| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
613 |
210 |
$867K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
5,844 |
2,839 |
$832K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
4,677 |
2,822 |
$359K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
512 |
414 |
$211K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
4,876 |
3,782 |
$172K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
2,005 |
1,614 |
$136K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,436 |
1,014 |
$111K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
562 |
533 |
$105K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
115 |
103 |
$91K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
86 |
67 |
$74K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
737 |
503 |
$40K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,393 |
1,060 |
$30K |
| K0040 |
Adjustable angle footplate, each |
440 |
320 |
$30K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
300 |
177 |
$27K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
591 |
443 |
$25K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
165 |
132 |
$16K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
178 |
141 |
$11K |
| K0004 |
High strength, lightweight wheelchair |
65 |
61 |
$5K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
13 |
12 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
233 |
175 |
$5K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
37 |
32 |
$4K |
| E0950 |
Wheelchair accessory, tray, each |
79 |
52 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
20 |
14 |
$3K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
36 |
32 |
$3K |
| E2374 |
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
15 |
12 |
$2K |
| K0019 |
Arm pad, replacement only, each |
163 |
117 |
$2K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
13 |
13 |
$563.43 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
16 |
13 |
$553.31 |