| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
7,017 |
4,575 |
$1.73M |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
10,251 |
7,716 |
$1.12M |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
3,942 |
3,634 |
$1.11M |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,538 |
2,312 |
$982K |
| E1399 |
Durable medical equipment, miscellaneous |
876 |
359 |
$648K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
359 |
276 |
$394K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,198 |
2,574 |
$365K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
5,842 |
5,152 |
$352K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
11,416 |
9,547 |
$319K |
| K0040 |
Adjustable angle footplate, each |
2,536 |
2,000 |
$239K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
1,679 |
1,208 |
$224K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,239 |
1,131 |
$220K |
| K0005 |
Ultralightweight wheelchair |
165 |
131 |
$204K |
| Z0160 |
|
2,548 |
1,616 |
$202K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
36 |
26 |
$165K |
| K0004 |
High strength, lightweight wheelchair |
2,322 |
1,721 |
$159K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
749 |
635 |
$141K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
111 |
95 |
$129K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,390 |
1,921 |
$128K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
1,859 |
1,500 |
$121K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
391 |
324 |
$113K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
717 |
599 |
$104K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
706 |
557 |
$101K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
59 |
39 |
$84K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
3,096 |
2,503 |
$83K |
| 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 |
67 |
50 |
$80K |
| E0950 |
Wheelchair accessory, tray, each |
880 |
701 |
$63K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
1,480 |
1,221 |
$56K |
| E2624 |
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
278 |
219 |
$55K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
603 |
450 |
$48K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
382 |
327 |
$47K |
| 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 |
178 |
142 |
$47K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
994 |
830 |
$45K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
255 |
191 |
$42K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
191 |
138 |
$36K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
560 |
383 |
$33K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
605 |
418 |
$33K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,341 |
1,093 |
$29K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
88 |
74 |
$25K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
203 |
155 |
$17K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
204 |
153 |
$16K |
| K0019 |
Arm pad, replacement only, each |
700 |
530 |
$11K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
30 |
25 |
$8K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
61 |
53 |
$7K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
218 |
177 |
$7K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
15 |
13 |
$5K |
| E2359 |
Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
16 |
14 |
$4K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
19 |
12 |
$4K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
51 |
50 |
$4K |
| E2206 |
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
72 |
45 |
$3K |
| E0952 |
Toe loop/holder, any type, each |
118 |
87 |
$2K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
15 |
13 |
$2K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
21 |
14 |
$1K |
| E0954 |
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot |
17 |
13 |
$1K |
| K0017 |
Detachable, adjustable height armrest, base, replacement only, each |
20 |
12 |
$926.89 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
342 |
336 |
$917.14 |
| K0038 |
Leg strap, each |
18 |
12 |
$385.29 |