| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
17,499 |
3,231 |
$6.97M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
14,075 |
5,153 |
$1.79M |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
2,114 |
1,613 |
$687K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
705 |
634 |
$639K |
| K0005 |
Ultralightweight wheelchair |
576 |
486 |
$606K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
11,062 |
4,884 |
$527K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
95 |
77 |
$318K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
8,239 |
6,423 |
$233K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
4,326 |
3,382 |
$211K |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
78 |
63 |
$187K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
2,911 |
2,111 |
$152K |
| 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 |
166 |
126 |
$146K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
1,186 |
962 |
$131K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
214 |
166 |
$127K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
1,994 |
1,047 |
$125K |
| K0040 |
Adjustable angle footplate, each |
2,123 |
1,595 |
$112K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
848 |
739 |
$108K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
2,097 |
1,725 |
$101K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,325 |
1,859 |
$69K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,920 |
2,416 |
$44K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
203 |
168 |
$42K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
960 |
757 |
$35K |
| E0950 |
Wheelchair accessory, tray, each |
663 |
561 |
$33K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
292 |
259 |
$32K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
1,011 |
808 |
$31K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
101 |
82 |
$24K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
126 |
115 |
$22K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
146 |
107 |
$21K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,461 |
1,149 |
$21K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
39 |
28 |
$21K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
17 |
16 |
$18K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
39 |
29 |
$18K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
204 |
177 |
$16K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
174 |
140 |
$14K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
122 |
122 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
75 |
67 |
$10K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
20 |
16 |
$9K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
50 |
37 |
$8K |
| E2615 |
Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware |
26 |
24 |
$8K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
55 |
48 |
$5K |
| T4541 |
Incontinence product, disposable underpad, large, each |
39 |
27 |
$5K |
| E0952 |
Toe loop/holder, any type, each |
235 |
195 |
$5K |
| 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 |
21 |
15 |
$5K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
101 |
69 |
$5K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
118 |
65 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
125 |
105 |
$3K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
49 |
38 |
$2K |
| K0019 |
Arm pad, replacement only, each |
265 |
186 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
171 |
159 |
$2K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
16 |
12 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
92 |
86 |
$792.46 |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
15 |
12 |
$788.67 |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
13 |
13 |
$284.51 |
| K0038 |
Leg strap, each |
16 |
12 |
$230.65 |
| E2619 |
Replacement cover for wheelchair seat cushion or back cushion, each |
17 |
12 |
$209.51 |