`E2216` Foam filled propulsion tire

Manual wheelchair accessory, foam filled propulsion tire, any size, 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 2 units per day (policy), rationale: Code Descriptor / CPT Instruction

Medicare pricing for E2216

DMEPOS fee schedule, July 2026 (DME26-C)

NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $52.36 to $59.95 in the contiguous states; $47.58 to $109.81 in AK, HI, PR and VI; rural $57.28 to $64.25
NU-KU, inexpensive or routinely purchased (IN): non-rural $57.29 to $67.40 in the contiguous states; $47.61 to $158.51 in AK, HI, PR and VI; ceiling $67.40, floor $57.29
RR (rental), inexpensive or routinely purchased (IN): non-rural $5.24 to $6.00 in the contiguous states; $4.81 to $10.99 in AK, HI, PR and VI; rural $6.29 to $6.86
RR-KU, inexpensive or routinely purchased (IN): non-rural $6.50 to $7.65 in the contiguous states; $4.83 to $15.92 in AK, HI, PR and VI; ceiling $7.65, floor $6.50
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $39.28 to $44.96 in the contiguous states; $35.71 to $82.34 in AK, HI, PR and VI; rural $42.96 to $48.19
UE-KU, inexpensive or routinely purchased (IN): non-rural $42.93 to $50.51 in the contiguous states; $35.70 to $118.87 in AK, HI, PR and VI; ceiling $50.51, floor $42.93

Payer policies and prior authorization for E2216

2 of 2 payer prior-auth lists that name E2216 require prior authorization or set conditions: Rocky Mountain Health Plans, UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	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 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 E2216

E2216 appears in 4 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

Payer	Policy	Role in policy	Reviewed	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 E2211-E2231)	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
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Wheelchairs and Accessories (DME101.010) HCPCS Codes E0950, E0951, E0952, E0953, E0954, E0955, E0956, E0957, E0958, E0959,	listed, no stance	Jan 1, 2026	payer document

Recent prior-auth changes

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, IN, LA, MA, MS, VA, WA, WV.

AZ: $60.87 (dme), effective Oct 1, 2026
CO: $32.81 (chp_plus, non-facility), effective Jul 1, 2026
IL: $52.94 (dme), effective Jan 1, 2026
IN: $49.26 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $5.45 (default), effective Jul 1, 2026
KY: $47.04 (dme), effective Jan 1, 2026
MD: $44.51 (dme), effective Apr 1, 2026
MS: $45.82 (comprehensive), effective Jul 1, 2026
NE: $5.70 (dme), effective Jul 1, 2026
OH: $35.00 (dme), effective Jul 1, 2021
OK: $52.51 (dme), effective Jan 1, 2026
TX: $0.00 (dmepos_tos_9_e_j_l_and_r, Home Health Dme), effective Jan 1, 2016
VA: $48.27 (dme), effective Dec 1, 2026
VT: $54.42 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $64.25 (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.

E2216 Foam filled propulsion tire