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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• E2617

  Custom fabricated wheelchair back cushion, any size, including any type mounting hardware

• E2619

  Replacement cover for wheelchair seat cushion or back cushion, each

• E2620

  Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware

• E2621

  Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware

• E2622

  Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth

• E2623

  Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth

• E2624

  Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth

• E2625

  Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth

• E2626

  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable

• E2627

  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type

• E2628

  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining

• E2629

  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)

• E2630

  Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support

• E2631

  Wheelchair accessory, addition to mobile arm support, elevating proximal arm

• E2632

  Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control

• E2633

  Wheelchair accessory, addition to mobile arm support, supinator

• E3000

  Speech volume modulation system, any type, including all components and accessories

• E3200

  Gait modulation system, rhythmic auditory stimulation, including restricted therapy software, all components and accessories, prescription only

• E8000

  Gait trainer, pediatric size, posterior support, includes all accessories and components

• E8001

  Gait trainer, pediatric size, upright support, includes all accessories and components

• E8002

  Gait trainer, pediatric size, anterior support, includes all accessories and components

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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 6/4/2026

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