| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,984 |
1,731 |
$691K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
2,789 |
2,407 |
$507K |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
796 |
666 |
$456K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
4,515 |
3,957 |
$364K |
| K0003 |
Lightweight wheelchair |
17,599 |
15,920 |
$329K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
3,629 |
2,190 |
$318K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
5,239 |
3,131 |
$235K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
1,188 |
1,088 |
$196K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
2,510 |
2,193 |
$159K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,021 |
878 |
$144K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
7,812 |
7,184 |
$135K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
2,100 |
1,837 |
$132K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
255 |
229 |
$127K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
4,337 |
2,611 |
$107K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
3,561 |
3,327 |
$103K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,613 |
2,039 |
$99K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
112 |
68 |
$94K |
| E0245 |
Tub stool or bench |
738 |
688 |
$88K |
| K0007 |
Extra heavy duty wheelchair |
2,183 |
1,932 |
$84K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,559 |
1,255 |
$83K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
4,299 |
2,537 |
$82K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
510 |
429 |
$78K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,095 |
963 |
$63K |
| K0006 |
Heavy duty wheelchair |
2,202 |
1,910 |
$62K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,170 |
1,994 |
$61K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
316 |
271 |
$43K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,766 |
1,624 |
$40K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,828 |
1,614 |
$36K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,066 |
973 |
$34K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,976 |
1,728 |
$26K |
| K0005 |
Ultralightweight wheelchair |
195 |
174 |
$25K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,572 |
1,421 |
$23K |
| E0570 |
Nebulizer, with compressor |
1,169 |
1,061 |
$18K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
418 |
388 |
$18K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
342 |
327 |
$18K |
| E0184 |
Dry pressure mattress |
437 |
394 |
$17K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,419 |
1,285 |
$15K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
154 |
123 |
$8K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
95 |
90 |
$7K |
| E1020 |
Residual limb support system for wheelchair, any type |
340 |
251 |
$6K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
856 |
785 |
$4K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
76 |
70 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
138 |
115 |
$4K |
| E0156 |
Seat attachment, walker |
443 |
400 |
$4K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
49 |
40 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
58 |
50 |
$3K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
39 |
36 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
174 |
152 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
85 |
68 |
$1K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
33 |
27 |
$1K |
| E2602 |
General use wheelchair seat cushion, width 22 inches or greater, any depth |
18 |
12 |
$881.86 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
47 |
41 |
$495.05 |
| A7030 |
Full face mask used with positive airway pressure device, each |
26 |
23 |
$286.75 |
| A7035 |
Headgear used with positive airway pressure device |
29 |
24 |
$112.73 |
| A7037 |
Tubing used with positive airway pressure device |
31 |
26 |
$109.41 |