`E0956` W/c lateral trunk/hip suppor

Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 4 units per day (clinical), rationale: Nature of Equipment

Medicare pricing for E0956

DMEPOS fee schedule, July 2026 (DME26-C)

NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $89.49 to $98.36 in the contiguous states; $111.97 to $124.07 in AK, HI, PR and VI; rural $111.97
NU-KE, inexpensive or routinely purchased (IN): non-rural $120.74 to $134.61 in AK, HI, PR and VI; rural $120.74
NU-KU, inexpensive or routinely purchased (IN): non-rural $121.07 in the contiguous states; $121.07 to $145.31 in AK, HI, PR and VI; ceiling $121.07, floor $102.91
RR (rental), inexpensive or routinely purchased (IN): non-rural $8.95 to $9.84 in the contiguous states; $11.20 to $12.42 in AK, HI, PR and VI; rural $11.20
RR-KE, inexpensive or routinely purchased (IN): non-rural $12.07 to $13.48 in AK, HI, PR and VI; rural $12.07
RR-KU, inexpensive or routinely purchased (IN): non-rural $12.10 in the contiguous states; $12.10 to $14.56 in AK, HI, PR and VI; ceiling $12.10, floor $10.29
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $67.12 to $73.77 in the contiguous states; $83.98 to $93.08 in AK, HI, PR and VI; rural $83.98
UE-KE, inexpensive or routinely purchased (IN): non-rural $90.56 to $100.98 in AK, HI, PR and VI; rural $90.56
UE-KU, inexpensive or routinely purchased (IN): non-rural $90.81 in the contiguous states; $90.81 to $109.00 in AK, HI, PR and VI; ceiling $90.81, floor $77.19

Payer policies and prior authorization for E0956

7 of 7 payer prior-auth lists that name E0956 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth required		Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth under conditions	Prior authorization is required only for the codes listed with a retail purchase or a cumulative rental cost of more than $500.	Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth under conditions	site of care: outpatient	Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth under conditions	Cost over $500	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name E0956

E0956 appears in 5 coverage policies from Aetna, Anthem, Capital Blue Cross, Centene.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Therapeutic Chairs (0434)	covered if criteria are met (range E0950-E1034)	Aug 3, 2026	payer document
Aetna	Therapeutic Chairs (0434)	not covered (range E0950-E1034)	Aug 3, 2026	payer document
Aetna	Wheelchairs and Power Operated Vehicles (Scooters) (0271)	listed, no stance	Aug 21, 2026	payer document
Anthem	Wheeled Mobility Devices: Wheelchair Accessories (CG-DME-34)	covered if criteria are met (range E0950-E0995)	Nov 6, 2025	payer document
Capital Blue Cross	Manual Wheelchairs and Accessories (MP 6.059)	covered if criteria are met	Sep 1, 2026	payer document
Centene	Wheelchair Seating (CP.MP.99)	covered if criteria are met	Jan 1, 2024	payer document

Recent prior-auth changes

Jul 1, 2026: PA removed, HealthSpring

Medicaid fee-for-service

Prior authorization required or conditional in CO, FL, IL, IN, KY, LA, MS, ND, NY, OH, VA, WA, WV.

AZ: $97.70 (dme), effective Oct 1, 2026
CO: $91.16 (dme), effective Jul 1, 2026
FL: $84.62 (dme), effective Jul 1, 2026
IL: $81.60 (dme), effective Jan 1, 2026
IN: $7.24 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $89.26 (default), effective Jul 1, 2026
KY: $78.72 (dme), effective Jan 1, 2026
LA: $66.45 (dme), effective Sep 1, 2021
MD: $76.07 (dme), effective Apr 1, 2026
MS: $89.58 (comprehensive), effective Jul 1, 2026
ND: $14.05 (dme), effective Aug 1, 2026
NE: $120.62 (dme), effective Jul 1, 2026
NY: $90.01 (dme), effective Jul 1, 2026
OH: $98.49 (dme), effective Jan 1, 2017
OK: $93.64 (dme), effective Jan 1, 2026
TX: $91.18 (dmepos_tos_9_e_j_l_and_r, Home Health Dme), effective Sep 1, 2026
VA: $91.05 (dme), effective Dec 1, 2026
VT: $101.49 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $91.00 (crt), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

E0956 W/c lateral trunk/hip suppor