| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
1,368 |
1,150 |
$1.87M |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
1,068 |
926 |
$1.50M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
5,365 |
2,955 |
$1.29M |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
4,861 |
3,381 |
$1.27M |
| E1399 |
Durable medical equipment, miscellaneous |
855 |
393 |
$1.09M |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
6,831 |
4,205 |
$446K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
5,708 |
4,162 |
$208K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
7,183 |
4,530 |
$148K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,322 |
1,038 |
$136K |
| E0986 |
Manual wheelchair accessory, power assist system |
180 |
124 |
$104K |
| K0040 |
Adjustable angle footplate, each |
1,468 |
1,096 |
$102K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,157 |
894 |
$53K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,537 |
1,334 |
$37K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
480 |
427 |
$29K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
75 |
67 |
$25K |
| K0005 |
Ultralightweight wheelchair |
12 |
12 |
$16K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
72 |
54 |
$10K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
55 |
49 |
$10K |
| E2359 |
Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
31 |
27 |
$7K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
13 |
12 |
$4K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
111 |
78 |
$3K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
12 |
12 |
$3K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
16 |
13 |
$3K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
13 |
12 |
$2K |
| E0950 |
Wheelchair accessory, tray, each |
14 |
12 |
$715.96 |
| E0954 |
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot |
17 |
12 |
$679.70 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
29 |
12 |
$141.40 |