| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
9,300 |
8,930 |
$335K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,455 |
4,344 |
$230K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,258 |
1,247 |
$141K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
2,631 |
2,506 |
$126K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
2,118 |
2,057 |
$114K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
497 |
496 |
$111K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
9,318 |
5,534 |
$110K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
819 |
791 |
$110K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
1,554 |
1,511 |
$106K |
| K0006 |
Heavy duty wheelchair |
1,182 |
1,160 |
$105K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
6,975 |
6,497 |
$96K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,135 |
1,131 |
$88K |
| E0245 |
Tub stool or bench |
1,408 |
1,403 |
$75K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
111 |
111 |
$68K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
321 |
289 |
$58K |
| E0601 |
Continuous positive airway pressure (cpap) device |
650 |
646 |
$44K |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
124 |
72 |
$42K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
754 |
753 |
$38K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
179 |
179 |
$32K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,148 |
1,143 |
$29K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
55 |
41 |
$28K |
| K0003 |
Lightweight wheelchair |
822 |
817 |
$27K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,324 |
1,189 |
$27K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
830 |
803 |
$25K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
26 |
26 |
$23K |
| E0570 |
Nebulizer, with compressor |
519 |
518 |
$22K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
270 |
270 |
$20K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
986 |
980 |
$20K |
| E1399 |
Durable medical equipment, miscellaneous |
532 |
525 |
$19K |
| E0156 |
Seat attachment, walker |
1,270 |
1,261 |
$17K |
| E0272 |
Mattress, foam rubber |
1,218 |
1,185 |
$14K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
270 |
267 |
$11K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
117 |
115 |
$8K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
194 |
194 |
$6K |
| E0305 |
Bed side rails, half length |
554 |
554 |
$6K |
| K0007 |
Extra heavy duty wheelchair |
39 |
39 |
$6K |
| T4541 |
Incontinence product, disposable underpad, large, each |
289 |
285 |
$5K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
140 |
82 |
$5K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
396 |
390 |
$5K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
66 |
66 |
$5K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
74 |
71 |
$5K |
| E0310 |
Bed side rails, full length |
357 |
356 |
$4K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
188 |
183 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
153 |
152 |
$4K |
| E2202 |
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches |
74 |
73 |
$3K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
24 |
24 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
377 |
216 |
$2K |
| K0002 |
Standard hemi (low seat) wheelchair |
36 |
36 |
$2K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
25 |
25 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
25 |
24 |
$1K |
| E0277 |
Powered pressure-reducing air mattress |
12 |
12 |
$325.56 |
| A7015 |
Aerosol mask, used with dme nebulizer |
142 |
141 |
$225.82 |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
27 |
27 |
$223.91 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
33 |
28 |
$86.48 |