Java Cushion
Medicare Code
E2624: Skin Protection and Positioning Wheelchair Seat Cushion, Adjustable, Width Less than 22 inches, Any Depth
Medicare Fee Schedule effective October 2021
Non-Rural Fee
E2624 / NU: $320.30
E2624 / NU KE*: $332.45
E2624 / NU KU**: $335.30
E2624 / RR: $32.03
E2624 / RR KE*: $33.25
E2624 / RR KU**: $33.54
Rural Fee
E2624 / NU: $325.30
E2624 / NU KE*: $349.61
E2624 / NU KU**: $335.30
E2624 / RR: $32.54
E2624 / RR KE*: $34.97
E2624 / RR KU**: $33.54
Pricing Category
Inexpensive & routinely purchased
*KE modifier is to be applied when the cushion is used as part of a non-competitively bid manual wheelchair system.
**The KU modifier is to be applied when the cushion is used as part of a Group 3 power wheelchair system.
Note: If the code is subject to competitive bidding and billed for use on a competitively bid wheelchair system, the allowable will be based on the single payment amount for the specific area.
Java Cushion Funding (PDF)
ICD-10 Cushions (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Java Cushion Cover
Medicare Code
E2619: Replacement Cover for Wheelchair Seat Cushion or Back Cushion, Each
This item cannot be billed separately when the cushion itself is being billed. This is a replacement only billable code.
2018 Medicare Fee Schedule*
Non-Rural Fee
E2619 / NU: $46.51
E2619 / NU KU: $49.77
E2619 / RR: $4.65
E2619 / RR KU: $4.97
Rural Fee
Medicare did not publish a set allowable for the Rural Fee
Pricing Category
Inexpensive & Routinely Purchased
*Allowable for KU modifier for Rural areas was not listed by Medicare, however will still be covered. The KU modifier is to be applied when the cushion is furnished as part of a group 3 power wheelchair system.
Note: If the code is subject to competitive bidding, the allowable will be based on the single payment amount for the specific area unless the cushion is being used with a Group 3 power wheelchair. .
Java Cushion Funding (PDF)
ICD-10 Cushions (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Forward Cushion
Medicare Code
E2607: Skin Protection and Positioning Wheelchair Seat Cushion, width Less Than 22 inches, Any Depth
2021 Medicare Fee Schedule
Non-Rural Fee
Varies by state, please see document below
Rural Fee
E2607 / NU:$254.06
E2607 / NU KE*:$273.43
E2607 / NU KU**: $290.81
E2607 / RR: $25.41
E2607 / RR KE*: $27.34
E2607 / RR KU**: $29.09
Pricing Category
Inexpensive & Routinely Purchased
* *KE modifier is to be applied when the cushion is used as part of a non-competitively big manual wheelchair system.
* KU modifier is to be applied when the cushion is used as part of a Group 3 power wheelchair system.
Forward Cushion Funding (PDF)
E2607 Non-Rural Fee Schedule (PDF)
ICD-10 Cushions (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Forward Cushion Cover
Medicare Code
E2619: Replacement Cover for Wheelchair Seat Cushion or Back Cushion, Each
This item cannot be billed separately when the cushion itself is being billed. This is a replacement only billable code.
2021 Medicare Fee Schedule
Non-Rural Fee
E2619 / NU: $49.56
E2619 / NU KE*: $51.42
E2619 / NU KU**: $51.47
E2619 / RR: $4.96
E2619 / RR KE*: $5.14
E2619 / RR KU**: $5.14
Rural Fee
E2619 / NU: $50.20
E2619 / NU KE*: $53.93
E2619 / NU KU**: $51.47
E2619 / RR: $5.02
E2619 / RR KE*: $5.39
E2619 / RR KU**: $5.14
Pricing Category
Inexpensive & Routinely Purchased
*KE modifier is to be applied when the cushion is used as part of a non-competitively bid manual wheelchair system.
**KU modifier is to be applied when the cushion is used as part of a Group 3 power wheelchair system.
Forward Cushion Funding (PDF)
E2607 Non-Rural Fee Schedule (PDF)
ICD-10 Cushions (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Ride Custom Cushion 2 and Ride Custom AccuSoft Cushion
Medicare Code
E2609: Custom Fabricated Wheelchair Seat Cushion, Any Size
2022 Medicare Fee Schedule
There is no set Medicare Fee Schedule for this HCPCs Code. This item is individually priced. Be sure to include the Manufacturer name and model name/number, and the MSRP. All parts and pieces tied to the custom back should be grouped into this one line when billing Medicare.
Custom Cushion Funding (PDF)
Custom Cushion 2 PDAC Coding Verification Letter (PDF)
Custom Cushion 2 Funding (PDF)
Ride Custom AccuSoft Cushion Funding (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
ICD10 Custom Cushions (PDF)
Ride Custom Cushion Covers
Medicare Code
E2619: Replacement Cover for Wheelchair Seat Cushion or Back Cushion, Each
This item cannot be billed separately when the cushion itself is being billed. This is a replacement only billable code.
2018 Medicare Fee Schedule*
Non-Rural Fee
E2619 / NU: $46.51
E2619 / NU KU: $49.77
E2619 / RR: $4.65
E2619 / RR KU: $4.97
Rural Fee
Medicare did not publish a set allowable for the Rural Fee
Pricing Category
Inexpensive & Routinely Purchased
*Allowable for KU modifier for Rural areas was not listed by Medicare, however will still be covered. The KU modifier is to be applied when the cushion is furnished as part of a Group 3 power wheelchair system.
Note: If the code is subject to competitive bidding, the allowable will be based on the single payment amount for the specific area, unless the cushion is used with a Group 3 power wheelchair..
Custom Cushion Funding (PDF)
Custom Cushion 2 Funding (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Java® Back & Java Back Tall
Medicare Code
E2615: Positioning Wheelchair Back Cushion, Posterior-Lateral, width less than 22 inches, any height, including any type mounting hardware
Medicare Fee Schedule effective October, 2021
Non-Rural Fee
Varies by state, please see document below
Rural Fee
E2615 / NU: $415.30
E2615 / NU KE*: 445.24
E2615 / NU KU**: Medicare did not publish a set allowable
E2615 / RR: $41.54
E2615 / RR KE*: $44.53
E2615 / RR KU**: Medicare did not publish a set allowable
Pricing Category
Inexpensive & Routinely Purchased
*KE modifier is to be applied when the cushion is used as part of a non-competitively bid manual wheelchair system.
**KU Modifier is to be applied when the cushion is used as part of a Group 3 power wheelchair system.
Note: If the code is subject to competitive bidding and billed for use on a competitively bid wheelchair system, the allowable will be based on the single payment amount for the specific area.
Java Back (3") Funding (PDF)
Java Back (6") Funding (PDF)
E2615 Non-Rural Fee Schedule (PDF)
E2620 Non-Rural Fee Schedule (PDF)
ICD-10 Backs (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Java® Back (Regular/Deep), (Grande/Deep), (Tall/Deep)
Medicare Code
E2620: Positioning Wheelchair Back Cushion, Planar Back with Lateral Supports, Width Less than 22 inches, Any Height, Including Any Type Mounting Hardware
Medicare Fee Schedule Effective October 2021
Non-Rural Fee
Varies by state, please see document below
Rural Fee
E2620 / NU: $476.69
E2620 / NU KE*: $513.34
E2620 / NU KU**: Medicare did not publish a set allowable
E2620 / RR: $47.67
E2620 / RR KE*: 51.34
E2620 / RR KU**: Medicare did not publish a set allowable
Pricing Category
Inexpensive & Routinely Purchased
*KE Modifier is to be applied when the back is used as part of a non-competitively bid manual wheelchair system.
**KU modifier is to be applied when the back is used as part of a Group 3 power wheelchair system.
Note: If the code is subject to competitive bidding and billed for use on a competitively bid wheelchair system, the allowable will be based on the single payment amount for the specific area.
Java Back (3") Funding (PDF)
Java Back (6") Funding (PDF)
E2615 Non-Rural Fee Schedule (PDF)
E2620 Non-Rural Fee Schedule (PDF)
ICD-10 Backs (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Java® Decaf Back & Tall (includes Fixed, Non-Removable Hardware)
Medicare Code
E2615: Positioning Wheelchair Back Cushion, Posterior-Lateral, Width Less Than 22 inches, Any Height, Including Any Type Mounting Hardware
Medicare Fee Schedule Effective October 2021
Non-Rural Fee
Varies by state, please see attached spreadsheet
Rural Fee
E2615 / NU: $415.30
E2615 / NU KE*: $445.24
E2615 / NU KU**: Medicare did not publish a set allowable
E2615 / RR: $41.54
E2615 / RR KE*: $44.53
E2615 / RR KU**: Medicare did not publish a set allowable
Pricing Category
Inexpensive & Routinely Purchased
*KE Modifier is to be applied when the cushion is used as part of a non-competitively bid manual wheelchair system.
**KU Modifier is to be applied when teh cushion is used as part of a Group 3 power wheelchair system.
Note: If the code is subject to competitive bidding, the allowable will be based on the single payment amount for the specific area, unless the back is used with a Group 3 power wheelchair system.
Optional Quick Release Hardware
Under Medicare guidelines, there is not a specific HCPC code for quick release hardware to be used on a wheelchair back. As the Wheelchair Back Code specifies, any type mounting hardware is included. If the hardware is billed as a replacement part, code K0108 would have to be used; code E1028 is not allowed to be used for seat or back hardware.
Java Decaf Back Funding (PDF)
E2615 Non-Rural Fee Schedule (PDF)
ICD-10 Backs (PDF)
Wheelchair Seating LCD (PDF)
Wheelchair Seating Policy Article (PDF)
Ride® Custom Back
Medicare Code
E2617: Custom Fabricated Wheelchair Back Cushion, Any Size, Including Any Type Mounting Hardware
2021 Medicare Fee Schedule
There is no set Medicare Fee Schedule for this HCPCs Code. This item is individually priced. Be sure to include the Manufacturer name and model name/number, and the MSRP. All parts and pieces tied to the custom back should be grouped into this one line when billing Medicare.
Custom Back Funding (PDF)
ICD-10 Backs (PDF)
Wheelchair Seating LCD (PDF)
WheelchairSeating Policy Article (PDF)
Corbac™ & Corbac Tall
Medicare Code
E2611: General Use Wheelchair Back Cushion, Width Less Than 22 inches, Any Height, Including Any Type Mounting Hardware
2018 Medicare Fee Schedule*
Non-Rural Fee
E2611 / NU: Varies by state, please see document below
E2611 / NU KU: $303.00
E2611 / RR: Varies by state, please see document below
E2611 / RR KU: $30.29
Rural Fee
E2611 / NU: $163.63
E2611 / NU KU: Medicare did not publish a set allowable
E2611 / RR: $16.36
E2611 / RR KU: Medicare did not publish a set allowable
Pricing Category
Inexpensive & Routinely Purchased
Allowable for KU modifier for Rural areas was not listed by Medicare, however will still be covered. The KU modifier is to be applied when the back is furnished as part of a Group 3 power wheelchair system.
Note: If the code is subject to competitive bidding, the allowable will be based on the single payment amount for the specific area unless the back is being used with a Group 3 power wheelchair.
Corbac Funding (PDF)
E2611 Non-Rural Fee Schedule (PDF)
Wheelchair Seating Policy LCD (PDF)
Wheelchair Seating Policy Article (PDF)