| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
174 |
111 |
$238K |
| E1008 |
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction |
209 |
137 |
$148K |
| 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 |
362 |
238 |
$63K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
388 |
244 |
$26K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
358 |
237 |
$24K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
350 |
229 |
$17K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,306 |
399 |
$13K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
532 |
412 |
$10K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
20 |
12 |
$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 |
315 |
175 |
$7K |
| E2359 |
Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
169 |
110 |
$5K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
495 |
309 |
$5K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
191 |
109 |
$4K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
227 |
72 |
$3K |
| K0004 |
High strength, lightweight wheelchair |
313 |
227 |
$2K |
| 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 |
391 |
234 |
$2K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
64 |
46 |
$1K |
| K0040 |
Adjustable angle footplate, each |
235 |
145 |
$858.57 |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
89 |
31 |
$763.46 |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
39 |
25 |
$736.94 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
82 |
55 |
$664.92 |
| E2370 |
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
233 |
132 |
$620.48 |
| K0001 |
Standard wheelchair |
89 |
71 |
$149.18 |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
20 |
13 |
$45.30 |