Before an item can be considered DME, it must meet all of the following requirements:

• It must be able to withstand repeated use.
• It must be primarily and customarily used to serve a medical purpose.
• It must be generally not useful to a person in the absence of an illness or injury.
• It must be appropriate for use in the home.

All E codes fall under the jurisdiction of the DME MAC unless otherwise noted.

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• E1814

  Dynamic adjustable knee flexion only device, includes soft interface material

• E1815

  Dynamic adjustable ankle extension and flexion device, includes soft interface material

• 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

• E1818

  Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories

• E1820

  Replacement soft interface material, dynamic adjustable extension/flexion device

• E1821

  Replacement soft interface material/cuffs for bi-directional static progressive stretch device

• E1822

  Dynamic adjustable ankle extension only device, includes soft interface material

• E1823

  Dynamic adjustable ankle flexion only device, includes soft interface material

• E1825

  Dynamic adjustable finger extension and flexion device, includes soft interface material

• E1826

  Dynamic adjustable finger extension only device, includes soft interface material

• E1827

  Dynamic adjustable finger flexion only device, includes soft interface material

• E1828

  Dynamic adjustable toe extension only device, includes soft interface material

• E1829

  Dynamic adjustable toe flexion only device, includes soft interface material

• E1830

  Dynamic adjustable toe extension and flexion device, includes soft interface material

• E1831

  Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

• E1832

  Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

• E1840

  Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material

• E1841

  Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories

• E1902

  Communication board, non-electronic augmentative or alternative communication device

• E1905

  Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software

• E2000

  Gastric suction pump, home model, portable or stationary, electric

• E2001

  Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system

• E2100

  Blood glucose monitor with integrated voice synthesizer

• E2101

  Blood glucose monitor with integrated lancing/blood sample

• E2102

  Adjunctive, non-implanted continuous glucose monitor or receiver

• E2103

  Non-adjunctive, non-implanted continuous glucose monitor or receiver

• E2104

  Home blood glucose monitor for use with integrated lancing/blood sample testing cartridge

• E2120

  Pulse generator system for tympanic treatment of inner ear endolymphatic fluid

• E2201

  Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches

• E2202

  Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches

• E2203

  Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches

• E2204

  Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches

• E2205

  Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each

• E2206

  Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each

• E2207

  Wheelchair accessory, crutch and cane holder, each

• E2208

  Wheelchair accessory, cylinder tank carrier, each

• E2209

  Accessory, arm trough, with or without hand support, each

• E2210

  Wheelchair accessory, bearings, any type, replacement only, each

• E2211

  Manual wheelchair accessory, pneumatic propulsion tire, any size, each

• E2212

  Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each

• E2213

  Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each

• E2214

  Manual wheelchair accessory, pneumatic caster tire, any size, each

• E2215

  Manual wheelchair accessory, tube for pneumatic caster tire, any size, each

• E2216

  Manual wheelchair accessory, foam filled propulsion tire, any size, each

• E2217

  Manual wheelchair accessory, foam filled caster tire, any size, each

• E2218

  Manual wheelchair accessory, foam propulsion tire, any size, each

• E2219

  Manual wheelchair accessory, foam caster tire, any size, each

• E2220

  Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each

• E2221

  Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

• E2222

  Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/3/2026

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