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HCPCS E1038 · Level II · DME code

E1038: Transport chair, adult size, patient weight capacity up to and including 300 pounds, HCPCS Level II DME code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for E1038

Medicare payment
$16.27 to $19.04
DMEPOS non-rural state fees (RR)
Coverage code
D
special coverage instructions apply
DME supplier MUE
1
MAI 2
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

E1038 is a Level II code from the E section (durable medical equipment), in use since 2003: "Transport chair, adult size, patient weight capacity up to and including 300 pounds". DMEPOS fees for E1038, a CR (capped rental items) item, run RR (rental) $16.27 in DC, DE, MD and 3 more to $19.04 in AL, AR, FL and 9 more, rural $22.72 in the October 2026 file. Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction). 1 active LCD lists E1038: L33788 (Manual Wheelchair Bases). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1D (wheelchairs); pricing indicator 36; type of service R (rental of DME). 2 other active codes open with "Transport chair"; related codes: E1037, E1039, E1028, E1007.

E1038 descriptor and code status

The October 2026 HCPCS Level II file describes E1038 as “Transport chair, adult size, patient weight capacity up to and including 300 pounds”. It sits in the E section (durable medical equipment), listed with the other E codes. Although searches often call it the "E1038 CPT code", E1038 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of E1038
FieldValue
Short descriptorTransport chair pt wt<=300lb
Added to HCPCS2003-01-01
Last actionN (no maintenance), effective 2006-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator36: DMEPOS capped rental DME (floors and ceilings)
BETOS categoryD1D: wheelchairs
Type of serviceR: rental of DME

Medicare payment for E1038

DMEPOS fees for E1038, a CR (capped rental items) item, run RR (rental) $16.27 in DC, DE, MD and 3 more to $19.04 in AL, AR, FL and 9 more, rural $22.72 in the October 2026 file. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category CR (capped rental items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for E1038 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)—$16.27 (DC, DE, MD…) to $19.04 (AL, AR, FL…)$22.72 (49 states)AK $22.72, HI $22.72, PR $25.27, VI $22.72

Hospital outpatient (OPPS Addendum B)

Status indicator Y (Non-implantable DME), with no separate OPPS payment rate.

Medically Unlikely Edits for E1038

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction). The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for E1038 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for E1038 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E1038 in v323r0.

E1038 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check E1038 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E1038

1 active Local Coverage Determination and 0 billing and coding articles list E1038. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on E1038

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists E1038

CARC 151 · N362

units of E1038 exceed the DME supplier MUE of 1 per date of service

CARC 4

the RR payment modifier is missing or does not match the item

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for E1038 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E1038 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS E1038

What does HCPCS code E1038 describe?

"Transport chair, adult size, patient weight capacity up to and including 300 pounds" (short descriptor "Transport chair pt wt<=300lb"), in the E section (durable medical equipment). Added 2003-01-01; last action N (no maintenance) effective 2006-01-01.

Is E1038 a CPT code?

No. E1038 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "E1038 CPT code" mean this Level II code.

What does Medicare pay for E1038?

DMEPOS fees for E1038, a CR (capped rental items) item, run RR (rental) $16.27 in DC, DE, MD and 3 more to $19.04 in AL, AR, FL and 9 more, rural $22.72 in the October 2026 file.

How many units of E1038 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction). For the DME supplier MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover E1038?

Coverage code D (special coverage instructions apply). 1 active LCD lists E1038: L33788 (Manual Wheelchair Bases).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.