California Medi-Cal DME Fee Schedule 2026: Rates and Billing Guide

California Medi-Cal DME fee schedule rates for 2026 set the most Medi-Cal fee-for-service will pay for each piece of durable medical equipment, orthotic, prosthetic and DME-type supply. Most listed rates are capped at 80% of the Medicare rural rate. Wheelchairs, speech-generating devices, complex rehab, and oxygen and respiratory gear get a higher ceiling of 100%.

A published rate is a ceiling, not a promise. A CPAP, a power wheelchair and a custom knee orthosis each reach their 2026 rate through different rental, approval and pricing rules, and many codes carry no fixed dollar amount at all. This guide from the California team at DME Billing Service shows how Medi-Cal turns a HCPCS code into a payment, so suppliers and billers collect the full allowance the first time.

Medi-Cal DME rates at a glance (rates file dated September 15, 2026)

Item	What the 2026 data shows
DMEPOS codes with a published line	1,553 HCPCS codes
Codes with a purchase maximum	1,250
Codes with a rental maximum	372
Codes with no fixed rate (priced By Report)	259
Rate ceiling for most equipment	80% of the Medicare rural rate
Rate ceiling for wheelchairs, SGDs, oxygen and respiratory	100% of the Medicare rural rate
Prior approval trigger for purchases	Over $100 per item group in a calendar month
Clean filing window	6 months from the month of service
Highest single purchase rate	L7180 electronic elbow, $16,310.00
Highest monthly rental	K0606 wearable defibrillator, $1,814.56

Counts come from our analysis of the DHCS Medi-Cal rates file dated September 15, 2026. The full code-by-code table appears further down this page.

Who the 2026 Medi-Cal DME fee schedule rates apply to

The published rates bind Medi-Cal fee-for-service (FFS) claims processed by DHCS. Other payers in California borrow from them or ignore them entirely, and mixing them up is one of the most common pricing errors.

Payer or program	Does the DHCS DME rate apply?	What to check instead
Medi-Cal FFS	Yes, it is the maximum allowance	The rates file and the DME provider manual
Medi-Cal managed care plans (MCPs)	Only if your contract says so	Your plan contract and the plan’s own prior auth rules. TARs for plan members do not go to DHCS.
CCS and EPSDT (members under 21)	Same rate base, broader coverage	Items can be covered when they correct or improve a condition, even beyond adult limits
Medicare + Medi-Cal (dual eligible)	Medi-Cal may pay the difference	The Charpentier crossover process (covered below)
Medi-Cal Rx	No	Enteral nutrition products are listed in the Medi-Cal Rx manual, not this schedule
California workers’ compensation	No	The Division of Workers’ Compensation runs its own DMEPOS fee schedule tied to Medicare updates

Two terms come up constantly. DMEPOS means durable medical equipment, prosthetics, orthotics and supplies, the umbrella the schedule covers. A TAR (Treatment Authorization Request) is Medi-Cal’s name for prior authorization; California Children’s Services uses a SAR (Service Authorization Request) instead.

Medical supplies split in a way that confuses many billers. Medi-Cal Rx has told providers that incontinence, ostomy, wound care, tracheostomy, respiratory, enteral feeding and DME supplies stay medical benefits, billed by HCPCS code on a CMS-1500 or through the member’s plan. Those supply lines are priced from DHCS’s separate Medical Supplies Billing Codes, Units and Quantity Limits list, so you won’t find them in the DME rate file.

How California sets Medi-Cal DME rates for 2026

California law ties every listed DME rate to Medicare, then lets the state pay less. Welfare and Institutions Code 14105.48 and State Plan Amendment 23-0003 make each listed code pay the lowest of these amounts:

1. The amount you billed, which itself cannot exceed the Upper Billing Limit (your usual public charge, or net purchase price plus no more than a 100% markup).
2. The Medi-Cal rate in effect on the prior December 31.
3. A share of the Medicare rural fee schedule for California, or the non-rural rate where no rural one exists:
   • 80% for most DME, orthotics and prosthetics
   • 100% for wheelchairs, wheelchair accessories and replacement parts, speech-generating devices and complex rehab technology
   • 100% for oxygen and respiratory equipment (from January 1, 2024)

The January 1 review only moves rates down. Each year DHCS compares Medi-Cal rates to the new Medicare benchmark and trims any code sitting above it. Codes at or below the cap are left alone, so a Medicare increase does not lift a Medi-Cal rate on its own. DHCS reported that its 2020 through 2023 reviews required no adjustments at all.

The data shows how sticky these figures are. In our comparison, all 78 oxygen and respiratory codes in DHCS’s January 2021 rate attachment carry the identical purchase and rental amounts in the September 2026 file. A CPAP (E0601) still pays $609.55 to buy and $75.37 a month to rent, exactly as it did in 2021.

The AB 97 cut no longer applies to DME. SPA 22-0039 exempted all DME items and services from the 10% AB 97 payment reduction for dates of service on or after July 1, 2022. If your remittance still shows a 10% haircut on a DME line, question it.

How to read 2026 Medi-Cal DME rates without misquoting them

DHCS does not publish a standalone DME rate sheet. Every DME rate sits inside the statewide Medi-Cal Provider Rates download, which mixes nearly 19,500 lines of surgery, lab, vision and equipment codes. Read each column this way:

Column	What it means for DME	Watch out for
Proc Code	The HCPCS Level II code (E, K, L, A, B, V5 series)	Descriptions are cut to about 28 characters, so confirm the full descriptor in the HCPCS book
Basic Rate	Maximum allowance to purchase, or the per-unit price for supplies	$0.00 is not “not covered”. It means no fixed maximum (see below)
Rental Rate	Maximum allowance per rental period	Usually a calendar month, but a few codes rent by the day
Conv Ind	009 = fixed price, so the dollar figure is final. 008 = manual review	Almost every DME line is 009
Proc Type	The provider category the line belongs to	A code can appear twice at different prices

$0.00 means By Report. When a code shows a zero purchase and zero rental amount, DHCS prices each claim by hand from your invoice and the manufacturer’s suggested retail price (MSRP). The 2021 DHCS rate attachment printed these same codes as “By Report”. In the 2026 file, 259 DMEPOS codes fall in this bucket, including the shoulder sling A4566.

$0.01 is a placeholder. About two dozen codes, mostly hearing aids such as V5030, list a penny. Treat these as manually priced too.

A rental-only line has no purchase price. Oxygen concentrators (E1390) rent for $136.87 a month and portable concentrators (E1392) for $45.01, with no purchase amount at all.

Some rentals run by the day. The hospital-grade breast pump (E0604) shows $2.72, a daily rental. Infant phototherapy (E0202) is also billed by the day, capped at 10 days per infant.

Duplicate rows are not errors. Most orthotics and diabetic shoes appear under two procedure types at the same price. Two codes differ: L5685 pays $80.66 on one row and $48.96 on the other, and L5973 lists $12,453.00 against $0.00. Bill against the row that matches your enrolled provider type.

California Medi-Cal DME fee schedule 2026: rates table

The 1,553 codes break down into six families:

Family	Codes	Typical items
Durable medical equipment	563	Wheelchairs, power chairs, oxygen, CPAP, ventilators, lifts, beds, pumps
Orthotics	433	Spinal, knee, ankle-foot and upper-limb braces, foot orthotics, shoes
Prosthetics	403	Lower and upper limb prostheses, breast and voice prostheses, cochlear parts
DME-type supplies	115	CPAP masks and tubing, compression garments, dressings, trach supplies
Hearing aids	29	Hearing aids, ear molds, accessories
Enteral and parenteral nutrition	10	Feeding pumps and parenteral supplies

Most-searched 2026 Medi-Cal DME rates

HCPCS	Item	Purchase max	Monthly rental max
E0601	CPAP device	$609.55	$75.37
E0470	Bi-level RAD without backup rate	$2,364.67	$182.77
E0471	Bi-level RAD with backup rate	$6,164.88	$469.44
E1390	Oxygen concentrator	By Report	$136.87
E0465	Home ventilator, invasive interface	By Report	$944.46
E0570	Nebulizer with compressor	$154.56	$12.53
K0001	Standard wheelchair	$639.24	$42.91
K0005	Ultralightweight wheelchair	$1,817.84	$181.78
E1161	Manual tilt-in-space wheelchair	$2,366.09	$236.61
K0823	Group 2 standard power wheelchair, captain’s chair	$4,828.44	$446.84
K0863	Group 3 very heavy-duty power wheelchair, multiple power options	$12,064.92	$1,005.41
E0630	Hydraulic patient lift	$852.38	$65.99
E0143	Folding wheeled walker	$64.69	$10.60
E0720	TENS, two lead	$172.44	$24.99
E2510	Speech-generating device, multiple access methods	$6,768.25	$600.99
E0784	External insulin infusion pump	By Report	$265.90
B9002	Enteral feeding pump	$907.45	$87.89
A7030	CPAP full face mask	$143.93	Purchase only
L1832	Knee orthosis, adjustable joint, prefabricated	$384.13	Purchase only
L0650	Lumbar-sacral orthosis, prefabricated off-the-shelf	$890.84	Purchase only

Rates are the Medi-Cal FFS maximums in the September 15, 2026 rates file. A plan contract or a TAR adjustment can change what you actually receive.

Medi-Cal DME rental rates vs. purchase rates

Medi-Cal has no fixed capped-rental month count like Medicare’s 13 months. Rental instead ends when the payments add up to the purchase price.

The modifiers Medi-Cal expects

The DME billing manual requires one of three pricing modifiers on equipment lines:

Modifier	Use it for	Notes
RR	Rental	Rental pays for the equipment plus its accessories and supplies
NU	Purchase	Also used for accessories and supplies on equipment the member already owns
RB	Repair or replacement part	Bill the item’s own code plus RB, for example E0295RB

Repair labor codes K0739 (general DME) and K0740 (oxygen equipment) take no modifier. Osteogenesis stimulators (E0747, E0748, E0760) are purchase-only and add KF.

When a rental turns into a purchase

Under 22 CCR 51321, once paid rentals equal the maximum purchase price, the member owns the item and rental payments stop. Two exceptions keep paying: life-support equipment such as ventilators, and items that need ongoing service.

Worked examples from the 2026 rates:

Item	Purchase max	Monthly rental	Full rental months	Final partial payment
CPAP (E0601)	$609.55	$75.37	8 ($602.96)	$6.59 in month 9
Group 2 power wheelchair (K0823)	$4,828.44	$446.84	10 ($4,468.40)	$360.04 in month 11
Hydraulic patient lift (E0630)	$852.38	$65.99	12 ($791.88)	$60.50 in month 13

Rental months follow calendar months under 22 CCR 51521(j). The delivery date is the date of service, so the signed delivery ticket anchors the first rental period.

What the rate already includes

The maximum allowance covers freight, delivery, setup, instruction and routine servicing of rented equipment. Shipping and handling cannot be billed on top, and labor for delivery or setup of new or rented items is not payable.

TARs and claim rules that decide whether the rate pays

A listed Medi-Cal DME rate only pays when the paperwork behind it holds up. These thresholds and claim fields decide whether you collect the allowance or a denial.

When a TAR is required

Service	TAR needed when	Source
DME purchase	Cumulative cost in an item group tops $100 in a calendar month	22 CCR 51321(b)
DME rental	Cumulative rental in an item group tops $50 within 15 months	22 CCR 51321(b)
Repair and maintenance	Cumulative cost in an item group tops $250	22 CCR 51321(b)
Unlisted equipment (E1399, K0108)	Always, at any dollar amount	22 CCR 51321(b)
Oxygen contents (E0441)	Beyond the equivalent of two H tanks in a month	22 CCR 51321(b)
Orthotics	Purchase, replacement and repair above $250 in 90 days	NHeLP Medi-Cal guide, ch. 10
Prosthetics	Above $500 in 90 days	NHeLP Medi-Cal guide, ch. 10
Enteral nutrition	Always	NHeLP Medi-Cal guide, ch. 10

The “item group” wording matters. Several items from the same group delivered in one month count together, so separate claims do not avoid a TAR once their combined cost crosses the limit. Approval is also capped at the lowest-cost item that meets the member’s needs, so justify every upgrade.

What the prescription must show

A signed written order from a licensed prescriber must list:

• Prescriber’s full name and phone number
• Date written
• The specific item
• Diagnosis, functional limitations and how the item helps
• Estimated length of medical need

A prescription older than one year needs renewing. The prescriber must also see the member face to face, in person or by telehealth, within six months before writing the order.

Claim fields that cause rejections

CMS-1500 box	What goes there
19	Repair details, invoice or MSRP statements, the QRTP name for wheelchairs, or the Charpentier message
22	Resubmission code: R (rate), L (benefit limit) or T (both)
23	The 11-digit TAR control number
24C	Delay reason code 7 when billing more than six months after the service month
24G	Item count when several unlisted items share one line

Electronic 837P claims carry the same data in their matching loops. For managed care members, skip DHCS entirely: follow the plan’s own authorization rules.

Filing deadlines and late-claim cuts

Under Welfare and Institutions Code 14115, Medi-Cal FFS claims are due within six months after the month of service. Late claims without a valid delay reason lose money:

Submitted in	Payment
Months 1 to 6	100%
Months 7 to 9	Reduced by 25%
Months 10 to 12	Reduced by 50%
After 12 months	Generally not payable

Exceptions exist for late eligibility identification, third-party liability and circumstances beyond your control.

Medi-Cal DME rates for By Report and unlisted items

About one in six DMEPOS codes has no fixed rate, so knowing the manual pricing formulas is worth real money. On every path below, Medi-Cal pays the lowest of the amounts listed. Wheelchair items are the only By Report path where documentation raises the payment: naming a qualified rehab professional (QRTP) lifts the MSRP share from 80% to 85%. The By Report rules above apply to dates of service from January 1, 2013, per the DME billing manual. The MSRP must be published on or before the date of service.

Worked example

Take an item with a $1,000 invoice, a $1,500 MSRP and a $1,800 billed charge:

Scenario	80% or 85% of MSRP	Invoice plus 67%	Medi-Cal pays
Non-wheelchair DME	$1,200	$1,670	$1,200
Wheelchair item, QRTP documented	$1,275	$1,670	$1,275
Wheelchair item, no QRTP named	$1,200	$1,670	$1,200

On the wheelchair line, naming the QRTP in Box 19 adds $75. For a By Report supply with a $40 invoice billed at $60, Medi-Cal pays $49.20 (invoice plus 23%).

What to attach

• Manufacturer’s purchase invoice and a catalog page showing MSRP
• Manufacturer name, model number, catalog number and item description
• A taxable or nontaxable statement for each item
• For unlisted supplies (A9900): proof the equipment is member-owned
• For several unlisted items on one E1399 or K0108 line: the item count in Box 24G, with each attachment line numbered

Claims missing any of these are denied, not suspended. Unlisted items always need a TAR first.

2026 Medi-Cal DME rates and rules by equipment category

The rate is only usable once you know the coverage rule sitting behind it. These are the item-level policies from the Medi-Cal DME manual and Title 22 that most often change what a claim pays.

Equipment	Rule that shapes payment	2026 rate anchor
Oxygen concentrators and systems	Rental only. Oxygen contents (E0441) need a TAR beyond two H tanks a month. Oxygen repair labor bills as K0740.	E1390 $136.87/mo
Ventilators	Life-support equipment, so rental keeps paying past the purchase price	E0465 $944.46/mo
Wheelchairs and seating	100% Medicare cap. Replacement generally once every five years. Listed replacement parts bill with RB and NU on the same line.	K0005 $1,817.84
Speech-generating devices	Same 100% cap and five-year replacement rule as wheelchairs	E2510 $6,768.25
TENS units (E0720, E0730)	Manual treats them as rental only. The unit becomes member-owned after 10 months. Supplies (A4595) limited to 1 unit a month for two leads, 2 for four.	E0720 $24.99/mo
Breast pumps	Manual (E0602) and electric (E0603) need no TAR. Hospital-grade (E0604) rents by the day. Replacement parts A4281 to A4286 limited to two per 12 months.	E0603 $93.15
Negative pressure wound therapy	First TAR covers up to 15 days, renewable to 120 days total. Dressing sets (A6550) capped at 15 a month.	E2402 rental $45.77
Lymphedema pumps (E0650 to E0682)	TAR required, 60-day trial rental first, after at least 30 days of conservative therapy	E0650 $576.18
Standers	Three-month rental before purchase, unless the member has already stood 3 to 4 times a week for 3 months	Priced by code
Hospital beds	Heavy-duty E0303 for 351 to 600 lb, E0304 above 600 lb. Total electric beds are treated as convenience items and not covered.	Priced by code
Blood glucose monitors	E0607 and E2104 are standard. Monitors with special features (E2100, E2101) always need a TAR.	E0607 $53.46
Hearing aids (V5 codes)	Many list a $0.01 placeholder, so payment comes through manual pricing	V5030 $0.01
Enteral nutrition	Pumps and supplies bill as DME. Formula products are covered through Medi-Cal Rx, and enteral always needs prior approval.	B9002 $907.45

Warranties and repairs

Purchased equipment must carry at least a six-month guarantee, and repairs at least three months. Medi-Cal will not pay parts or labor for defects inside those windows. Outside them, repair labor bills in 15-minute units rounded to the nearest quarter hour, and total repair cost cannot exceed the item’s replacement value. Since January 1, 2025, power wheelchair suppliers must be able to get parts, tools and manuals at fair and reasonable prices.

Dual-eligible members (Charpentier crossovers)

For members with both Medicare and Medi-Cal, you can bill Medi-Cal for the gap between Medicare’s payment and the Medi-Cal rate. Put “Medi/Medi: Charpentier/Rates” (or Benefit Limitation, or Both) in the TAR justification and in Box 19. Attach the Medicare EOMB or MRN and proof of any other carrier’s payment.

Denials that cost you the Medi-Cal DME rate, and how to fix them

Most rejected DME claims in California fall into a handful of patterns. Each has a direct fix.

Denial trigger	Why it happens	Fix
No TAR on file	Monthly group spending crossed $100 (purchase) or $50 (rental within 15 months)	Track cumulative spend per item group before delivery, not per claim
Accessory billed with RR	Accessories are bundled into the rental payment	Bill accessories only for member-owned equipment, with NU
Rental paid after cap	Paid rentals already equal the purchase price	Stop billing at the cap unless the item is life support
By Report claim denied	Invoice, MSRP page or taxable statement missing	Attach all of them before submitting
MSRP rejected	The price list is dated after the date of service	Use a catalog page published on or before delivery
Shipping or setup line denied	Delivery, setup and instruction are built into the rate	Remove the line; do not bill K0739 for setup
Labor denied during warranty	Repairs inside the 6-month (purchase) or 3-month (repair) guarantee are the supplier’s cost	Check the warranty date before billing labor
Payment cut by 25% or 50%	Filed 7 to 12 months after the service month	Submit within 6 months, or use delay reason code 7 with proof
Plan member billed to DHCS	Managed care members are paid by their plan	Verify eligibility and plan assignment on the date of service
Prescription rejected	Older than one year, or missing diagnosis, functional need or length of need	Request a renewed, complete order
Frequency limit hit	Item already replaced within its limit (for example two pump part sets per year)	Document loss, theft or a changed condition to justify early replacement
Enteral formula denied on a medical claim	Formula products belong to Medi-Cal Rx	Route formula through a pharmacy; keep pumps and supplies on the DME claim

If a denial looks like a processing error, send a Claims Inquiry Form (CIF). If you disagree with the decision itself, file a formal provider appeal. If denials keep eating into your Medi-Cal reimbursement, our California DME billing services handle TARs, rental tracking, By Report pricing packets and appeals for suppliers across the state. Contact us to talk through your Medi-Cal claims.

Pre-billing List for Collecting The Full Medi-Cal DME rate

• Confirm the member’s Medi-Cal eligibility and whether a managed care plan covers the date of service
• Match the HCPCS code to the right row (procedure type) in the current rates file
• Check whether the item is purchase, rental, rental-only or By Report
• Add up same-group costs for the month and secure a TAR when a threshold is crossed
• Verify the prescription is under one year old and lists all five required elements
• Confirm the face-to-face visit happened within six months before the order
• Apply RR, NU or RB correctly, and KF for bone growth stimulators
• For By Report items, attach the invoice, a dated MSRP page and the taxable statement
• For wheelchairs, name the QRTP in Box 19 to unlock 85% of MSRP
• Track rental months against the purchase price so billing stops at the cap
• Submit within six months of the service month