| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
1,691 |
346 |
$606K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
6,087 |
2,466 |
$496K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
7,926 |
3,448 |
$345K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
5,999 |
4,686 |
$262K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
2,311 |
1,876 |
$115K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
362 |
319 |
$58K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
593 |
318 |
$33K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
539 |
364 |
$32K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
68 |
59 |
$17K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
273 |
194 |
$15K |
| K0040 |
Adjustable angle footplate, each |
334 |
221 |
$15K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
647 |
491 |
$13K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
63 |
49 |
$9K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
207 |
141 |
$7K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
38 |
25 |
$6K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
189 |
125 |
$4K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
31 |
24 |
$4K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
81 |
50 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
162 |
97 |
$2K |
| E0950 |
Wheelchair accessory, tray, each |
15 |
12 |
$787.33 |
| K0019 |
Arm pad, replacement only, each |
38 |
25 |
$655.97 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
32 |
26 |
$628.56 |
| K0004 |
High strength, lightweight wheelchair |
12 |
12 |
$464.85 |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
20 |
13 |
$445.26 |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
18 |
14 |
$413.86 |