| Code | Description | States | Median rate |
|---|---|---|---|
| E2000 | Gastric suction pump, home model, portable or stationary, electric | 33 | $446.22 |
| E2001 | Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system | 11 | $358.81 |
| E2100 | Blood glucose monitor with integrated voice synthesizer | 32 | $733.29 |
| E2101 | Blood glucose monitor with integrated lancing/blood sample | 23 | $231.11 |
| E2102 | Adjunctive, non-implanted continuous glucose monitor or receiver | 24 | $191.38 |
| E2103 | Non-adjunctive, non-implanted continuous glucose monitor or receiver | 30 | $258.09 |
| E2104 | Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge | 13 | $46.73 |
| E2201 | Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches | 43 | $345.44 |
| E2202 | Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches | 41 | $450.28 |
| E2203 | Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches | 43 | $470.16 |
| E2204 | Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches | 40 | $787.78 |
| E2205 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each | 41 | $32.67 |
| E2206 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each | 44 | $40.64 |
| E2207 | Wheelchair accessory, crutch and cane holder, each | 36 | $43.62 |
| E2208 | Wheelchair accessory, cylinder tank carrier, each | 40 | $101.51 |
| E2209 | Accessory, arm trough, with or without hand support, each | 42 | $97.31 |
| E2210 | Wheelchair accessory, bearings, any type, replacement only, each | 42 | $6.07 |
| E2211 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each | 42 | $34.74 |
| E2212 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each | 42 | $5.80 |
| E2213 | Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each | 41 | $29.19 |
| E2214 | Manual wheelchair accessory, pneumatic caster tire, any size, each | 41 | $31.06 |
| E2215 | Manual wheelchair accessory, tube for pneumatic caster tire, any size, each | 42 | $9.48 |
| E2216 | Manual wheelchair accessory, foam filled propulsion tire, any size, each | 32 | $47.04 |
| E2217 | Manual wheelchair accessory, foam filled caster tire, any size, each | 32 | $39.71 |
| E2218 | Manual wheelchair accessory, foam propulsion tire, any size, each | 35 | $48.39 |
| E2219 | Manual wheelchair accessory, foam caster tire, any size, each | 41 | $38.60 |
| E2220 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each | 42 | $26.61 |
| E2221 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | 42 | $25.22 |
| E2222 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each | 39 | $21.82 |
| E2224 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each | 40 | $84.22 |
| E2225 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each | 39 | $17.40 |
| E2226 | Manual wheelchair accessory, caster fork, any size, replacement only, each | 41 | $37.93 |
| E2227 | Manual wheelchair accessory, gear reduction drive wheel, each | 30 | $1,796.47 |
| E2228 | Manual wheelchair accessory, wheel braking system and lock, complete, each | 32 | $924.11 |
| E2231 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware | 39 | $153.51 |
| E2291 | Back, planar, for pediatric size wheelchair including fixed attaching hardware | 12 | $262.77 |
| E2292 | Seat, planar, for pediatric size wheelchair including fixed attaching hardware | 11 | $216.07 |
| E2293 | Back, contoured, for pediatric size wheelchair including fixed attaching hardware | 10 | $403.93 |
| E2294 | Seat, contoured, for pediatric size wheelchair including fixed attaching hardware | 10 | $225.81 |
| E2298 | Complex rehabilitative power wheelchair accessory, power seat elevation system, any type | 29 | $2,000.30 |
| E2310 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware | 40 | $1,107.66 |
| E2311 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware | 41 | $2,141.40 |
| E2312 | Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware | 37 | $2,299.10 |
| E2313 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each | 40 | $322.16 |
| E2321 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware | 39 | $1,567.23 |
| E2322 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware | 37 | $1,456.35 |
| E2323 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated | 42 | $70.15 |
| E2324 | Power wheelchair accessory, chin cup for chin control interface | 41 | $45.75 |
| E2325 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware | 41 | $1,290.50 |
| E2326 | Power wheelchair accessory, breath tube kit for sip and puff interface | 40 | $341.20 |
| E2327 | Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware | 39 | $2,567.00 |
| E2328 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware | 36 | $5,021.46 |
| E2329 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware | 35 | $1,761.13 |
| E2330 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware | 38 | $3,432.04 |
| E2340 | Power wheelchair accessory, nonstandard seat frame width, 20-23 inches | 41 | $399.86 |
| E2341 | Power wheelchair accessory, nonstandard seat frame width, 24-27 inches | 40 | $599.85 |
| E2342 | Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches | 40 | $489.01 |
| E2343 | Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches | 39 | $799.82 |
| E2351 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface | 34 | $705.43 |
| E2359 | Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | 41 | $180.94 |
| E2360 | Power wheelchair accessory, 22nf non-sealed lead acid battery, each | 40 | $119.00 |
| E2361 | Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) | 43 | $138.35 |
| E2362 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each | 38 | $103.02 |
| E2363 | Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | 43 | $177.55 |
| E2364 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each | 37 | $118.78 |
| E2365 | Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) | 41 | $103.92 |
| E2366 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each | 44 | $212.64 |
| E2367 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each | 39 | $418.64 |
| E2368 | Power wheelchair component, drive wheel motor, replacement only | 41 | $464.91 |
| E2369 | Power wheelchair component, drive wheel gear box, replacement only | 41 | $404.24 |
| E2370 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only | 40 | $683.78 |
| E2371 | Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each | 39 | $143.84 |
| E2372 | Power wheelchair accessory, group 27 non-sealed lead acid battery, each | 11 | $105.56 |
| E2373 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware | 40 | $828.84 |
| E2374 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only | 41 | $486.67 |
| E2375 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only | 41 | $721.06 |
| E2376 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only | 38 | $1,213.90 |
| E2377 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue | 40 | $455.25 |
| E2378 | Power wheelchair component, actuator, replacement only | 32 | $544.65 |
| E2381 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each | 40 | $67.79 |
| E2382 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each | 41 | $19.35 |
| E2383 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each | 41 | $139.78 |
| E2384 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each | 41 | $72.11 |
| E2385 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each | 41 | $46.35 |
| E2386 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each | 41 | $127.45 |
| E2387 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each | 41 | $59.03 |
| E2388 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each | 40 | $50.05 |
| E2389 | Power wheelchair accessory, foam caster tire, any size, replacement only, each | 40 | $27.17 |
| E2390 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each | 40 | $42.49 |
| E2391 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | 40 | $19.45 |
| E2392 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each | 39 | $48.92 |
| E2394 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each | 39 | $68.86 |
| E2395 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each | 39 | $49.83 |
| E2396 | Power wheelchair accessory, caster fork, any size, replacement only, each | 39 | $54.84 |
| E2397 | Power wheelchair accessory, lithium-based battery, each | 28 | $483.44 |
| E2398 | Wheelchair accessory, dynamic positioning hardware for back | 19 | $160.01 |
| E2402 | Negative pressure wound therapy electrical pump, stationary or portable | 40 | $1,256.24 |
| E2500 | Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time | 40 | $445.84 |
| E2502 | Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time | 38 | $1,363.34 |
| E2504 | Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time | 39 | $1,721.85 |
| E2506 | Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time | 40 | $2,637.02 |
| E2508 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device | 40 | $4,077.72 |
| E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access | 39 | $7,716.55 |
| E2513 | Accessory for speech generating device, electromyographic sensor | 11 | $3,764.51 |
| E2601 | General use wheelchair seat cushion, width less than 22 inches, any depth | 43 | $51.71 |
| E2602 | General use wheelchair seat cushion, width 22 inches or greater, any depth | 42 | $103.63 |
| E2603 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth | 41 | $136.34 |
| E2604 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth | 41 | $172.04 |
| E2605 | Positioning wheelchair seat cushion, width less than 22 inches, any depth | 41 | $245.79 |
| E2606 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth | 40 | $385.07 |
| E2607 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth | 41 | $250.12 |
| E2608 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth | 41 | $303.87 |
| E2611 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware | 42 | $252.23 |
| E2612 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware | 42 | $371.19 |
| E2613 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware | 41 | $356.61 |
| E2614 | Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware | 41 | $496.69 |
| E2615 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware | 41 | $395.44 |
| E2616 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware | 41 | $553.34 |
| E2619 | Replacement cover for wheelchair seat cushion or back cushion, each | 41 | $51.27 |
| E2620 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware | 41 | $469.33 |
| E2621 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware | 41 | $524.84 |
| E2622 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth | 41 | $322.60 |
| E2623 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth | 41 | $409.88 |
| E2624 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth | 41 | $331.68 |
| E2625 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth | 41 | $409.49 |
| E2626 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable | 32 | $634.86 |
| E2627 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type | 30 | $954.07 |
| E2628 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining | 30 | $723.57 |
| E2629 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) | 31 | $963.96 |
| E2630 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support | 32 | $640.31 |
| E2631 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm | 31 | $254.53 |
| E2632 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control | 31 | $162.55 |
| E2633 | Wheelchair accessory, addition to mobile arm support, supinator | 31 | $138.92 |
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.