| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification |
163 |
148 |
$998K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12,011 |
10,994 |
$528K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
508 |
306 |
$485K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
999 |
926 |
$275K |
| E1399 |
Durable medical equipment, miscellaneous |
110 |
82 |
$158K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,488 |
3,175 |
$102K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,740 |
7,052 |
$82K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
2,462 |
2,242 |
$67K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
982 |
835 |
$66K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,070 |
951 |
$64K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
982 |
885 |
$33K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
44 |
15 |
$32K |
| K0005 |
Ultralightweight wheelchair |
19 |
19 |
$31K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
4,780 |
2,377 |
$25K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,029 |
614 |
$24K |
| E0570 |
Nebulizer, with compressor |
2,568 |
2,325 |
$22K |
| A7030 |
Full face mask used with positive airway pressure device, each |
434 |
374 |
$21K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
352 |
213 |
$19K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,052 |
971 |
$18K |
| K0004 |
High strength, lightweight wheelchair |
937 |
883 |
$17K |
| K0001 |
Standard wheelchair |
1,691 |
1,568 |
$14K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
67 |
40 |
$14K |
| E1392 |
Portable oxygen concentrator, rental |
1,220 |
1,124 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
604 |
530 |
$13K |
| A7037 |
Tubing used with positive airway pressure device |
1,053 |
908 |
$11K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
161 |
125 |
$11K |
| A7031 |
Face mask interface, replacement for full face mask, each |
397 |
355 |
$10K |
| A7035 |
Headgear used with positive airway pressure device |
808 |
676 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
68 |
63 |
$6K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
106 |
100 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,143 |
931 |
$4K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
101 |
92 |
$4K |
| K0040 |
Adjustable angle footplate, each |
84 |
41 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
48 |
17 |
$3K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
114 |
65 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
71 |
65 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
106 |
60 |
$1K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
14 |
12 |
$820.66 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
14 |
12 |
$771.15 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
41 |
40 |
$345.05 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
13 |
12 |
$341.77 |
| E0156 |
Seat attachment, walker |
72 |
69 |
$243.42 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
59 |
52 |
$237.55 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
66 |
63 |
$85.38 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
13 |
12 |
$75.50 |