| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,238 |
1,227 |
$55K |
| K0001 |
Standard wheelchair |
1,923 |
1,904 |
$17K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
576 |
329 |
$10K |
| K0003 |
Lightweight wheelchair |
794 |
790 |
$9K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
42 |
42 |
$9K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
97 |
96 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,058 |
2,039 |
$3K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
27 |
26 |
$2K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
104 |
104 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
119 |
93 |
$1K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
64 |
38 |
$626.61 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
132 |
103 |
$623.56 |
| E2375 |
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only |
12 |
12 |
$320.85 |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
26 |
13 |
$143.26 |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
24 |
12 |
$126.36 |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
13 |
13 |
$122.68 |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
26 |
13 |
$75.04 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
50 |
48 |
$74.39 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$42.80 |