E0197 HCPCS code: Air pressure pad for mattress, standard mattress length and width
E0197 is the HCPCS Level II code for air pressure pad for mattress, standard mattress length and width. The 2026 Medicare DMEPOS fee schedule pays $20.93 to $73.25 (RR, rental (monthly)) depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume fell 20% from 2022 to 2024 (894 to 713 services). In 2024, 61 suppliers billed Medicare for E0197 (rentals), serving 157 beneficiaries; Oklahoma, Minnesota, California accounted for 36% of services. Its average fee ranks 38 of 51 E01 codes billed RR (family range $1.36–$4,390.87); rural fees run 32% higher.
Code details
| Field | Value |
|---|---|
| Section | E codes — Durable medical equipment |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 36 — DMEPOS: capped rental item |
| BETOS category | D1E — Other durable medical equipment |
| Added | 1991-01-01 |
| Last action effective | 2016-07-01 |
2026 Medicare DMEPOS fee schedule for E0197
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $20.93 | $73.25 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $69.94 | — |
| AL | RR | $21.12 | $30.91 |
| AR | RR | $21.12 | $30.91 |
| AZ | RR | $21.58 | $30.91 |
| CA | RR | $21.61 | $34.17 |
| CO | RR | $23.02 | $34.17 |
| CT | RR | $23.59 | $30.91 |
| DC | RR | $22.72 | $34.17 |
| DE | RR | $22.72 | $34.17 |
| FL | RR | $21.12 | $30.91 |
| GA | RR | $21.12 | $30.91 |
| HI | RR | $73.25 | — |
| IA | RR | $23.93 | $34.17 |
| ID | RR | $23.02 | $34.17 |
| IL | RR | $23.50 | $31.91 |
| IN | RR | $23.50 | $30.91 |
| KS | RR | $23.93 | $34.17 |
| KY | RR | $21.12 | $30.91 |
| LA | RR | $21.12 | $30.91 |
| MA | RR | $23.59 | $30.91 |
| MD | RR | $22.72 | $34.17 |
| ME | RR | $23.59 | $30.91 |
| MI | RR | $23.50 | $34.17 |
| MN | RR | $23.93 | $34.17 |
| MO | RR | $23.93 | $34.17 |
| MS | RR | $21.12 | $30.91 |
| MT | RR | $23.02 | $34.17 |
| NC | RR | $21.12 | $30.91 |
| ND | RR | $23.93 | $34.17 |
| NE | RR | $23.93 | $34.17 |
| NH | RR | $23.59 | $30.91 |
| NJ | RR | $22.72 | $34.17 |
| NM | RR | $21.58 | $30.91 |
| NV | RR | $21.61 | $30.91 |
| NY | RR | $22.72 | $30.91 |
| OH | RR | $23.50 | $34.17 |
| OK | RR | $21.58 | $30.91 |
| OR | RR | $21.61 | $34.17 |
| PA | RR | $22.72 | $34.17 |
| PR | RR | $20.93 | — |
| RI | RR | $23.59 | $34.17 |
| SC | RR | $21.12 | $30.91 |
| SD | RR | $23.93 | $31.65 |
| TN | RR | $21.12 | $30.91 |
| TX | RR | $21.58 | $30.91 |
| UT | RR | $23.02 | $34.17 |
| VA | RR | $21.12 | $34.17 |
| VI | RR | $37.03 | — |
| VT | RR | $23.59 | $30.91 |
| WA | RR | $21.61 | $34.17 |
| WI | RR | $23.50 | $34.17 |
| WV | RR | $21.12 | $34.17 |
| WY | RR | $23.02 | $34.17 |
How the E0197 fee compares
| Measure | Value |
|---|---|
| Rank among 51 E01 codes billed RR (lowest = 1) | 38 |
| Family fee range (average of state fees) | $1.36–$4,390.87 |
| Rural fee uplift | 32.4% |
Who bills E0197 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 61 |
| Suppliers billing purchases | — |
| Referring clinicians | 143 |
| Medicare beneficiaries | 157 |
| States with claims | 20 |
| Share of services in top 3 states (Oklahoma, Minnesota, California) | 36% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 50 | 197 |
| 2023 | 60 | 211 |
| 2024 | 61 | 157 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E0197, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 894 | 197 | $17.84 | $12.67 |
| 2023 | 1,092 | 211 | $18.10 | $13.12 |
| 2024 | 713 | 157 | $18.12 | $12.80 |
States with the most E0197 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Oklahoma | 92 | $13.66 |
| Minnesota | 79 | $12.99 |
| California | 72 | $11.91 |
| Pennsylvania | 58 | $11.10 |
| South Carolina | 57 | $12.19 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52489: Pressure Reducing Support Surfaces - Group 1 - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for E0197
- 2026-01-01: Average state fee (RR) rose 2.6%: $24.00 to $24.63
- 1991-01-01: E0197 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code E0197?
E0197 is the HCPCS Level II code for air pressure pad for mattress, standard mattress length and width. Short descriptor: "Air pressure pad for mattres".
How much does Medicare pay for E0197?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $20.93–$73.25. Rural fees can be higher.
Does Medicare cover E0197?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for E0197 change in 2026?
The average non-rural state fee for RR moved from $24.00 in 2025 to $24.63 in 2026 (+2.6%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of E0197 can be billed per day?
1 on DME suppliers (NCCI medically unlikely edits).
Related E01 codes
- E0100 — Cane, includes canes of all materials, adjustable or fixed, with tip ($6.11–$48.89)
- E0105 — Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips ($10.74–$86.55)
- E0110 — Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips ($17.71–$141.62)
- E0111 — Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips ($8.81–$80.49)
- E0112 — Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips ($7.97–$63.92)
- E0113 — Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip ($4.00–$55.77)
- E0114 — Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips ($10.38–$88.73)
- E0116 — Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each ($5.58–$44.38)
- E0117 — Crutch, underarm, articulating, spring assisted, each ($27.45–$32.96)
- E0118 — Crutch substitute, lower leg platform, with or without wheels, each
- E0130 — Walker, rigid (pickup), adjustable or fixed height ($5.35–$86.89)
- E0135 — Walker, folding (pickup), adjustable or fixed height ($5.35–$105.44)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under E0197
- Watch E0197 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0197
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.