| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
2,789 |
550 |
$888K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
3,473 |
1,836 |
$392K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,435 |
1,434 |
$322K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
4,542 |
3,875 |
$255K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,340 |
3,268 |
$113K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
66 |
66 |
$94K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
2,158 |
2,155 |
$93K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
786 |
734 |
$55K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
977 |
977 |
$52K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,071 |
1,068 |
$49K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
595 |
595 |
$38K |
| K0040 |
Adjustable angle footplate, each |
275 |
264 |
$23K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
110 |
110 |
$21K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
366 |
362 |
$19K |
| K0004 |
High strength, lightweight wheelchair |
464 |
464 |
$17K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
12 |
12 |
$16K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
692 |
688 |
$14K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
205 |
205 |
$14K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
246 |
246 |
$8K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
152 |
152 |
$6K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
27 |
27 |
$4K |
| E0197 |
Air pressure pad for mattress, standard mattress length and width |
277 |
276 |
$3K |
| E0950 |
Wheelchair accessory, tray, each |
24 |
24 |
$2K |
| K0038 |
Leg strap, each |
25 |
25 |
$591.85 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
12 |
12 |
$379.85 |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
12 |
12 |
$330.40 |