| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
9,404 |
3,336 |
$833K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
2,434 |
2,244 |
$512K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
452 |
360 |
$348K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
5,513 |
3,749 |
$314K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
399 |
326 |
$277K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
5,206 |
4,228 |
$270K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,075 |
1,061 |
$184K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
3,654 |
3,241 |
$159K |
| E1399 |
Durable medical equipment, miscellaneous |
757 |
183 |
$156K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,408 |
1,021 |
$120K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,467 |
2,456 |
$111K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,075 |
1,045 |
$87K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,678 |
1,667 |
$68K |
| K0040 |
Adjustable angle footplate, each |
936 |
684 |
$64K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,796 |
1,726 |
$56K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,333 |
1,257 |
$55K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
593 |
417 |
$54K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
1,018 |
840 |
$50K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
669 |
621 |
$49K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
251 |
251 |
$46K |
| 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) |
469 |
468 |
$41K |
| A7030 |
Full face mask used with positive airway pressure device, each |
807 |
798 |
$38K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
433 |
421 |
$32K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,463 |
1,243 |
$31K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
460 |
368 |
$29K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
575 |
417 |
$24K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
831 |
588 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
1,041 |
1,017 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
438 |
429 |
$18K |
| K0001 |
Standard wheelchair |
583 |
568 |
$15K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
725 |
720 |
$14K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
95 |
94 |
$14K |
| A7031 |
Face mask interface, replacement for full face mask, each |
515 |
504 |
$13K |
| A4927 |
Gloves, non-sterile, per 100 |
930 |
888 |
$12K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
767 |
758 |
$8K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
60 |
52 |
$7K |
| 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 |
44 |
36 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
352 |
227 |
$5K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
32 |
29 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
134 |
134 |
$4K |
| E2206 |
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
136 |
86 |
$4K |
| K0019 |
Arm pad, replacement only, each |
444 |
292 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,592 |
1,572 |
$4K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
64 |
52 |
$4K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
115 |
86 |
$4K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
15 |
12 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
12 |
12 |
$3K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
17 |
13 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
153 |
150 |
$2K |
| E0950 |
Wheelchair accessory, tray, each |
44 |
36 |
$2K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
23 |
12 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
24 |
24 |
$2K |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
30 |
24 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
107 |
107 |
$2K |
| E0952 |
Toe loop/holder, any type, each |
81 |
63 |
$1K |
| E0570 |
Nebulizer, with compressor |
36 |
36 |
$1K |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
105 |
80 |
$873.01 |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
20 |
15 |
$741.26 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
17 |
12 |
$324.02 |