| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
2,474 |
1,072 |
$1.13M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
9,213 |
4,708 |
$1.01M |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
9,483 |
5,965 |
$736K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
11,361 |
9,481 |
$610K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
2,615 |
2,261 |
$590K |
| K0005 |
Ultralightweight wheelchair |
432 |
356 |
$481K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,990 |
1,671 |
$350K |
| E0986 |
Manual wheelchair accessory, power assist system |
482 |
387 |
$337K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
1,610 |
1,256 |
$310K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
4,284 |
3,815 |
$241K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,028 |
2,230 |
$222K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
988 |
847 |
$204K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
600 |
395 |
$188K |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
57 |
41 |
$156K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
58 |
38 |
$154K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
1,253 |
882 |
$123K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
1,125 |
927 |
$120K |
| K0040 |
Adjustable angle footplate, each |
2,024 |
1,576 |
$115K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,561 |
2,352 |
$109K |
| 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 |
116 |
89 |
$101K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
363 |
295 |
$78K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,791 |
1,460 |
$76K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
1,328 |
1,132 |
$72K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,606 |
2,221 |
$59K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
485 |
453 |
$54K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
187 |
169 |
$50K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
185 |
145 |
$48K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
798 |
611 |
$46K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
146 |
118 |
$34K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
1,002 |
834 |
$32K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
285 |
276 |
$32K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
116 |
91 |
$27K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,049 |
842 |
$26K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
701 |
567 |
$26K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
30 |
24 |
$21K |
| 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 |
108 |
93 |
$21K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
111 |
104 |
$19K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
227 |
190 |
$18K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
41 |
28 |
$18K |
| K0019 |
Arm pad, replacement only, each |
1,268 |
1,011 |
$17K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
131 |
107 |
$13K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
318 |
256 |
$13K |
| E0950 |
Wheelchair accessory, tray, each |
170 |
140 |
$12K |
| E2206 |
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
377 |
249 |
$10K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
58 |
42 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
137 |
132 |
$9K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
72 |
64 |
$6K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
185 |
147 |
$6K |
| E2615 |
Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware |
18 |
16 |
$5K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
75 |
56 |
$5K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
30 |
24 |
$5K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
24 |
24 |
$4K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
12 |
12 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
25 |
24 |
$3K |
| K0004 |
High strength, lightweight wheelchair |
16 |
12 |
$3K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
13 |
12 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
116 |
80 |
$1K |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
18 |
12 |
$816.08 |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
22 |
12 |
$802.93 |
| K0077 |
Front caster assembly, complete, with solid tire, replacement only, each |
17 |
12 |
$771.98 |
| E2205 |
Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each |
13 |
13 |
$679.76 |
| K0043 |
Footrest, lower extension tube, replacement only, each |
21 |
14 |
$265.02 |
| E0952 |
Toe loop/holder, any type, each |
17 |
12 |
$245.99 |
| A4927 |
Gloves, non-sterile, per 100 |
12 |
12 |
$212.91 |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
14 |
12 |
$108.10 |