| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
1,124 |
1,008 |
$643K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
6,623 |
2,883 |
$549K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
2,166 |
1,990 |
$509K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
411 |
349 |
$344K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
347 |
298 |
$324K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
4,096 |
3,259 |
$198K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
3,425 |
2,606 |
$158K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,519 |
2,272 |
$140K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
409 |
388 |
$104K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
2,673 |
2,384 |
$96K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,163 |
1,082 |
$67K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
770 |
534 |
$56K |
| A7030 |
Full face mask used with positive airway pressure device, each |
680 |
619 |
$44K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
950 |
915 |
$38K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
353 |
336 |
$32K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
266 |
260 |
$28K |
| K0001 |
Standard wheelchair |
698 |
632 |
$24K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
976 |
784 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
909 |
818 |
$16K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
325 |
272 |
$15K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
665 |
585 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
118 |
97 |
$12K |
| A4927 |
Gloves, non-sterile, per 100 |
701 |
685 |
$11K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
78 |
70 |
$10K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
112 |
78 |
$10K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
313 |
194 |
$9K |
| E1399 |
Durable medical equipment, miscellaneous |
27 |
12 |
$9K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
275 |
243 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
148 |
105 |
$6K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
42 |
38 |
$5K |
| K0040 |
Adjustable angle footplate, each |
58 |
52 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,132 |
1,831 |
$5K |
| E0950 |
Wheelchair accessory, tray, each |
102 |
78 |
$4K |
| A7031 |
Face mask interface, replacement for full face mask, each |
203 |
174 |
$4K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
42 |
36 |
$3K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
16 |
12 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
160 |
127 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
14 |
14 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
117 |
111 |
$2K |
| K0019 |
Arm pad, replacement only, each |
181 |
119 |
$2K |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
36 |
24 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
86 |
73 |
$1K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
27 |
27 |
$1K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
38 |
25 |
$1K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
32 |
26 |
$932.90 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
45 |
27 |
$733.24 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
15 |
14 |
$682.05 |
| E0570 |
Nebulizer, with compressor |
39 |
39 |
$645.17 |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
45 |
25 |
$259.75 |