| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
5,389 |
4,343 |
$5.08M |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
4,879 |
3,982 |
$4.97M |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
3,257 |
2,651 |
$4.09M |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
861 |
681 |
$3.66M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
10,859 |
5,783 |
$2.77M |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
10,109 |
6,300 |
$1.98M |
| K0005 |
Ultralightweight wheelchair |
1,351 |
1,110 |
$1.95M |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
458 |
373 |
$1.70M |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
1,229 |
973 |
$1.59M |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
1,098 |
874 |
$1.50M |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
4,492 |
3,123 |
$675K |
| E2203 |
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches |
1,924 |
1,605 |
$645K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
5,047 |
4,079 |
$593K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
4,995 |
3,805 |
$567K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
3,405 |
2,732 |
$458K |
| K0040 |
Adjustable angle footplate, each |
4,789 |
3,689 |
$445K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,240 |
1,046 |
$331K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
1,153 |
921 |
$272K |
| E0986 |
Manual wheelchair accessory, power assist system |
90 |
76 |
$265K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
2,266 |
1,840 |
$232K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,951 |
3,091 |
$227K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
1,188 |
942 |
$211K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
889 |
736 |
$155K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,858 |
3,175 |
$138K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
518 |
417 |
$114K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
2,977 |
2,344 |
$97K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
660 |
565 |
$93K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
1,933 |
1,569 |
$79K |
| E2204 |
Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches |
131 |
114 |
$71K |
| E0954 |
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot |
382 |
261 |
$51K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
2,183 |
1,396 |
$38K |
| E2300 |
Wheelchair accessory, power seat elevation system, any type |
23 |
15 |
$36K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,252 |
1,051 |
$32K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
142 |
92 |
$15K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
38 |
30 |
$10K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
19 |
12 |
$4K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
13 |
13 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,252 |
1,065 |
$3K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
51 |
45 |
$2K |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
26 |
26 |
$2K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
20 |
14 |
$2K |
| E2323 |
Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated |
36 |
29 |
$1K |
| K0019 |
Arm pad, replacement only, each |
29 |
25 |
$394.43 |
| K0004 |
High strength, lightweight wheelchair |
14 |
12 |
$69.88 |