169.54 | $196.46 |
| PA | $173.93 | $196.46 |
| PR | $296.74 | — |
| RI | $184.71 | $196.46 |
| SC | $168.05 | $193.77 |
| SD | $167.66 | $172.68 |
| TN | $168.05 | $193.77 |
| TX | $172.96 | $196.46 |
| UT | $176.43 | $196.46 |
| VA | $168.05 | $196.46 |
| VI | $196.46 | — |
| VT | $172.68 | $172.68 |
| WA | $169.54 | $196.46 |
| WI | $171.92 | $172.68 |
| WV | $168.05 | $172.68 |
| WY | $172.68 | $172.68 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $172.68 to $403.71 depending on state and rural status.
Former-CBA payment limits: ceiling $203.15 · floor $172.68
| State | Non-rural | Rural |
|---|---|---|
| AK | $204.46 | — |
| AL | $172.68 | — |
| AR | $172.68 | — |
| AZ | $203.15 | — |
| CA | $202.46 | — |
| CO | $203.15 | — |
| CT | $203.15 | — |
| DC | $203.15 | — |
| DE | $203.15 | — |
| FL | $199.42 | — |
| GA | $203.15 | — |
| HI | $218.70 | — |
| IA | $203.15 | — |
| ID | $203.15 | — |
| IL | $203.15 | — |
| IN | $203.15 | — |
| KS | $172.68 | — |
| KY | $191.55 | — |
| LA | $193.28 | — |
| MA | $203.15 | — |
| MD | $203.15 | — |
| ME | $203.15 | — |
| MI | $200.69 | — |
| MN | $172.68 | — |
| MO | $172.68 | — |
| MS | $172.68 | — |
| MT | $172.68 | — |
| NC | $172.68 | — |
| ND | $172.68 | — |
| NE | $172.68 | — |
| NH | $203.15 | — |
| NJ | $203.15 | — |
| NM | $198.71 | — |
| NV | $203.15 | — |
| NY | $203.15 | — |
| OH | $172.68 | — |
| OK | $203.15 | — |
| OR | $203.15 | — |
| PA | $203.15 | — |
| PR | $403.71 | — |
| RI | $203.15 | — |
| SC | $197.75 | — |
| SD | $172.68 | — |
| TN | $197.75 | — |
| TX | $203.15 | — |
| UT | $203.15 | — |
| VA | $203.15 | — |
| VI | $203.15 | — |
| VT | $172.68 | — |
| WA | $203.15 | — |
| WI | $172.68 | — |
| WV | $172.68 | — |
| WY | $172.68 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $16.77 to $29.69 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $19.72 | — |
| AL | $16.80 | $17.28 |
| AR | $16.80 | $17.28 |
| AZ | $17.30 | $19.65 |
| CA | $16.95 | $19.59 |
| CO | $17.64 | $19.65 |
| CT | $18.47 | $19.65 |
| DC | $17.39 | $19.65 |
| DE | $17.39 | $19.65 |
| FL | $16.80 | $19.46 |
| GA | $16.80 | $19.65 |
| HI | $20.42 | — |
| IA | $16.77 | $19.65 |
| ID | $17.64 | $19.65 |
| IL | $17.19 | $19.65 |
| IN | $17.19 | $19.65 |
| KS | $16.77 | $17.28 |
| KY | $16.80 | $19.08 |
| LA | $16.80 | $19.17 |
| MA | $18.47 | $19.65 |
| MD | $17.39 | $19.65 |
| ME | $18.47 | $19.65 |
| MI | $17.19 | $19.52 |
| MN | $16.77 | $17.28 |
| MO | $16.77 | $17.28 |
| MS | $16.80 | $17.28 |
| MT | $17.28 | $17.28 |
| NC | $16.80 | $17.28 |
| ND | $16.77 | $17.28 |
| NE | $16.77 | $17.28 |
| NH | $18.47 | $19.65 |
| NJ | $17.39 | $19.65 |
| NM | $17.30 | $19.43 |
| NV | $16.95 | $19.65 |
| NY | $17.39 | $19.65 |
| OH | $17.19 | $17.28 |
| OK | $17.30 | $19.65 |
| OR | $16.95 | $19.65 |
| PA | $17.39 | $19.65 |
| PR | $29.69 | — |
| RI | $18.47 | $19.65 |
| SC | $16.80 | $19.40 |
| SD | $16.77 | $17.28 |
| TN | $16.80 | $19.40 |
| TX | $17.30 | $19.65 |
| UT | $17.64 | $19.65 |
| VA | $16.80 | $19.65 |
| VI | $19.65 | — |
| VT | $17.28 | $17.28 |
| WA | $16.95 | $19.65 |
| WI | $17.19 | $17.28 |
| WV | $16.80 | $17.28 |
| WY | $17.28 | $17.28 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $17.28 to $40.40 depending on state and rural status.
Former-CBA payment limits: ceiling $20.33 · floor $17.28
| State | Non-rural | Rural |
|---|---|---|
| AK | $20.47 | — |
| AL | $17.28 | — |
| AR | $17.28 | — |
| AZ | $20.33 | — |
| CA | $20.21 | — |
| CO | $20.33 | — |
| CT | $20.33 | — |
| DC | $20.33 | — |
| DE | $20.33 | — |
| FL | $19.93 | — |
| GA | $20.33 | — |
| HI | $21.87 | — |
| IA | $20.33 | — |
| ID | $20.33 | — |
| IL | $20.33 | — |
| IN | $20.33 | — |
| KS | $17.28 | — |
| KY | $19.18 | — |
| LA | $19.38 | — |
| MA | $20.33 | — |
| MD | $20.33 | — |
| ME | $20.33 | — |
| MI | $20.07 | — |
| MN | $17.28 | — |
| MO | $17.28 | — |
| MS | $17.28 | — |
| MT | $17.28 | — |
| NC | $17.28 | — |
| ND | $17.28 | — |
| NE | $17.28 | — |
| NH | $20.33 | — |
| NJ | $20.33 | — |
| NM | $19.89 | — |
| NV | $20.33 | — |
| NY | $20.33 | — |
| OH | $17.28 | — |
| OK | $20.33 | — |
| OR | $20.33 | — |
| PA | $20.33 | — |
| PR | $40.40 | — |
| RI | $20.33 | — |
| SC | $19.83 | — |
| SD | $17.28 | — |
| TN | $19.83 | — |
| TX | $20.33 | — |
| UT | $20.33 | — |
| VA | $20.33 | — |
| VI | $20.33 | — |
| VT | $17.28 | — |
| WA | $20.33 | — |
| WI | $17.28 | — |
| WV | $17.28 | — |
| WY | $17.28 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $125.75 to $222.57 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $147.85 | — |
| AL | $126.04 | $129.51 |
| AR | $126.04 | $129.51 |
| AZ | $129.72 | $147.35 |
| CA | $127.15 | $147.10 |
| CO | $132.33 | $147.35 |
| CT | $138.53 | $147.35 |
| DC | $130.45 | $147.35 |
| DE | $130.45 | $147.35 |
| FL | $126.04 | $145.97 |
| GA | $126.04 | $147.35 |
| HI | $153.17 | — |
| IA | $125.75 | $147.35 |
| ID | $132.33 | $147.35 |
| IL | $128.94 | $147.35 |
| IN | $128.94 | $147.35 |
| KS | $125.75 | $129.51 |
| KY | $126.04 | $143.01 |
| LA | $126.04 | $143.64 |
| MA | $138.53 | $147.35 |
| MD | $130.45 | $147.35 |
| ME | $138.53 | $147.35 |
| MI | $128.94 | $146.43 |
| MN | $125.75 | $129.51 |
| MO | $125.75 | $129.51 |
| MS | $126.04 | $129.51 |
| MT | $129.51 | $129.51 |
| NC | $126.04 | $129.51 |
| ND | $125.75 | $129.51 |
| NE | $125.75 | $129.51 |
| NH | $138.53 | $147.35 |
| NJ | $130.45 | $147.35 |
| NM | $129.72 | $145.70 |
| NV | $127.15 | $147.35 |
| NY | $130.45 | $147.35 |
| OH | $128.94 | $129.51 |
| OK | $129.72 | $147.35 |
| OR | $127.15 | $147.35 |
| PA | $130.45 | $147.35 |
| PR | $222.57 | — |
| RI | $138.53 | $147.35 |
| SC | $126.04 | $145.31 |
| SD | $125.75 | $129.51 |
| TN | $126.04 | $145.31 |
| TX | $129.72 | $147.35 |
| UT | $132.33 | $147.35 |
| VA | $126.04 | $147.35 |
| VI | $147.35 | — |
| VT | $129.51 | $129.51 |
| WA | $127.15 | $147.35 |
| WI | $128.94 | $129.51 |
| WV | $126.04 | $129.51 |
| WY | $129.51 | $129.51 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $129.53 to $302.79 depending on state and rural status.
Former-CBA payment limits: ceiling $152.39 · floor $129.53
| State | Non-rural | Rural |
|---|---|---|
| AK | $153.38 | — |
| AL | $129.53 | — |
| AR | $129.53 | — |
| AZ | $152.39 | — |
| CA | $151.85 | — |
| CO | $152.39 | — |
| CT | $152.39 | — |
| DC | $152.39 | — |
| DE | $152.39 | — |
| FL | $149.59 | — |
| GA | $152.39 | — |
| HI | $164.02 | — |
| IA | $152.39 | — |
| ID | $152.39 | — |
| IL | $152.39 | — |
| IN | $152.39 | — |
| KS | $129.53 | — |
| KY | $143.67 | — |
| LA | $144.96 | — |
| MA | $152.39 | — |
| MD | $152.39 | — |
| ME | $152.39 | — |
| MI | $150.51 | — |
| MN | $129.53 | — |
| MO | $129.53 | — |
| MS | $129.53 | — |
| MT | $129.53 | — |
| NC | $129.53 | — |
| ND | $129.53 | — |
| NE | $129.53 | — |
| NH | $152.39 | — |
| NJ | $152.39 | — |
| NM | $149.06 | — |
| NV | $152.39 | — |
| NY | $152.39 | — |
| OH | $129.53 | — |
| OK | $152.39 | — |
| OR | $152.39 | — |
| PA | $152.39 | — |
| PR | $302.79 | — |
| RI | $152.39 | — |
| SC | $148.30 | — |
| SD | $129.53 | — |
| TN | $148.30 | — |
| TX | $152.39 | — |
| UT | $152.39 | — |
| VA | $152.39 | — |
| VI | $152.39 | — |
| VT | $129.53 | — |
| WA | $152.39 | — |
| WI | $129.53 | — |
| WV | $129.53 | — |
| WY | $129.53 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E2633 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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