MyMedi-AI

K0020 — Fixed, adjustable height armrest, pair

HCPCS Level II K-code · short descriptor: “Fixed adjust armrest pair”

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
1
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.

K0020 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $56.11 to $63.14 depending on state and rural status.

StateNon-ruralRural
AK$56.11—
AL$57.07$57.07
AR$57.07$57.07
AZ$56.11$56.11
CA$56.11$56.11
CO$57.07$57.07
CT$57.07$57.07
DC$57.07$57.07
DE$57.07$57.07
FL$57.07$57.07
GA$57.07$57.07
HI$56.11—
IA$56.11$56.11
ID$56.11$56.11
IL$57.07$57.07
IN$57.07$57.07
KS$56.11$56.11
KY$57.07$57.07
LA$57.07$57.07
MA$57.07$57.07
MD$57.07$57.07
ME$57.07$57.07
MI$57.07$57.07
MN$57.07$57.07
MO$57.07$57.07
MS$57.07$57.07
MT$56.11$56.11
NC$57.07$57.07
ND$56.11$56.11
NE$56.11$56.11
NH$57.07$57.07
NJ$57.07$57.07
NM$57.07$57.07
NV$56.11$56.11
NY$57.07$57.07
OH$57.07$57.07
OK$57.07$57.07
OR$56.11$56.11
PA$57.07$57.07
PR$63.14—
RI$57.07$57.07
SC$57.07$57.07
SD$56.11$56.11
TN$57.07$57.07
TX$57.07$57.07
UT$57.07$57.07
VA$57.07$57.07
VI$57.07—
VT$57.07$57.07
WA$57.07$57.07
WI$57.07$57.07
WV$57.07$57.07
WY$56.11$56.11

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $60.53 to $68.10 depending on state and rural status.

StateNon-ruralRural
AK$61.02—
AL—$61.57
AR—$61.57
AZ—$60.53
CA—$60.53
CO—$61.57
CT—$61.57
DC—$61.57
DE—$61.57
FL—$61.57
GA—$61.57
HI$61.02—
IA—$60.53
ID—$60.53
IL—$61.57
IN—$61.57
KS—$60.53
KY—$61.57
LA—$61.57
MA—$61.57
MD—$61.57
ME—$61.57
MI—$61.57
MN—$61.57
MO—$61.57
MS—$61.57
MT—$60.53
NC—$61.57
ND—$60.53
NE—$60.53
NH—$61.57
NJ—$61.57
NM—$61.57
NV—$60.53
NY—$61.57
OH—$61.57
OK—$61.57
OR—$60.53
PA—$61.57
PR$68.10—
RI—$61.57
SC—$61.57
SD—$60.53
TN—$61.57
TX—$61.57
UT—$61.57
VA—$61.57
VI$61.58—
VT—$61.57
WA—$61.57
WI—$61.57
WV—$61.57
WY—$60.53

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $56.11 to $68.46 depending on state and rural status.

Former-CBA payment limits: ceiling $57.06 · floor $48.50

StateNon-ruralRural
AK$56.11—
AL$57.06—
AR$57.06—
AZ$56.11—
CA$56.11—
CO$57.06—
CT$57.06—
DC$57.06—
DE$57.06—
FL$57.06—
GA$57.06—
HI$56.11—
IA$56.11—
ID$56.11—
IL$57.06—
IN$57.06—
KS$56.11—
KY$57.06—
LA$57.06—
MA$57.06—
MD$57.06—
ME$57.06—
MI$57.06—
MN$57.06—
MO$57.06—
MS$57.06—
MT$56.11—
NC$57.06—
ND$56.11—
NE$56.11—
NH$57.06—
NJ$57.06—
NM$57.06—
NV$56.11—
NY$57.06—
OH$57.06—
OK$57.06—
OR$56.11—
PA$57.06—
PR$68.46—
RI$57.06—
SC$57.06—
SD$56.11—
TN$57.06—
TX$57.06—
UT$57.06—
VA$57.06—
VI$57.06—
VT$57.06—
WA$57.06—
WI$57.06—
WV$57.06—
WY$56.11—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $5.11 to $6.30 depending on state and rural status.

StateNon-ruralRural
AK$5.61—
AL$5.71$5.71
AR$5.71$5.71
AZ$5.61$5.61
CA$5.61$5.61
CO$5.71$5.71
CT$5.71$5.71
DC$5.71$5.71
DE$5.71$5.71
FL$5.71$5.71
GA$5.71$5.71
HI$5.61—
IA$5.61$5.61
ID$5.61$5.61
IL$5.71$5.71
IN$5.71$5.71
KS$5.61$5.61
KY$5.71$5.71
LA$5.71$5.71
MA$5.71$5.71
MD$5.71$5.71
ME$5.71$5.71
MI$5.71$5.71
MN$5.71$5.71
MO$5.71$5.71
MS$5.71$5.71
MT$5.61$5.61
NC$5.71$5.71
ND$5.61$5.61
NE$5.61$5.61
NH$5.71$5.71
NJ$5.71$5.71
NM$5.71$5.71
NV$5.61$5.61
NY$5.71$5.71
OH$5.71$5.71
OK$5.71$5.71
OR$5.61$5.61
PA$5.71$5.71
PR$6.30—
RI$5.71$5.71
SC$5.71$5.71
SD$5.61$5.61
TN$5.71$5.71
TX$5.71$5.71
UT$5.11$5.11
VA$5.71$5.71
VI$5.71—
VT$5.71$5.71
WA$5.71$5.71
WI$5.71$5.71
WV$5.71$5.71
WY$5.61$5.61

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $5.51 to $6.79 depending on state and rural status.

StateNon-ruralRural
AK$6.10—
AL—$6.16
AR—$6.16
AZ—$6.05
CA—$6.05
CO—$6.16
CT—$6.16
DC—$6.16
DE—$6.16
FL—$6.16
GA—$6.16
HI$6.10—
IA—$6.05
ID—$6.05
IL—$6.16
IN—$6.16
KS—$6.05
KY—$6.16
LA—$6.16
MA—$6.16
MD—$6.16
ME—$6.16
MI—$6.16
MN—$6.16
MO—$6.16
MS—$6.16
MT—$6.05
NC—$6.16
ND—$6.05
NE—$6.05
NH—$6.16
NJ—$6.16
NM—$6.16
NV—$6.05
NY—$6.16
OH—$6.16
OK—$6.16
OR—$6.05
PA—$6.16
PR$6.79—
RI—$6.16
SC—$6.16
SD—$6.05
TN—$6.16
TX—$6.16
UT—$5.51
VA—$6.16
VI$6.16—
VT—$6.16
WA—$6.16
WI—$6.16
WV—$6.16
WY—$6.05

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $5.10 to $6.82 depending on state and rural status.

Former-CBA payment limits: ceiling $5.71 · floor $4.85

StateNon-ruralRural
AK$5.61—
AL$5.71—
AR$5.71—
AZ$5.61—
CA$5.61—
CO$5.71—
CT$5.71—
DC$5.71—
DE$5.71—
FL$5.71—
GA$5.71—
HI$5.61—
IA$5.61—
ID$5.61—
IL$5.71—
IN$5.71—
KS$5.61—
KY$5.71—
LA$5.71—
MA$5.71—
MD$5.71—
ME$5.71—
MI$5.71—
MN$5.71—
MO$5.71—
MS$5.71—
MT$5.61—
NC$5.71—
ND$5.61—
NE$5.61—
NH$5.71—
NJ$5.71—
NM$5.71—
NV$5.61—
NY$5.71—
OH$5.71—
OK$5.71—
OR$5.61—
PA$5.71—
PR$6.82—
RI$5.71—
SC$5.71—
SD$5.61—
TN$5.71—
TX$5.71—
UT$5.10—
VA$5.71—
VI$5.71—
VT$5.71—
WA$5.71—
WI$5.71—
WV$5.71—
WY$5.61—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $42.08 to $47.38 depending on state and rural status.

StateNon-ruralRural
AK$42.08—
AL$42.79$42.79
AR$42.79$42.79
AZ$42.08$42.08
CA$42.08$42.08
CO$42.79$42.79
CT$42.79$42.79
DC$42.79$42.79
DE$42.79$42.79
FL$42.79$42.79
GA$42.79$42.79
HI$42.08—
IA$42.08$42.08
ID$42.08$42.08
IL$42.79$42.79
IN$42.79$42.79
KS$42.08$42.08
KY$42.79$42.79
LA$42.79$42.79
MA$42.79$42.79
MD$42.79$42.79
ME$42.79$42.79
MI$42.79$42.79
MN$42.79$42.79
MO$42.79$42.79
MS$42.79$42.79
MT$42.08$42.08
NC$42.79$42.79
ND$42.08$42.08
NE$42.08$42.08
NH$42.79$42.79
NJ$42.79$42.79
NM$42.79$42.79
NV$42.08$42.08
NY$42.79$42.79
OH$42.79$42.79
OK$42.79$42.79
OR$42.08$42.08
PA$42.79$42.79
PR$47.38—
RI$42.79$42.79
SC$42.79$42.79
SD$42.08$42.08
TN$42.79$42.79
TX$42.79$42.79
UT$42.79$42.79
VA$42.79$42.79
VI$42.79—
VT$42.79$42.79
WA$42.79$42.79
WI$42.79$42.79
WV$42.79$42.79
WY$42.08$42.08

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $45.39 to $51.10 depending on state and rural status.

StateNon-ruralRural
AK$45.77—
AL—$46.17
AR—$46.17
AZ—$45.39
CA—$45.39
CO—$46.17
CT—$46.17
DC—$46.17
DE—$46.17
FL—$46.17
GA—$46.17
HI$45.77—
IA—$45.39
ID—$45.39
IL—$46.17
IN—$46.17
KS—$45.39
KY—$46.17
LA—$46.17
MA—$46.17
MD—$46.17
ME—$46.17
MI—$46.17
MN—$46.17
MO—$46.17
MS—$46.17
MT—$45.39
NC—$46.17
ND—$45.39
NE—$45.39
NH—$46.17
NJ—$46.17
NM—$46.17
NV—$45.39
NY—$46.17
OH—$46.17
OK—$46.17
OR—$45.39
PA—$46.17
PR$51.10—
RI—$46.17
SC—$46.17
SD—$45.39
TN—$46.17
TX—$46.17
UT—$46.17
VA—$46.17
VI$46.18—
VT—$46.17
WA—$46.17
WI—$46.17
WV—$46.17
WY—$45.39

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $42.08 to $51.39 depending on state and rural status.

Former-CBA payment limits: ceiling $42.80 · floor $36.38

StateNon-ruralRural
AK$42.08—
AL$42.80—
AR$42.80—
AZ$42.08—
CA$42.08—
CO$42.80—
CT$42.80—
DC$42.80—
DE$42.80—
FL$42.80—
GA$42.80—
HI$42.08—
IA$42.08—
ID$42.08—
IL$42.80—
IN$42.80—
KS$42.08—
KY$42.80—
LA$42.80—
MA$42.80—
MD$42.80—
ME$42.80—
MI$42.80—
MN$42.80—
MO$42.80—
MS$42.80—
MT$42.08—
NC$42.80—
ND$42.08—
NE$42.08—
NH$42.80—
NJ$42.80—
NM$42.80—
NV$42.08—
NY$42.80—
OH$42.80—
OK$42.80—
OR$42.08—
PA$42.80—
PR$51.39—
RI$42.80—
SC$42.80—
SD$42.08—
TN$42.80—
TX$42.80—
UT$42.80—
VA$42.80—
VI$42.80—
VT$42.80—
WA$42.80—
WI$42.80—
WV$42.80—
WY$42.08—
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 K0020 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Code Descriptor / CPT Instruction.

Common denial codes to watch

CO-50 medical necessityCO-151 frequency/units

Related K-codes

K0001K0002K0003K0004K0005K0006K0007K0008K0009K0010K0011K0012

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