| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
6,478 |
2,669 |
$4.83M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
10,682 |
4,757 |
$2.11M |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
6,800 |
4,070 |
$932K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,542 |
1,076 |
$858K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
2,485 |
1,865 |
$428K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
2,360 |
1,938 |
$326K |
| K0005 |
Ultralightweight wheelchair |
182 |
161 |
$233K |
| K0040 |
Adjustable angle footplate, each |
2,116 |
1,667 |
$193K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
5,708 |
4,850 |
$165K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
2,097 |
1,779 |
$142K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,285 |
1,863 |
$123K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
179 |
158 |
$121K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
17 |
14 |
$107K |
| E0950 |
Wheelchair accessory, tray, each |
1,330 |
1,127 |
$106K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
1,783 |
1,451 |
$94K |
| 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 |
68 |
56 |
$84K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
433 |
375 |
$84K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,813 |
2,369 |
$78K |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
15 |
12 |
$63K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
529 |
451 |
$53K |
| E0700 |
Safety equipment, device or accessory, any type |
77 |
54 |
$46K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
134 |
117 |
$34K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
17 |
13 |
$30K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
45 |
39 |
$26K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
211 |
187 |
$25K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
61 |
51 |
$18K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
70 |
51 |
$16K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
31 |
28 |
$10K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
49 |
39 |
$8K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
189 |
156 |
$7K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
701 |
580 |
$6K |
| W4132 |
|
466 |
428 |
$6K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
32 |
24 |
$5K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
64 |
64 |
$5K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
44 |
38 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
226 |
182 |
$4K |
| K0019 |
Arm pad, replacement only, each |
29 |
25 |
$340.89 |
| K0043 |
Footrest, lower extension tube, replacement only, each |
12 |
12 |
$234.44 |