| Code | Description | States | Median rate |
|---|---|---|---|
| E1002 | Wheelchair accessory, power seating system, tilt only | 43 | $3,939.24 |
| E1003 | Wheelchair accessory, power seating system, recline only, without shear reduction | 36 | $4,580.20 |
| E1004 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction | 38 | $4,877.02 |
| E1005 | Wheelchair accessory, power seating system, recline only, with power shear reduction | 38 | $5,386.46 |
| E1006 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction | 37 | $6,343.60 |
| E1007 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction | 43 | $8,287.80 |
| E1008 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction | 39 | $8,484.78 |
| E1010 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair | 37 | $1,161.60 |
| E1012 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each | 36 | $1,119.80 |
| E1014 | Reclining back, addition to pediatric size wheelchair | 40 | $365.73 |
| E1015 | Shock absorber for manual wheelchair, each | 36 | $126.57 |
| E1016 | Shock absorber for power wheelchair, each | 34 | $128.43 |
| E1020 | Residual limb support system for wheelchair, any type | 41 | $220.29 |
| E1028 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other | 41 | $173.80 |
| E1029 | Wheelchair accessory, ventilator tray, fixed | 37 | $369.54 |
| E1030 | Wheelchair accessory, ventilator tray, gimbaled | 31 | $1,203.28 |
| E1031 | Rollabout chair, any and all types with casters 5" or greater | 33 | $492.92 |
| E1032 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware used with joystick or other drive control interface | 35 | $168.71 |
| E1033 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for headrest, cushioned, any type | 35 | $164.70 |
| E1034 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for lateral trunk or hip support, any type | 35 | $168.71 |
| E1035 | Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs | 27 | $6,281.94 |
| E1036 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs | 15 | $9,726.27 |
| E1037 | Transport chair, pediatric size | 28 | $1,077.56 |
| E1038 | Transport chair, adult size, patient weight capacity up to and including 300 pounds | 29 | $147.18 |
| E1039 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds | 28 | $251.52 |
| E1050 | Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests | 31 | $806.57 |
| E1060 | Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests | 33 | $923.48 |
| E1070 | Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest | 32 | $838.60 |
| E1083 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest | 28 | $579.94 |
| E1084 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests | 29 | $712.26 |
| E1085 | Hemi-wheelchair, fixed full length arms, swing away detachable foot rests | 18 | $605.87 |
| E1086 | Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests | 20 | $705.25 |
| E1087 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests | 28 | $945.47 |
| E1088 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests | 29 | $1,329.35 |
| E1089 | High strength lightweight wheelchair, fixed length arms, swing away detachable footrest | 22 | $1,030.10 |
| E1090 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests | 23 | $1,042.60 |
| E1092 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests | 29 | $990.20 |
| E1093 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests | 28 | $932.97 |
| E1100 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests | 27 | $863.69 |
| E1110 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest | 28 | $802.45 |
| E1130 | Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests | 24 | $409.18 |
| E1140 | Wheelchair, detachable arms, desk or full length, swing away detachable footrests | 23 | $624.61 |
| E1150 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests | 30 | $827.10 |
| E1160 | Wheelchair, fixed full length arms, swing away detachable elevating legrests | 30 | $615.32 |
| E1161 | Manual adult size wheelchair, includes tilt in space | 44 | $2,557.85 |
| E1170 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests | 28 | $721.15 |
| E1171 | Amputee wheelchair, fixed full length arms, without footrests or legrest | 26 | $651.80 |
| E1172 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest | 28 | $829.59 |
| E1180 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests | 29 | $772.65 |
| E1190 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests | 28 | $917.12 |
| E1195 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests | 27 | $1,014.51 |
| E1200 | Amputee wheelchair, fixed full length arms, swing away detachable footrest | 29 | $720.72 |
| E1221 | Wheelchair with fixed arm, footrests | 24 | $344.86 |
| E1222 | Wheelchair with fixed arm, elevating legrests | 24 | $428.25 |
| E1223 | Wheelchair with detachable arms, footrests | 24 | $486.01 |
| E1224 | Wheelchair with detachable arms, elevating legrests | 26 | $555.50 |
| E1225 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each | 42 | $373.73 |
| E1226 | Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each | 43 | $465.88 |
| E1227 | Special height arms for wheelchair | 32 | $276.84 |
| E1228 | Special back height for wheelchair | 32 | $204.35 |
| E1230 | Power operated vehicle (three or four wheel nonhighway) specify brand name and model number | 27 | $2,212.79 |
| E1231 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system | 12 | $1,870.89 |
| E1232 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system | 42 | $2,401.20 |
| E1233 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system | 42 | $2,462.81 |
| E1234 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system | 42 | $2,165.95 |
| E1235 | Wheelchair, pediatric size, rigid, adjustable, with seating system | 41 | $2,053.60 |
| E1236 | Wheelchair, pediatric size, folding, adjustable, with seating system | 43 | $1,840.00 |
| E1237 | Wheelchair, pediatric size, rigid, adjustable, without seating system | 42 | $1,856.05 |
| E1238 | Wheelchair, pediatric size, folding, adjustable, without seating system | 41 | $1,811.60 |
| E1240 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest | 30 | $900.46 |
| E1250 | Lightweight wheelchair, fixed full length arms, swing away detachable footrest | 20 | $630.67 |
| E1260 | Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest | 22 | $763.40 |
| E1270 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests | 29 | $597.60 |
| E1280 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests | 29 | $1,027.54 |
| E1285 | Heavy duty wheelchair, fixed full length arms, swing away detachable footrest | 21 | $980.70 |
| E1290 | Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest | 21 | $1,110.02 |
| E1295 | Heavy duty wheelchair, fixed full length arms, elevating legrest | 29 | $1,046.20 |
| E1296 | Special wheelchair seat height from floor | 35 | $487.99 |
| E1297 | Special wheelchair seat depth, by upholstery | 37 | $103.09 |
| E1298 | Special wheelchair seat depth and/or width, by construction | 36 | $417.74 |
| E1310 | Whirlpool, non-portable (built-in type) | 15 | $2,424.48 |
| E1353 | Regulator | 26 | $32.57 |
| E1355 | Stand/rack | 24 | $24.34 |
| E1372 | Immersion external heater for nebulizer | 32 | $149.01 |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 40 | $140.19 |
| E1391 | Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each | 28 | $98.79 |
| E1392 | Portable oxygen concentrator, rental | 34 | $43.29 |
| E1405 | Oxygen and water vapor enriching system with heated delivery | 22 | $126.90 |
| E1406 | Oxygen and water vapor enriching system without heated delivery | 23 | $132.52 |
| E1510 | Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i.v. poles, pressure gauge, concentrate container | 11 | $569.29 |
| E1594 | Cycler dialysis machine for peritoneal dialysis | 10 | $371.13 |
| E1700 | Jaw motion rehabilitation system | 22 | $340.36 |
| E1701 | Replacement cushions for jaw motion rehabilitation system, pkg. of 6 | 21 | $12.09 |
| E1702 | Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200 | 20 | $25.75 |
| E1800 | Dynamic adjustable elbow extension and flexion device, includes soft interface material | 33 | $1,191.63 |
| E1801 | Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | 28 | $1,187.20 |
| E1802 | Dynamic adjustable forearm pronation/supination device, includes soft interface material | 28 | $3,362.44 |
| E1803 | Dynamic adjustable elbow extension only device, includes soft interface material | 21 | $1,236.67 |
| E1804 | Dynamic adjustable elbow flexion only device, includes soft interface material | 21 | $1,236.67 |
| E1805 | Dynamic adjustable wrist extension and flexion device, includes soft interface material | 32 | $1,228.97 |
| E1806 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories | 28 | $974.80 |
| E1807 | Dynamic adjustable wrist extension only device, includes soft interface material | 20 | $1,412.32 |
| E1808 | Dynamic adjustable wrist flexion only device, includes soft interface material | 20 | $1,412.32 |
| E1810 | Dynamic adjustable knee extension and flexion device, includes soft interface material | 36 | $1,195.97 |
| E1811 | Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | 28 | $1,234.40 |
| E1812 | Dynamic knee, extension/flexion device with active resistance control | 26 | $415.46 |
| E1813 | Dynamic adjustable knee extension only device, includes soft interface material | 21 | $1,257.74 |
| E1814 | Dynamic adjustable knee flexion only device, includes soft interface material | 21 | $1,257.74 |
| E1815 | Dynamic adjustable ankle extension and flexion device, includes soft interface material | 32 | $1,228.97 |
| E1816 | Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories | 29 | $793.85 |
| E1818 | Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories | 28 | $1,353.04 |
| E1820 | Replacement soft interface material, dynamic adjustable extension/flexion device | 28 | $95.54 |
| E1821 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device | 23 | $127.48 |
| E1822 | Dynamic adjustable ankle extension only device, includes soft interface material | 21 | $1,164.17 |
| E1823 | Dynamic adjustable ankle flexion only device, includes soft interface material | 21 | $1,164.17 |
| E1825 | Dynamic adjustable finger extension and flexion device, includes soft interface material | 31 | $1,124.59 |
| E1826 | Dynamic adjustable finger extension only device, includes soft interface material | 20 | $1,412.32 |
| E1827 | Dynamic adjustable finger flexion only device, includes soft interface material | 21 | $1,164.17 |
| E1828 | Dynamic adjustable toe extension only device, includes soft interface material | 20 | $916.01 |
| E1829 | Dynamic adjustable toe flexion only device, includes soft interface material | 20 | $916.01 |
| E1830 | Dynamic adjustable toe extension and flexion device, includes soft interface material | 27 | $1,176.01 |
| E1831 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | 12 | $767.74 |
| E1832 | Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories | 14 | $685.06 |
| E1840 | Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material | 27 | $3,522.10 |
| E1841 | Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories | 23 | $4,687.85 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.