| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0637 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
25 |
15 |
$12K |
| K0005 |
Ultralightweight wheelchair |
110 |
70 |
$10K |
| K0003 |
Lightweight wheelchair |
1,468 |
1,187 |
$10K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
370 |
284 |
$9K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
737 |
282 |
$5K |
| K0001 |
Standard wheelchair |
769 |
625 |
$4K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
95 |
72 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
721 |
273 |
$3K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
383 |
291 |
$2K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
692 |
261 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
601 |
232 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
413 |
292 |
$657.02 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
94 |
28 |
$429.90 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
139 |
100 |
$288.57 |
| E2218 |
Manual wheelchair accessory, foam propulsion tire, any size, each |
147 |
48 |
$264.30 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$261.88 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
51 |
18 |
$203.17 |