E1701 — Replacement cushions for jaw motion rehabilitation system, pkg. of 6
E1701 is a HCPCS Level II code for replacement cushions for jaw motion rehabilitation system, pkg. of 6. It belongs to the Durable Medical Equipment section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of E1701 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- DME supplier
- 3 units MAI 3 — Date of Service Edit: Clinical · Clinical: Data
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for E1701
- Long descriptor
- Replacement cushions for jaw motion rehabilitation system, pkg. of 6
- Short descriptor
- Repl cushions for jaw motion
- Added
- January 1, 1993
- BETOS
- D1E
- Pricing indicator
- 34 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
DME supplies. Price subject to floors and ceilings.
Codes adjacent to E1701
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If E1701 is not quite right, the correct code is very often within a few positions of it.
- E1632Wearable artificial kidney, each
- E1634Peritoneal dialysis clamps, each
- E1635Compact (portable) travel hemodialyzer system
- E1636Sorbent cartridges, for hemodialysis, per 10
- E1637Hemostats, each
- E1639Scale, each
- E1699Dialysis equipment, not otherwise specified
- E1700Jaw motion rehabilitation system
- E1702Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200
- E1800Dynamic adjustable elbow extension and flexion device, includes soft interface material
- E1801Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories
- E1802Dynamic adjustable forearm pronation/supination device, includes soft interface material
- E1803Dynamic adjustable elbow extension only device, includes soft interface material
- E1804Dynamic adjustable elbow flexion only device, includes soft interface material
- E1805Dynamic adjustable wrist extension and flexion device, includes soft interface material
- E1806Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories
Questions about E1701
What is HCPCS code E1701?
E1701 is a HCPCS Level II code for replacement cushions for jaw motion rehabilitation system, pkg. of 6. It sits in the Durable Medical Equipment section.
Does Medicare cover E1701?
The CMS HCPCS file marks E1701 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.