`E0958` Whlchr att- conv 1 arm drive

Manual wheelchair accessory, one-arm drive attachment, each

Medicare coverage: Special coverage instructions apply
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 1 units per day (clinical), rationale: Nature of Equipment

Medicare pricing for E0958

DMEPOS fee schedule, July 2026 (DME26-C)

RR (rental), capped rental (CR): non-rural $48.32 to $54.40 in the contiguous states; $58.01 to $69.13 in AK, HI, PR and VI; rural $52.85 to $59.02
RR-KU, capped rental (CR): non-rural $52.84 to $62.17 in the contiguous states; $58.01 to $76.67 in AK, HI, PR and VI; ceiling $62.17, floor $52.84

Payer policies and prior authorization for E0958

4 of 4 payer prior-auth lists that name E0958 require prior authorization or set conditions: Rocky Mountain Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Since	Source
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	UnitedHealthcare Complete (Individual & Family plans)	All	prior auth required	Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth required	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name E0958

E0958 appears in 4 coverage policies from Aetna, Anthem, Capital Blue Cross.

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)	covered if criteria are met	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

Recent prior-auth changes

Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

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

AZ: $1.96 (dme_rentals), effective Oct 1, 2026
CO: $40.91 (chp_plus, non-facility), effective Jul 1, 2026
FL: $332.42 (dme), effective Jul 1, 2026
IL: $418.98 (dme), effective Jan 1, 2026
IN: $393.30 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $49.37 (default), effective Jul 1, 2026
KY: $41.74 (dme), effective Jan 1, 2026
LA: $26.96 (dme), effective Jul 1, 2012
MD: $407.06 (dme), effective Apr 1, 2026
MS: $448.20 (comprehensive), effective Jul 1, 2026
ND: $544.00 (dme), effective Aug 1, 2026
NE: $533.88 (dme), effective Jul 1, 2026
OH: $420.00 (dme), effective Jan 1, 2024
OK: $590.20 (dme), effective Jan 1, 2026
TX: $400.47 (dmepos_tos_9_e_j_l_and_r, Home Health Dme), effective Apr 1, 2017
VA: $539.41 (dme), effective Dec 1, 2026
VT: $465.15 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $467.25 (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.

E0958 Whlchr att- conv 1 arm drive