MyMedi-AI

K0019 — Arm pad, replacement only, each

HCPCS Level II K-code · short descriptor: “Arm pad repl, each”

Code system
HCPCS Level II
Family
K — DME MAC temporary codes
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.

K0019 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $14.77 to $25.74 depending on state and rural status.

StateNon-ruralRural
AK$25.74—
AL$15.76$19.50
AR$15.76$19.50
AZ$14.77$19.50
CA$16.06$19.50
CO$17.36$19.50
CT$16.80$19.50
DC$16.36$18.96
DE$16.36$18.96
FL$15.76$18.96
GA$15.76$19.36
HI$25.74—
IA$15.91$19.50
ID$17.36$19.50
IL$16.97$18.96
IN$16.97$19.47
KS$15.91$19.50
KY$15.76$19.47
LA$15.76$19.50
MA$16.80$19.47
MD$16.36$18.96
ME$16.80$19.50
MI$16.97$19.36
MN$15.91$19.50
MO$15.91$19.50
MS$15.76$19.50
MT$17.36$19.50
NC$15.76$19.26
ND$15.91$19.50
NE$15.91$19.50
NH$16.80$18.96
NJ$16.36$18.96
NM$14.77$19.50
NV$16.06$19.50
NY$16.36$18.96
OH$16.97$18.96
OK$14.77$19.48
OR$16.06$19.50
PA$16.36$18.96
PR$22.06—
RI$16.80$18.96
SC$15.76$19.47
SD$15.91$19.50
TN$15.76$19.50
TX$14.77$18.96
UT$17.36$19.50
VA$15.76$18.96
VI$20.05—
VT$16.80$19.36
WA$16.06$19.50
WI$16.97$19.47
WV$15.76$18.96
WY$17.36$19.50

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $20.41 to $28.02 depending on state and rural status.

StateNon-ruralRural
AK$28.02—
AL—$21.03
AR—$21.03
AZ—$21.03
CA—$21.03
CO—$21.03
CT—$21.03
DC—$20.41
DE—$20.41
FL—$20.41
GA—$20.87
HI$28.02—
IA—$21.03
ID—$21.03
IL—$20.41
IN—$21.00
KS—$21.03
KY—$21.00
LA—$21.03
MA—$21.00
MD—$20.41
ME—$21.03
MI—$20.88
MN—$21.03
MO—$21.03
MS—$21.03
MT—$21.03
NC—$20.76
ND—$21.03
NE—$21.03
NH—$20.41
NJ—$20.41
NM—$21.03
NV—$21.03
NY—$20.41
OH—$20.41
OK—$21.02
OR—$21.03
PA—$20.41
PR$23.80—
RI—$20.41
SC—$21.00
SD—$21.03
TN—$21.03
TX—$20.41
UT—$21.03
VA—$20.41
VI$21.50—
VT—$20.87
WA—$21.03
WI—$21.00
WV—$20.41
WY—$21.03

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $20.08 to $31.45 depending on state and rural status.

Former-CBA payment limits: ceiling $21.13 · floor $17.96

StateNon-ruralRural
AK$31.45—
AL$21.13—
AR$21.13—
AZ$21.13—
CA$21.13—
CO$21.13—
CT$21.13—
DC$20.08—
DE$20.08—
FL$20.08—
GA$20.87—
HI$31.45—
IA$21.13—
ID$21.13—
IL$20.08—
IN$21.07—
KS$21.13—
KY$21.06—
LA$21.13—
MA$21.06—
MD$20.08—
ME$21.13—
MI$20.88—
MN$21.13—
MO$21.13—
MS$21.13—
MT$21.13—
NC$20.70—
ND$21.13—
NE$21.13—
NH$20.08—
NJ$20.08—
NM$21.13—
NV$21.13—
NY$20.08—
OH$20.08—
OK$21.11—
OR$21.13—
PA$20.08—
PR$24.09—
RI$20.08—
SC$21.06—
SD$21.13—
TN$21.13—
TX$20.08—
UT$21.13—
VA$20.08—
VI$20.08—
VT$20.87—
WA$21.13—
WI$21.07—
WV$20.08—
WY$21.13—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $1.48 to $2.58 depending on state and rural status.

StateNon-ruralRural
AK$2.58—
AL$1.58$1.95
AR$1.58$1.95
AZ$1.48$1.95
CA$1.61$1.95
CO$1.74$1.95
CT$1.68$1.95
DC$1.64$1.90
DE$1.64$1.90
FL$1.58$1.90
GA$1.58$1.94
HI$2.58—
IA$1.59$1.95
ID$1.74$1.95
IL$1.70$1.90
IN$1.70$1.94
KS$1.59$1.95
KY$1.58$1.94
LA$1.58$1.95
MA$1.68$1.94
MD$1.64$1.90
ME$1.68$1.95
MI$1.70$1.94
MN$1.59$1.95
MO$1.59$1.95
MS$1.58$1.95
MT$1.74$1.95
NC$1.58$1.93
ND$1.59$1.95
NE$1.59$1.95
NH$1.68$1.90
NJ$1.64$1.90
NM$1.48$1.95
NV$1.61$1.95
NY$1.64$1.90
OH$1.70$1.90
OK$1.48$1.94
OR$1.61$1.95
PA$1.64$1.90
PR$2.19—
RI$1.68$1.90
SC$1.58$1.94
SD$1.59$1.95
TN$1.58$1.95
TX$1.48$1.90
UT$1.74$1.95
VA$1.58$1.90
VI$2.01—
VT$1.68$1.94
WA$1.61$1.95
WI$1.70$1.94
WV$1.58$1.90
WY$1.74$1.95

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $2.05 to $2.81 depending on state and rural status.

StateNon-ruralRural
AK$2.81—
AL—$2.10
AR—$2.10
AZ—$2.10
CA—$2.10
CO—$2.10
CT—$2.10
DC—$2.05
DE—$2.05
FL—$2.05
GA—$2.09
HI$2.81—
IA—$2.10
ID—$2.10
IL—$2.05
IN—$2.10
KS—$2.10
KY—$2.10
LA—$2.10
MA—$2.10
MD—$2.05
ME—$2.10
MI—$2.09
MN—$2.10
MO—$2.10
MS—$2.10
MT—$2.10
NC—$2.08
ND—$2.10
NE—$2.10
NH—$2.05
NJ—$2.05
NM—$2.10
NV—$2.10
NY—$2.05
OH—$2.05
OK—$2.10
OR—$2.10
PA—$2.05
PR$2.37—
RI—$2.05
SC—$2.10
SD—$2.10
TN—$2.10
TX—$2.05
UT—$2.10
VA—$2.05
VI$2.15—
VT—$2.09
WA—$2.10
WI—$2.10
WV—$2.05
WY—$2.10

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $2.01 to $3.18 depending on state and rural status.

Former-CBA payment limits: ceiling $2.12 · floor $1.80

StateNon-ruralRural
AK$3.18—
AL$2.12—
AR$2.12—
AZ$2.12—
CA$2.12—
CO$2.12—
CT$2.12—
DC$2.01—
DE$2.01—
FL$2.01—
GA$2.10—
HI$3.18—
IA$2.12—
ID$2.12—
IL$2.01—
IN$2.11—
KS$2.12—
KY$2.11—
LA$2.12—
MA$2.11—
MD$2.01—
ME$2.12—
MI$2.10—
MN$2.12—
MO$2.12—
MS$2.12—
MT$2.12—
NC$2.09—
ND$2.12—
NE$2.12—
NH$2.01—
NJ$2.01—
NM$2.12—
NV$2.12—
NY$2.01—
OH$2.01—
OK$2.11—
OR$2.12—
PA$2.01—
PR$2.38—
RI$2.01—
SC$2.11—
SD$2.12—
TN$2.12—
TX$2.01—
UT$2.12—
VA$2.01—
VI$2.01—
VT$2.10—
WA$2.12—
WI$2.11—
WV$2.01—
WY$2.12—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $11.08 to $19.30 depending on state and rural status.

StateNon-ruralRural
AK$19.30—
AL$11.82$14.63
AR$11.82$14.63
AZ$11.08$14.63
CA$12.05$14.63
CO$13.02$14.63
CT$12.60$14.63
DC$12.27$14.21
DE$12.27$14.21
FL$11.82$14.21
GA$11.82$14.52
HI$19.30—
IA$11.93$14.63
ID$13.02$14.63
IL$12.73$14.21
IN$12.73$14.60
KS$11.93$14.63
KY$11.82$14.60
LA$11.82$14.63
MA$12.60$14.60
MD$12.27$14.21
ME$12.60$14.63
MI$12.73$14.53
MN$11.93$14.63
MO$11.93$14.63
MS$11.82$14.63
MT$13.02$14.63
NC$11.82$14.44
ND$11.93$14.63
NE$11.93$14.63
NH$12.60$14.21
NJ$12.27$14.21
NM$11.08$14.63
NV$12.05$14.63
NY$12.27$14.21
OH$12.73$14.21
OK$11.08$14.62
OR$12.05$14.63
PA$12.27$14.21
PR$16.55—
RI$12.60$14.21
SC$11.82$14.60
SD$11.93$14.63
TN$11.82$14.63
TX$11.08$14.21
UT$13.02$14.63
VA$11.82$14.21
VI$15.03—
VT$12.60$14.52
WA$12.05$14.63
WI$12.73$14.60
WV$11.82$14.21
WY$13.02$14.63

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $15.30 to $21.01 depending on state and rural status.

StateNon-ruralRural
AK$21.01—
AL—$15.78
AR—$15.78
AZ—$15.78
CA—$15.78
CO—$15.78
CT—$15.78
DC—$15.30
DE—$15.30
FL—$15.30
GA—$15.66
HI$21.01—
IA—$15.78
ID—$15.78
IL—$15.30
IN—$15.75
KS—$15.78
KY—$15.75
LA—$15.78
MA—$15.75
MD—$15.30
ME—$15.78
MI—$15.67
MN—$15.78
MO—$15.78
MS—$15.78
MT—$15.78
NC—$15.57
ND—$15.78
NE—$15.78
NH—$15.30
NJ—$15.30
NM—$15.78
NV—$15.78
NY—$15.30
OH—$15.30
OK—$15.77
OR—$15.78
PA—$15.30
PR$17.86—
RI—$15.30
SC—$15.75
SD—$15.78
TN—$15.78
TX—$15.30
UT—$15.78
VA—$15.30
VI$16.12—
VT—$15.66
WA—$15.78
WI—$15.75
WV—$15.30
WY—$15.78

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $15.03 to $23.58 depending on state and rural status.

Former-CBA payment limits: ceiling $15.91 · floor $13.52

StateNon-ruralRural
AK$23.58—
AL$15.91—
AR$15.91—
AZ$15.91—
CA$15.91—
CO$15.91—
CT$15.91—
DC$15.03—
DE$15.03—
FL$15.03—
GA$15.66—
HI$23.58—
IA$15.91—
ID$15.91—
IL$15.03—
IN$15.84—
KS$15.91—
KY$15.83—
LA$15.91—
MA$15.83—
MD$15.03—
ME$15.91—
MI$15.68—
MN$15.91—
MO$15.91—
MS$15.91—
MT$15.91—
NC$15.51—
ND$15.91—
NE$15.91—
NH$15.03—
NJ$15.03—
NM$15.91—
NV$15.91—
NY$15.03—
OH$15.03—
OK$15.89—
OR$15.91—
PA$15.03—
PR$18.09—
RI$15.03—
SC$15.83—
SD$15.91—
TN$15.91—
TX$15.03—
UT$15.91—
VA$15.03—
VI$15.03—
VT$15.66—
WA$15.91—
WI$15.84—
WV$15.03—
WY$15.91—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps K0019 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

CO-50 medical necessityCO-151 frequency/units

Related K-codes

K0001K0002K0003K0004K0005K0006K0007K0008K0009K0010K0011K0012

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