`E2219` Foam caster tire any size ea

Manual wheelchair accessory, foam caster 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 (clinical), rationale: Nature of Equipment

Medicare pricing for E2219

DMEPOS fee schedule, July 2026 (DME26-C)

NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $46.34 to $53.05 in the contiguous states; $42.11 to $97.18 in AK, HI, PR and VI; rural $50.69 to $56.86
NU-KU, inexpensive or routinely purchased (IN): non-rural $50.68 to $59.62 in the contiguous states; $42.12 to $140.28 in AK, HI, PR and VI; ceiling $59.62, floor $50.68
RR (rental), inexpensive or routinely purchased (IN): non-rural $4.64 to $5.31 in the contiguous states; $4.26 to $9.73 in AK, HI, PR and VI; rural $5.57 to $6.07
RR-KU, inexpensive or routinely purchased (IN): non-rural $5.72 to $6.73 in the contiguous states; $4.27 to $14.06 in AK, HI, PR and VI; ceiling $6.73, floor $5.72
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $34.76 to $39.79 in the contiguous states; $31.60 to $72.87 in AK, HI, PR and VI; rural $38.02 to $42.65
UE-KU, inexpensive or routinely purchased (IN): non-rural $38.01 to $44.72 in the contiguous states; $31.60 to $105.15 in AK, HI, PR and VI; ceiling $44.72, floor $38.01

Payer policies and prior authorization for E2219

3 of 3 payer prior-auth lists that name E2219 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	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

Payer coverage policies that name E2219

E2219 appears in 5 coverage policies from Aetna, Anthem, Blue Shield of California, 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
Blue Shield of California	BSC1.02 Power Wheelchairs and Power Operated Vehicles for Permanent Use	listed, no stance		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, ND, NY, VA, WV.

AZ: $53.87 (dme), effective Oct 1, 2026
CO: $34.47 (dme), effective Jul 1, 2026
FL: $30.53 (dme), effective Jul 1, 2026
IL: $41.29 (dme), effective Jan 1, 2026
IN: $4.09 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $34.03 (dme), effective Jan 1, 2026
LA: $28.22 (dme), effective Sep 1, 2021
MD: $39.39 (dme), effective Apr 1, 2026
MS: $20.28 (comprehensive), effective Jul 1, 2026
ND: $61.59 (dme), effective Aug 1, 2026
NE: $5.30 (dme), effective Jul 1, 2026
NY: $25.68 (dme), effective Jul 1, 2026
OH: $38.60 (dme), effective Jan 1, 2017
OK: $46.47 (dme), effective Jan 1, 2026
TX: $32.07 (dmepos_tos_9_e_j_l_and_r, Home Health Dme), effective Mar 1, 2012
VA: $48.14 (dme), effective Dec 1, 2026
VT: $48.15 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $44.82 (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.

E2219 Foam caster tire any size ea