| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
4,379 |
1,542 |
$2.70M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
3,294 |
1,387 |
$950K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,814 |
2,175 |
$835K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,820 |
3,332 |
$472K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,006 |
900 |
$116K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
726 |
622 |
$98K |
| K0040 |
Adjustable angle footplate, each |
1,028 |
929 |
$92K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
139 |
110 |
$84K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
1,023 |
915 |
$68K |
| K0005 |
Ultralightweight wheelchair |
43 |
39 |
$63K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
137 |
124 |
$56K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
299 |
264 |
$36K |
| E8000 |
Gait trainer, pediatric size, posterior support, includes all accessories and components |
17 |
13 |
$28K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
477 |
427 |
$25K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,012 |
942 |
$25K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
114 |
99 |
$18K |
| K0071 |
Front caster assembly, complete, with pneumatic tire, replacement only, each |
86 |
81 |
$16K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
24 |
24 |
$15K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
46 |
42 |
$14K |
| E1296 |
Special wheelchair seat height from floor |
45 |
44 |
$11K |
| E1298 |
Special wheelchair seat depth and/or width, by construction |
53 |
51 |
$9K |
| K0039 |
Leg strap, h style, each |
99 |
91 |
$7K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
91 |
86 |
$6K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
14 |
14 |
$5K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
29 |
27 |
$4K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
79 |
71 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
99 |
86 |
$3K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
56 |
46 |
$3K |
| E0950 |
Wheelchair accessory, tray, each |
26 |
26 |
$2K |
| E2206 |
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
27 |
25 |
$2K |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
13 |
13 |
$1K |
| E2619 |
Replacement cover for wheelchair seat cushion or back cushion, each |
29 |
26 |
$1K |
| A9270 |
Non-covered item or service |
638 |
491 |
$828.48 |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
14 |
14 |
$803.07 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
30 |
27 |
$552.01 |