| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,461 |
3,869 |
$118K |
| K0001 |
Standard wheelchair |
10,238 |
9,079 |
$105K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
448 |
316 |
$91K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,291 |
1,142 |
$46K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
9,765 |
8,580 |
$41K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
741 |
654 |
$35K |
| K0003 |
Lightweight wheelchair |
1,666 |
1,504 |
$31K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
645 |
557 |
$18K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
316 |
278 |
$16K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,843 |
1,574 |
$15K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
871 |
757 |
$11K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,130 |
983 |
$11K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
642 |
553 |
$11K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,411 |
2,173 |
$8K |
| K0007 |
Extra heavy duty wheelchair |
174 |
153 |
$6K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
384 |
341 |
$4K |
| K0006 |
Heavy duty wheelchair |
132 |
105 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
42 |
42 |
$3K |
| K0002 |
Standard hemi (low seat) wheelchair |
191 |
178 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
359 |
326 |
$2K |
| A4554 |
Disposable underpads, all sizes |
126 |
105 |
$2K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
545 |
474 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
12 |
12 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
13 |
13 |
$691.25 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
159 |
145 |
$615.01 |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
41 |
36 |
$393.18 |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
1,234 |
1,138 |
$310.73 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
78 |
78 |
$31.22 |