HCPCS Index 2017

Degarelix,   J9155
Dacarbazine,   J9130
Daclizumab,   J7513
Dactinomycin,   J9120
Dalalone,   J1100
Dalteparin sodium,   J1645
Dalbavancin, 5mg,   J0875
Daptomycin,   J0878
Daratumumab,   J9145
Darbepoetin Alfa,   J0881 - J0882
Injection, darbepoetin alfa, 1 microgram (non-esrd use)   J0881
Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)   J0882
Daunorubicin Citrate,   J9151
Daunorubicin HCl,   J9150
Decitabine,   J0894
Decubitus care equipment,   E0180 - E0199
Powered pressure reducing mattress overlaypad, alternating, with pump, includes heavy duty   E0181
Pump for alternating pressure pad, for replacement only   E0182
Dry pressure mattress   E0184
Gel or gel-like pressure pad for mattress, standard mattress length and width   E0185
Air pressure mattress   E0186
Water pressure mattress   E0187
Synthetic sheepskin pad   E0188
Lambswool sheepskin pad, any size   E0189
Positioning cushionpillowwedge, any shape or size, includes all components and accessories   E0190
Heel or elbow protector, each   E0191
Powered air flotation bed (low air loss therapy)   E0193
Air fluidized bed   E0194
Gel pressure mattress   E0196
Air pressure pad for mattress, standard mattress length and width   E0197
Water pressure pad for mattress, standard mattress length and width   E0198
Dry pressure pad for mattress, standard mattress length and width   E0199
Deferoxamine mesylate,   J0895
Defibrillator, external,   E0617, K0606
electrode,   K0609
garment,   K0608
battery,   K0607
Deionizer, water purification system,   E1615
Deliveryset-updispensing,   A9901
Denileukin diftitox,   J9160
Denosumab,   J0897
Depo-estradiol cypionate,   J1000
Desmopressin acetate,   J2597
Detector, blood leak, dialysis,   E1560
Dexamethasone acetate,   J1094
Dexamethasone, inhalation solution, concentrated,   J7637
Dexamethasone, inhalation solution, unit dose,   J7638
Dexamethasone, intravitreal implant,   J7312
Dexamethasone, oral,   J8540
Dexamethasone sodium phosphate,   J1100
Dextran,   J7100
saline (normal),   J7042
water,   J7060, J7070
Dextrose, 5 in lactated ringers infusion,   J7121
Dextrostick,   A4772
radiology services,   R0070 - R0076
Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen   R0070
Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen   R0075
Transportation of portable ekg to facility or location, per patient   R0076
flutemetamol f18,   Q9982
florbetaben,   Q9983
Dialysate concentrate additives,   A4765
Dialysate solution,   A4728
Dialysate testing solution,   A4760
air bubble detector,   E1530
bath conductivity, meter,   E1550
chemicalsantiseptics solution,   A4674
disposable cycler set,   A4671
equipment,   E1510 - E1702
Jaw motion rehabilitation system   E1700
Replacement cushions for jaw motion rehabilitation system, pkg of 6   E1701
Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, iv poles, pressure gauge, concentrate container   E1510
Heparin infusion pump for hemodialysis   E1520
Replacement measuring scales for jaw motion rehabilitation system, pkg of 200   E1702
Air bubble detector for hemodialysis, each, replacement   E1530
Pressure alarm for hemodialysis, each, replacement   E1540
Bath conductivity meter for hemodialysis, each   E1550
Blood leak detector for hemodialysis, each, replacement   E1560
Adjustable chair, for esrd patients   E1570
Transducer protectorsfluid barriers, for hemodialysis, any size, per 10   E1575
Unipuncture control system for hemodialysis   E1580
Hemodialysis machine   E1590
Automatic intermittent peritoneal dialysis system   E1592
Cycler dialysis machine for peritoneal dialysis   E1594
Delivery andor installation charges for hemodialysis equipment   E1600
Reverse osmosis water purification system, for hemodialysis   E1610
Deionizer water purification system, for hemodialysis   E1615
Blood pump for hemodialysis, replacement   E1620
Water softening system, for hemodialysis   E1625
Reciprocating peritoneal dialysis system   E1630
Wearable artificial kidney, each   E1632
Peritoneal dialysis clamps, each   E1634
Compact (portable) travel hemodialyzer system   E1635
Sorbent cartridges, for hemodialysis, per 10   E1636
Hemostats, each   E1637
Scale, each   E1639
Dialysis equipment, not otherwise specified   E1699
extension line,   A4672 - A4673
Drainage extension line, sterile, for dialysis, each   A4672
Extension line with easy lock connectors, used with dialysis   A4673
filter,   A4680
fluid barrier,   E1575
kit,   A482
pressure alarm,   E1540
shunt,   A4740
supplies,   A4650 - A4927
Peritoneal dialysis catheter anchoring device, belt, each   A4653
Syringe, with or without needle, each   A4657
Sphygmomanometerblood pressure apparatus with cuff and stethoscope   A4660
Implantable radiation dosimeter, each   A4650
Blood pressure cuff only   A4663
Calibrated microcapillary tube, each   A4651
Microcapillary tube sealant   A4652
Automatic blood pressure monitor   A4670
Disposable cycler set used with cycler dialysis machine, each   A4671
Drainage extension line, sterile, for dialysis, each   A4672
Extension line with easy lock connectors, used with dialysis   A4673
Chemicalsantiseptics solution used to cleansterilize dialysis equipment, per 8 oz   A4674
Activated carbon filter for hemodialysis, each   A4680
Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each   A4690
Bicarbonate concentrate, solution, for hemodialysis, per gallon   A4706
Bicarbonate concentrate, powder, for hemodialysis, per packet   A4707
Acetate concentrate solution, for hemodialysis, per gallon   A4708
Acid concentrate, solution, for hemodialysis, per gallon   A4709
Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon   A4714
y set tubing for peritoneal dialysis   A4719
Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis   A4720
Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis   A4721
Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis   A4722
Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis   A4723
Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis   A4724
Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis   A4725
Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis   A4726
Dialysate solution, non-dextrose containing, 500 ml   A4728
Fistula cannulation set for hemodialysis, each   A4730
Topical anesthetic, for dialysis, per gram   A4736
Injectable anesthetic, for dialysis, per 10 ml   A4737
Shunt accessory, for hemodialysis, any type, each   A4740
Blood tubing, arterial or venous, for hemodialysis, each   A4750
Blood tubing, arterial and venous combined, for hemodialysis, each   A4755
Dialysate solution test kit, for peritoneal dialysis, any type, each   A4760
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet   A4765
Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml   A4766
Blood collection tube, vacuum, for dialysis, per 50   A4770
Serum clotting time tube, for dialysis, per 50   A4771
Blood glucose test strips, for dialysis, per 50   A4772
Occult blood test strips, for dialysis, per 50   A4773
Ammonia test strips, for dialysis, per 50   A4774
Protamine sulfate, for hemodialysis, per 50 mg   A4802
Disposable catheter tips for peritoneal dialysis, per 10   A4860
Plumbing andor electrical work for home hemodialysis equipment   A4870
Contracts, repair and maintenance, for hemodialysis equipment   A4890
Drain bagbottle, for dialysis, each   A4911
Miscellaneous dialysis supplies, not otherwise specified   A4913
Venous pressure clamp, for hemodialysis, each   A4918
Gloves, non-sterile, per 100   A4927
tourniquet,   A4929
unipuncture control system,   E1580
venous pressure clamp,   A4918
Dialyzer,   A4690
Diaper,   T1500, T4521 - T4540 , T4543, T4544
Adult sized disposable incontinence product, briefdiaper, small, each   T4521
Adult sized disposable incontinence product, briefdiaper, medium, each   T4522
Adult sized disposable incontinence product, briefdiaper, large, each   T4523
Adult sized disposable incontinence product, briefdiaper, extra large, each   T4524
Adult sized disposable incontinence product, protective underwearpull-on, small size, each   T4525
Adult sized disposable incontinence product, protective underwearpull-on, medium size, each   T4526
Adult sized disposable incontinence product, protective underwearpull-on, large size, each   T4527
Adult sized disposable incontinence product, protective underwearpull-on, extra large size, each   T4528
Pediatric sized disposable incontinence product, briefdiaper, smallmedium size, each   T4529
Pediatric sized disposable incontinence product, briefdiaper, large size, each   T4530
Pediatric sized disposable incontinence product, protective underwearpull-on, smallmedium size, each   T4531
Pediatric sized disposable incontinence product, protective underwearpull-on, large size, each   T4532
Youth sized disposable incontinence product, briefdiaper, each   T4533
Youth sized disposable incontinence product, protective underwearpull-on, each   T4534
Disposable linershieldguardpadundergarment, for incontinence, each   T4535
Incontinence product, protective underwearpull-on, reusable, any size, each   T4536
Incontinence product, protective underpad, reusable, bed size, each   T4537
Diaper service, reusable diaper, each diaper   T4538
Incontinence product, diaperbrief, reusable, any size, each   T4539
Incontinence product, protective underpad, reusable, chair size, each   T4540
Diaper, adult incontinence garment,   A4520, A4553
incontinence supply, rectal insert, any type, each,   A4337
Diazepam,   J3360
Diazoxide,   J1730
Diclofenac,   J1130
Dicyclomine HCl,   J0500
Diethylstilbestrol diphosphate,   J9165
Digoxin,   J1160
Digoxin immune fab (ovine),   J1162
Dihydroergotamine mesylate,   J1110
Dimenhydrinate,   J1240
Dimercaprol,   J0470
Dimethyl sulfoxide (DMSO),   J1212
Diphenhydramine HCl,   J1200
Dipyridamole,   J1245
lower extremities, prosthesis,   L5000 - L5999
Addition to lower extremity, test socket, symes   L5618
Addition to lower extremity, endoskeletal system, above knee, hydracadence system   L5610
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model   L5510
Hemipelvectomy, canadian type molded socket, hip joint, single axis constant friction knee, shin, sach foot   L5280
Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)   L5785
Addition, exoskeletal knee-shin system, single axis, manual lock   L5710
Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed   L5500
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee   L5400
Ankle, symes, molded socket, sach foot   L5050
Replacement, socket, below knee, molded to patient model   L5700
Below knee, molded socket, shin, sach foot   L5100
Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)   L5654
Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot   L5150
Partial foot, shoe insert with longitudinal arch, toe filler   L5000
Addition, endoskeletal knee-shin system, single axis, manual lock   L5810
Above knee, molded socket, single axis constant friction knee, shin, sach foot   L5200
Hip disarticulation, canadian type molded socket, hip joint, single axis constant friction knee, shin, sach foot   L5250
Addition to lower extremity, symes type, expandable wall socket   L5630
Replacement, socket, above kneeknee disarticulation, including attachment plate, molded to patient model   L5701
Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot   L5160
Partial foot, molded socket, ankle height, with toe filler   L5010
Ankle, symes, metal frame, molded leather socket, articulated anklefoot   L5060
Below knee, plastic socket, joints and thigh lacer, sach foot   L5105
Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each   L5210
Hip disarticulation, tilt table type molded socket, locking hip joint, single axis constant friction knee, shin, sach foot   L5270
Below knee, molded socket, shin, sach foot, endoskeletal system   L5301
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment   L5410
Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed   L5505
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed   L5520
Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)   L5655
Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material   L5711
Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control   L5611
Addition to lower extremity, test socket, below knee   L5620
Addition to lower extremity, above knee or knee disarticulation, acrylic socket   L5631
Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material   L5811
Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)   L5790
Addition to lower extremity, symes type, 'ptb' brim design socket   L5632
Replacement, socket, hip disarticulation, including hip joint, molded to patient model   L5702
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model   L5530
Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)   L5795
Addition to lower extremity, test socket, knee disarticulation   L5622
Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system   L5312
Partial foot, molded socket, tibial tubercle height, with toe filler   L5020
Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)   L5712
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation   L5420
Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)   L5656
Above knee, short prosthesis, no knee joint ('stubbies'), with articulated anklefoot, dynamically aligned, each   L5220
Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control   L5613
Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)   L5812
Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket   L5535
Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock   L5814
Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control   L5614
Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee   L5321
Addition to lower extremity, test socket, above knee   L5624
Addition to lower extremity, symes type, posterior opening (canadian) socket   L5634
Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only   L5703
Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control   L5714
Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot   L5230
Addition to lower extremity, knee disarticulation, leather socket   L5640
Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)   L5658
Immediate post surgical or early fitting, application of initial rigid dressing, incl fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment   L5430
Addition to lower extremity, socket insert, multi-durometer symes   L5661
Addition to lower extremity, symes type, medial opening socket   L5636
Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock   L5816
Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock   L5716
Custom shaped protective cover, below knee   L5704
Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model   L5540
Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot   L5331
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee   L5450
Addition to lower extremity, test socket, hip disarticulation   L5626
Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control   L5616
Addition to lower extremity, test socket, hemipelvectomy   L5628
Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each   L5617
Addition to lower extremity, below knee, total contact   L5637
Custom shaped protective cover, above knee   L5705
Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot   L5341
Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control   L5818
Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control   L5718
Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee   L5460
Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model   L5560
Addition to lower extremity, socket insert, multi-durometer, below knee   L5665
Addition to lower extremity, below knee, cuff suspension   L5666
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed   L5570
Addition to lower extremity, below knee, acrylic socket   L5629
Addition to lower extremity, below knee, leather socket   L5638
Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control   L5822
Custom shaped protective cover, knee disarticulation   L5706
Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control   L5722
Addition, exoskeletal knee-shin system, single axis, fluid swing phase control   L5724
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model   L5580
Addition to lower extremity, below knee, molded distal cushion   L5668
Addition, endoskeletal knee-shin system, single axis, fluid swing phase control   L5824
Addition to lower extremity, below knee, wood socket   L5639
Custom shaped protective cover, hip disarticulation   L5707
Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)   L5670
Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame   L5826
Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control   L5726
Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket   L5585
Addition to lower extremity, above knee, leather socket   L5642
Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control   L5728
Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control   L5828
Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model   L5590
Addition to lower extremity, below knee above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert   L5671
Addition, exoskeletal knee-shin system, single axis, pneumatichydra pneumatic swing phase control   L5780
Addition, endoskeletal knee-shin system, single axis, pneumatic swing phase control   L5830
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model   L5595
Addition to lower extremity, hip disarticulation, flexible inner socket, external frame   L5643
Addition to lower extremity, below knee, removable medial brim suspension   L5672
Addition to lower extremity, above knee, wood socket   L5644
Addition, endoskeletal kneeshin system, 4-bar linkage or multiaxial, pneumatic swing phase control   L5840
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system   L5781
Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model   L5600
Addition to lower extremity, below kneeabove knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism   L5673
Addition to lower extremity, below knee, flexible inner socket, external frame   L5645
Additions to lower extremity, below knee, knee joints, single axis, pair   L5676
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty   L5782
Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable   L5845
Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket   L5646
Additions to lower extremity, below knee, knee joints, polycentric, pair   L5677
Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability   L5848
Addition to lower extremity, below knee suction socket   L5647
Additions to lower extremity, below knee, joint covers, pair   L5678
Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist   L5850
Addition to lower extremity, below kneeabove knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism   L5679
Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket   L5648
Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist   L5855
Addition to lower extremity, below knee, thigh lacer, nonmolded   L5680
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type   L5856
Addition to lower extremity, ischial containmentnarrow m-l socket   L5649
Additions to lower extremity, total contact, above knee or knee disarticulation socket   L5650
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type   L5857
Addition to lower extremity, below kneeabove knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)   L5681
Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type   L5858
Addition to lower extremity, above knee, flexible inner socket, external frame   L5651
Addition to lower extremity, below knee, thigh lacer, glutealischial, molded   L5682
Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)   L5969
Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexionextension assist control, includes any type motor(s)   L5859
Addition to lower extremity, below kneeabove knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)   L5683
Addition to lower extremity, suction suspension, above knee or knee disarticulation socket   L5652
Addition to lower extremity, knee disarticulation, expandable wall socket   L5653
Addition, endoskeletal system, below knee, alignable system   L5910
Addition to lower extremity, below knee, fork strap   L5684
Addition to lower extremity prosthesis, below knee, suspensionsealing sleeve, with or without valve, any material, each   L5685
Addition, endoskeletal system, above knee or hip disarticulation, alignable system   L5920
Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock   L5925
Addition to lower extremity, below knee, back check (extension control)   L5686
Addition, endoskeletal system, high activity knee control frame   L5930
Addition to lower extremity, below knee, waist belt, webbing   L5688
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)   L5940
Addition to lower extremity, below knee, waist belt, padded and lined   L5690
Addition to lower extremity, above knee, pelvic control belt, light   L5692
Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)   L5950
Addition to lower extremity, above knee, pelvic control belt, padded and lined   L5694
Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)   L5960
Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion andor extension control   L5961
Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each   L5695
Addition to lower extremity, above knee or knee disarticulation, pelvic joint   L5696
Addition, endoskeletal system, below knee, flexible protective outer surface covering system   L5962
Addition, endoskeletal system, above knee, flexible protective outer surface covering system   L5964
Addition to lower extremity, above knee or knee disarticulation, pelvic band   L5697
Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system   L5966
Addition to lower extremity, above knee or knee disarticulation, silesian bandage   L5698
Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature   L5968
All lower extremity prostheses, shoulder harness   L5699
All lower extremity prostheses, foot, external keel, sach foot   L5970
All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only   L5971
All lower extremity prostheses, foot, flexible keel   L5972
Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion andor plantar flexion control, includes power source   L5973
All lower extremity prostheses, foot, single axis anklefoot   L5974
All lower extremity prosthesis, combination single axis ankle and flexible keel foot   L5975
All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)   L5976
All lower extremity prostheses, foot, multiaxial anklefoot   L5978
All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system   L5979
All lower extremity prostheses, flex foot system   L5980
All lower extremity prostheses, flex-walk system or equal   L5981
All exoskeletal lower extremity prostheses, axial rotation unit   L5982
All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability   L5984
All endoskeletal lower extremity prostheses, dynamic prosthetic pylon   L5985
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)   L5986
All lower extremity prosthesis, shank foot system with vertical loading pylon   L5987
Addition to lower limb prosthesis, vertical shock reducing pylon feature   L5988
Addition to lower extremity prosthesis, user adjustable heel height   L5990
Lower extremity prosthesis, not otherwise specified   L5999
upper extremities, prosthesis,   L6000 - L6692
Below elbow, molded socket, flexible elbow hinge, triceps pad   L6100
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm   L6300
Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6450
Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6400
Above elbow, molded double wall socket, internal locking elbow, forearm   L6250
Elbow disarticulation, molded socket, outside locking hinge, forearm   L6200
Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow   L6380
Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6570
Partial hand, thumb remaining   L6000
Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6500
Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping   L6550
Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad   L6050
Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm   L6350
Upper extremity additions, polycentric hinge, pair   L6600
Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model   L6580
Upper extremity additions, single pivot hinge, pair   L6605
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow   L6382
Partial hand, little andor ring finger remaining   L6010
Interscapular thoracic, passive restoration (complete prosthesis)   L6360
Shoulder disarticulation, passive restoration (complete prosthesis)   L6310
Below elbow, molded socket, (muenster or northwestern suspension types)   L6110
Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm   L6205
Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad   L6055
Upper extremity addition, shoulder lock mechanism, external powered actuator   L6648
Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic   L6384
Below elbow, molded double wall split socket, step-up hinges, half cuff   L6120
Interscapular thoracic, passive restoration (shoulder cap only)   L6370
Shoulder disarticulation, passive restoration (shoulder cap only)   L6320
Partial hand, no finger remaining   L6020
Upper extremity additions, flexible metal hinge, pair   L6610
Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed   L6582
Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model   L6584
Immediate post surgical or early fitting, each additional cast change and realignment   L6386
Transcarpalmetacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)   L6026
Addition to upper extremity prosthesis, external powered, additional switch, any type   L6611
Below elbow, molded double wall split socket, stump activated locking hinge, half cuff   L6130
Immediate post surgical or early fitting, application of rigid dressing only   L6388
Upper extremity addition, disconnect locking wrist unit   L6615
Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed   L6586
Upper extremity addition, additional disconnect insert for locking wrist unit, each   L6616
Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model   L6588
Upper extremity addition, flexionextension wrist unit, with or without friction   L6620
Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed   L6590
Upper extremity prosthesis addition, flexionextension wrist with or without friction, for use with external powered terminal device   L6621
Upper extremity addition, spring assisted rotational wrist unit with latch release   L6623
Upper extremity addition, flexionextension and rotation wrist unit   L6624
Upper extremity addition, rotation wrist unit with cable lock   L6625
Upper extremity addition, quick disconnect hook adapter, otto bock or equal   L6628
Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal   L6629
Upper extremity addition, stainless steel, any wrist   L6630
Upper extremity addition, latex suspension sleeve, each   L6632
Upper extremity addition, lift assist for elbow   L6635
Upper extremity addition, nudge control elbow lock   L6637
Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow   L6638
Upper extremity additions, shoulder abduction joint, pair   L6640
Upper extremity addition, excursion amplifier, pulley type   L6641
Upper extremity addition, excursion amplifier, lever type   L6642
Upper extremity addition, shoulder flexion-abduction joint, each   L6645
Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system   L6646
Upper extremity addition, shoulder lock mechanism, body powered actuator   L6647
Upper extremity addition, shoulder universal joint, each   L6650
Upper extremity addition, standard control cable, extra   L6655
Upper extremity addition, heavy duty control cable   L6660
Upper extremity addition, teflon, or equal, cable lining   L6665
Upper extremity addition, hook to hand, cable adapter   L6670
Upper extremity addition, harness, chest or shoulder, saddle type   L6672
Upper extremity addition, harness, (eg, figure of eight type), single cable design   L6675
Upper extremity addition, harness, (eg, figure of eight type), dual cable design   L6676
Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow   L6677
Upper extremity addition, test socket, wrist disarticulation or below elbow   L6680
Upper extremity addition, test socket, elbow disarticulation or above elbow   L6682
Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic   L6684
Upper extremity addition, suction socket   L6686
Upper extremity addition, frame type socket, below elbow or wrist disarticulation   L6687
Upper extremity addition, frame type socket, above elbow or elbow disarticulation   L6688
Upper extremity addition, frame type socket, shoulder disarticulation   L6689
Upper extremity addition, frame type socket, interscapular-thoracic   L6690
Upper extremity addition, removable insert, each   L6691
Upper extremity addition, silicone gel insert or equal, each   L6692
Disposable supplies, ambulance,   A0382, A0384, A0392 - A0398
Als specialized service disposable supplies defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)   A0392
Als specialized service disposable supplies iv drug therapy   A0394
Als specialized service disposable supplies esophageal intubation   A0396
Als routine disposable supplies   A0398
DMSO,   J1212
Dobutamine HCl,   J1250
Docetaxel,   J9171
Dolasetron mesylate,   J1260
Dome and mouthpiece (for nebulizer),   A7016
Dopamine HCl,   J1265
Doripenem,   J1267
Dornase alpha, inhalation solution, unit dose form,   J7639
Doxercalciferol,   J1270
Doxil,   J900
Doxorubicin HCl,   J9000, J9002
bag,   A4357, A4358
board, postural,   E0606
bottle,   A5102
Dressing (see also Bandage),   A6020 - A6406
hydrocolloid,   A6234 - A6241
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6234
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6235
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6236
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6237
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6238
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6239
Hydrocolloid dressing, wound filler, paste, sterile, per ounce   A6240
Hydrocolloid dressing, wound filler, dry form, sterile, per gram   A6241
Collagen dressing, sterile, size 16 sq in or less, each   A6021
Collagen dressing, sterile, size more than 16 sq in but less than or equal to 48 sq in, each   A6022
Collagen dressing, sterile, size more than 48 sq in, each   A6023
Collagen dressing wound filler, sterile, per 6 inches   A6024
Gel sheet for dermal or epidermal application, (eg, silicone, hydrogel, other), each   A6025
Wound pouch, each   A6154
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq in or less, each dressing   A6196
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, each dressing   A6197
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq in, each dressing   A6198
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   A6199
Composite dressing, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6203
Composite dressing, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6204
Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6205
Contact layer, sterile, 16 sq in or less, each dressing   A6206
Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6207
Contact layer, sterile, more than 48 sq in, each dressing   A6208
Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6209
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6210
Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6211
Foam dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6212
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6213
Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6214
Foam dressing, wound filler, sterile, per gram   A6215
Gauze, non-impregnated, non-sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6216
Gauze, non-impregnated, non-sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6217
Gauze, non-impregnated, non-sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6218
Gauze, non-impregnated, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6219
Gauze, non-impregnated, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6220
Gauze, non-impregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6221
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6222
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, without adhesive border, each dressing   A6223
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6224
Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6228
Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6229
Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6230
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq in or less, each dressing   A6231
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq in, but less than or equal to 48 sq in, each dressing   A6232
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq in, each dressing   A6233
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6234
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6235
holderbinder,   A446
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6236
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6237
Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6238
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6239
Hydrocolloid dressing, wound filler, paste, sterile, per ounce   A6240
Hydrocolloid dressing, wound filler, dry form, sterile, per gram   A6241
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6242
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6243
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6244
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6245
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6246
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6247
Hydrogel dressing, wound filler, gel, per fluid ounce   A6248
Skin sealants, protectants, moisturizers, ointments, any type, any size   A6250
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6251
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6252
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6253
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6254
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6255
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6256
Transparent film, sterile, 16 sq in or less, each dressing   A6257
Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6258
Transparent film, sterile, more than 48 sq in, each dressing   A6259
Wound cleansers, any type, any size   A6260
Wound filler, gelpaste, per fluid ounce, not otherwise specified   A6261
Wound filler, dry form, per gram, not otherwise specified   A6262
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard   A6266
Gauze, non-impregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6402
Gauze, non-impregnated, sterile, pad size more than 16 sq in less than or equal to 48 sq in, without adhesive border, each dressing   A6403
Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6404
alginate,   A6196 - A6199
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq in or less, each dressing   A6196
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, each dressing   A6197
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq in, each dressing   A6198
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   A6199
collagen,   A6020 - A6024
Collagen dressing, sterile, size 16 sq in or less, each   A6021
Collagen dressing, sterile, size more than 16 sq in but less than or equal to 48 sq in, each   A6022
Collagen dressing, sterile, size more than 48 sq in, each   A6023
Collagen dressing wound filler, sterile, per 6 inches   A6024
composite,   A6200 - A6205
Composite dressing, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6203
Composite dressing, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6204
Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6205
contact layer,   A6206 - A6208
Contact layer, sterile, 16 sq in or less, each dressing   A6206
Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6207
Contact layer, sterile, more than 48 sq in, each dressing   A6208
foam,   A6209 - A6215
Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6209
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6210
Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6211
Foam dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6212
Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6213
Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6214
Foam dressing, wound filler, sterile, per gram   A6215
gauze,   A6216 - A6230 , A6402 - A6406
Gauze, non-impregnated, non-sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6216
Gauze, non-impregnated, non-sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6217
Gauze, non-impregnated, non-sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6218
Gauze, non-impregnated, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6219
Gauze, non-impregnated, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6220
Gauze, non-impregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6221
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6222
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, without adhesive border, each dressing   A6223
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6224
Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6228
Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6229
Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6230
Gauze, non-impregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6402
Gauze, non-impregnated, sterile, pad size more than 16 sq in less than or equal to 48 sq in, without adhesive border, each dressing   A6403
Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6404
hydrogel,   A6242 - A6248
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6242
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6243
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6244
Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6245
Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6246
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6247
Hydrogel dressing, wound filler, gel, per fluid ounce   A6248
specialty absorptive,   A6251 - A6256
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing   A6251
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing   A6252
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6253
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing   A6254
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing   A6255
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6256
transparent film,   A6257 - A6259
Transparent film, sterile, 16 sq in or less, each dressing   A6257
Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6258
Transparent film, sterile, more than 48 sq in, each dressing   A6259
tubular,   A6457
Droperidol,   J1790
and fentanyl citrate,   J1810
Dropper,   A4649
administered through a metered dose inhaler,   J3535
chemotherapy,   J8500 - J9999
Rolapitant, oral, 1 mg   J8670
Injection, bendamustine hcl (bendeka), 1 mg   J9034
Injection, elotuzumab, 1 mg   J9176
Injection, irinotecan liposome, 1 mg   J9205
Injection, necitumumab, 1 mg   J9295
Injection, trabectedin, 01 mg   J9352
Injection, daratumumab, 10 mg   J9145
Injection, talimogene laherparepvec, per 1 million plaque forming units   J9325
Aprepitant, oral, 5 mg   J8501
Busulfan oral, 2 mg   J8510
Cabergoline, oral, 025 mg   J8515
Capecitabine, oral, 150 mg   J8520
Capecitabine, oral, 500 mg   J8521
Cyclophosphamide oral, 25 mg   J8530
Dexamethasone, oral, 025 mg   J8540
Etoposide oral, 50 mg   J8560
Fludarabine phosphate, oral, 10 mg   J8562
Gefitinib, oral, 250 mg   J8565
Antiemetic drug, oral, not otherwise specified   J8597
Melphalan oral, 2 mg   J8600
Methotrexate oral, 25 mg   J8610
Nabilone, oral, 1 mg   J8650
Netupitant 300 mg and palonosetron 05 mg   J8655
Temozolomide, oral, 5 mg   J8700
Topotecan, oral, 025 mg   J8705
Prescription drug, oral, chemotherapeutic, nos   J8999
Injection, doxorubicin hydrochloride, 10 mg   J9000
Injection, aldesleukin, per single use vial   J9015
Injection, arsenic trioxide, 1 mg   J9017
Injection, asparaginase (erwinaze), 1,000 iu   J9019
Injection, asparaginase, not otherwise specified, 10,000 units   J9020
Injection, azacitidine, 1 mg   J9025
Injection, clofarabine, 1 mg   J9027
Bcg (intravesical) per instillation   J9031
Injection, belinostat, 10 mg   J9032
Injection, bendamustine hcl (treanda), 1 mg   J9033
Injection, bevacizumab, 10 mg   J9035
Injection, blinatumomab, 1 microgram   J9039
Injection, bleomycin sulfate, 15 units   J9040
Injection, bortezomib, 01 mg   J9041
Injection, brentuximab vedotin, 1 mg   J9042
Injection, cabazitaxel, 1 mg   J9043
Injection, carboplatin, 50 mg   J9045
Injection, carfilzomib, 1 mg   J9047
Injection, carmustine, 100 mg   J9050
Injection, cetuximab, 10 mg   J9055
Injection, cisplatin, powder or solution, 10 mg   J9060
Injection, cladribine, per 1 mg   J9065
Cyclophosphamide, 100 mg   J9070
Injection, cytarabine liposome, 10 mg   J9098
Injection, cytarabine, 100 mg   J9100
Injection, dactinomycin, 05 mg   J9120
Dacarbazine, 100 mg   J9130
Injection, daunorubicin, 10 mg   J9150
Injection, daunorubicin citrate, liposomal formulation, 10 mg   J9151
Injection, degarelix, 1 mg   J9155
Injection, denileukin diftitox, 300 micrograms   J9160
Injection, diethylstilbestrol diphosphate, 250 mg   J9165
Injection, docetaxel, 1 mg   J9171
Injection, elliotts' b solution, 1 ml   J9175
Injection, epirubicin hcl, 2 mg   J9178
Injection, eribulin mesylate, 01 mg   J9179
Injection, etoposide, 10 mg   J9181
Injection, fludarabine phosphate, 50 mg   J9185
Injection, fluorouracil, 500 mg   J9190
Injection, floxuridine, 500 mg   J9200
Injection, gemcitabine hydrochloride, 200 mg   J9201
Goserelin acetate implant, per 36 mg   J9202
Injection, irinotecan, 20 mg   J9206
Injection, ixabepilone, 1 mg   J9207
Injection, ifosfamide, 1 gram   J9208
Injection, mesna, 200 mg   J9209
Injection, idarubicin hydrochloride, 5 mg   J9211
Injection, interferon alfacon-1, recombinant, 1 microgram   J9212
Injection, interferon, alfa-2a, recombinant, 3 million units   J9213
Injection, interferon, alfa-2b, recombinant, 1 million units   J9214
Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu   J9215
Injection, interferon, gamma 1-b, 3 million units   J9216
Leuprolide acetate (for depot suspension), 75 mg   J9217
Leuprolide acetate, per 1 mg   J9218
Leuprolide acetate implant, 65 mg   J9219
Histrelin implant (vantas), 50 mg   J9225
Histrelin implant (supprelin la), 50 mg   J9226
Injection, ipilimumab, 1 mg   J9228
Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg   J9230
Injection, melphalan hydrochloride, 50 mg   J9245
Methotrexate sodium, 5 mg   J9250
Methotrexate sodium, 50 mg   J9260
Injection, nelarabine, 50 mg   J9261
Injection, omacetaxine mepesuccinate, 001 mg   J9262
Injection, oxaliplatin, 05 mg   J9263
Injection, paclitaxel protein-bound particles, 1 mg   J9264
Injection, pegaspargase, per single dose vial   J9266
Injection, paclitaxel, 1 mg   J9267
Injection, pentostatin, 10 mg   J9268
Injection, plicamycin, 25 mg   J9270
Injection, pembrolizumab, 1 mg   J9271
Injection, mitomycin, 5 mg   J9280
Injection, mitoxantrone hydrochloride, per 5 mg   J9293
Injection, nivolumab, 1 mg   J9299
Injection, gemtuzumab ozogamicin, 5 mg   J9300
Injection, obinutuzumab, 10 mg   J9301
Injection, ofatumumab, 10 mg   J9302
Injection, panitumumab, 10 mg   J9303
Injection, pemetrexed, 10 mg   J9305
Injection, pertuzumab, 1 mg   J9306
Injection, pralatrexate, 1 mg   J9307
Injection, ramucirumab, 5 mg   J9308
Injection, rituximab, 100 mg   J9310
Injection, romidepsin, 1 mg   J9315
Injection, streptozocin, 1 gram   J9320
Injection, temozolomide, 1 mg   J9328
Injection, temsirolimus, 1 mg   J9330
Injection, thiotepa, 15 mg   J9340
Injection, topotecan, 01 mg   J9351
Injection, ado-trastuzumab emtansine, 1 mg   J9354
Injection, trastuzumab, 10 mg   J9355
Injection, valrubicin, intravesical, 200 mg   J9357
Injection, vinblastine sulfate, 1 mg   J9360
Vincristine sulfate, 1 mg   J9370
Injection, vincristine sulfate liposome, 1 mg   J9371
Injection, vinorelbine tartrate, 10 mg   J9390
Injection, fulvestrant, 25 mg   J9395
Injection, ziv-aflibercept, 1 mg   J9400
Injection, porfimer sodium, 75 mg   J9600
Not otherwise classified, antineoplastic drugs   J9999
disposable delivery system, 5 ml or less per hour,   A4306
disposable delivery system, 50 ml or greater per hour,   A4305
immunosuppressive,   J7500 - J7599
Azathioprine, oral, 50 mg   J7500
Azathioprine, parenteral, 100 mg   J7501
Cyclosporine, oral, 100 mg   J7502
Tacrolimus, extended release, (envarsus xr), oral, 025 mg   J7503
Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg   J7504
Muromonab-cd3, parenteral, 5 mg   J7505
Tacrolimus, immediate release, oral, 1 mg   J7507
Tacrolimus, extended release, (astagraf xl), oral, 01 mg   J7508
Methylprednisolone oral, per 4 mg   J7509
Prednisolone oral, per 5 mg   J7510
Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg   J7511
Prednisone, immediate release or delayed release, oral, 1 mg   J7512
Daclizumab, parenteral, 25 mg   J7513
Cyclosporine, oral, 25 mg   J7515
Cyclosporin, parenteral, 250 mg   J7516
Mycophenolate mofetil, oral, 250 mg   J7517
Mycophenolic acid, oral, 180 mg   J7518
Sirolimus, oral, 1 mg   J7520
Tacrolimus, parenteral, 5 mg   J7525
Everolimus, oral, 025 mg   J7527
Immunosuppressive drug, not otherwise classified   J7599
infusion supplies,   A4230 - A4232 , A4221, A4222
Infusion set for external insulin pump, non needle cannula type   A4230
Infusion set for external insulin pump, needle type   A4231
Syringe with needle for external insulin pump, sterile, 3 cc   A4232
inhalation solutions,   J7608 - J7699
Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram   J7608
Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg   J7609
Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg   J7610
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg   J7611
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 05 mg   J7612
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg   J7613
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 05 mg   J7614
Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 05 mg   J7615
Albuterol, up to 25 mg and ipratropium bromide, up to 05 mg, fda-approved final product, non-compounded, administered through dme   J7620
Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7622
Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7624
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 05 mg   J7626
Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 05 mg   J7627
Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7628
Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7629
Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams   J7631
Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams   J7632
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 025 milligram   J7633
Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 025 milligram   J7634
Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7635
Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7636
Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7637
Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7638
Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram   J7639
Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms   J7640
Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram   J7641
Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7642
Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7643
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram   J7644
Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7645
Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7647
Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram   J7648
Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram   J7649
Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7650
Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7657
Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram   J7658
Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram   J7659
Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7660
Mannitol, administered through an inhaler, 5 mg   J7665
Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams   J7667
Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams   J7668
Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams   J7669
Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams   J7670
Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg   J7674
Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg   J7676
Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7680
Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7681
Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams   J7682
Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram   J7683
Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram   J7684
Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams   J7685
Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 174 mg   J7686
Noc drugs, inhalation solution administered through dme   J7699
not otherwise classified,   J3490, J7599, J7699, J7799, J7999, J8499, J8999, J9999
prescription, oral,   J8499, J8999
Dry pressure padmattress,   E0179, E0184, E0199
Durable medical equipment (DME),   E0100 - E1830
Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests   E1280
Traction frame, attached to footboard, extremity traction, (eg, buck's)   E0870
Restraints, any type (body, chest, wrist or ankle)   E0710
Safety equipment, device or accessory, any type   E0700
Pneumatic compressor, non-segmental home model   E0650
Trapeze bars, aka patient helper, attached to bed, with grab bar   E0910
Whirlpool, portable (overtub type)   E1300
Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1050
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest   E1240
Sling or seat, patient lift, canvas or nylon   E0621
Hospital bed, fixed height, with any type side rails, with mattress   E0250
Regulator   E1353
Bathshower chair, with or without wheels, any size   E0240
Centrifuge, for dialysis   E1500
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation   E0720
Heat lamp, without stand (table model), includes bulb, or infrared element   E0200
Jaw motion rehabilitation system   E1700
Dynamic adjustable elbow extensionflexion device, includes soft interface material   E1800
Heparin infusion pump for hemodialysis   E1520
Stationary compressed gaseous oxygen system, rental includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing   E0424
Powered pressure reducing mattress overlaypad, alternating, with pump, includes heavy duty   E0181
Respiratory suction pump, home model, portable or stationary, electric   E0600
Platform attachment, forearm crutch, each   E0153
Sitz type bath or equipment, portable, used with or without commode   E0160
Oxygen accessory, flow regulator capable of positive inspiratory pressure   E1352
Ippb machine, all types, with built-in nebulization manual or automatic valves internal or external power source   E0500
Cane, includes canes of all materials, adjustable or fixed, with tip   E0100
Traction frame, attached to footboard, pelvic traction   E0890
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests   E1130
Wheelchair accessory, tray, each   E0950
Iv pole   E0776
Wheelchair specially sized or constructed, (indicate brand name, model number, if any) and justification   E1220
Rollabout chair, any and all types with casters 5 or greater   E1031
Walker, rigid (pickup), adjustable or fixed height   E0130
Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips   E0110
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery   E0550
Ambulatory traction device, all types, each   E0830
Traction frame, attached to headboard, cervical traction   E0840
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests   E1170
Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1100
Traction equipment, overdoor, cervical   E0860
Home blood glucose monitor   E0607
Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)   E0610
Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter   E0555
Heel loopholder, any type, with or without ankle strap, each   E0951
Pump for alternating pressure pad, for replacement only   E0182
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips   E0105
Traction stand, free standing, pelvic traction, (eg, buck's)   E0900
Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, iv poles, pressure gauge, concentrate container   E1510
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater   E0779
Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest   E1110
Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digitalvisible check systems   E0615
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests   E1060
Patient lift, bathroom or toilet, not otherwise classified   E0625
Pneumatic compressor, segmental home model without calibrated gradient pressure   E0651
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar   E0911
Transfer device, any type, each   E0705
Traction stand, free standing, extremity traction, (eg, buck's)   E0880
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation   E0730
Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips   E0111
Walker, folding (pickup), adjustable or fixed height   E0135
Platform attachment, walker, each   E0154
Sitz type bath or equipment, portable, used with or without commode, with faucet attachments   E0161
Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs   E1035
Wheelchair with fixed arm, footrests   E1221
Static progressive stretch elbow device, extension andor flexion, with or without range of motion adjustment, includes all components and accessories   E1801
Replacement cushions for jaw motion rehabilitation system, pkg of 6   E1701
Phototherapy (bilirubin) light with photometer   E0202
Bath tub wall rail, each   E0241
Hospital bed, fixed height, with any type side rails, without mattress   E0251
Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each   E1354
Whirlpool, non-portable (built-in type)   E1310
Heavy duty wheelchair, fixed full length arms, swing away detachable footrest   E1285
Lightweight wheelchair, fixed full length arms, swing away detachable footrest   E1250
Amputee wheelchair, fixed full length arms, without footrests or legrest   E1171
Wheelchair, detachable arms, desk or full length, swing away detachable footrests   E1140
Stationary compressed gas system, purchase includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing   E0425
Continuous positive airway pressure (cpap) device   E0601
Traction equipment, cervical, free-standing standframe, pneumatic, applying traction force to other than mandible   E0849
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1070
Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips   E0112
Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric)   E0731
Therapeutic lightbox, minimum 10,000 lux, table top model   E0203
Replacement measuring scales for jaw motion rehabilitation system, pkg of 200   E1702
Implantable cardiac event recorder with memory, activator and programmer   E0616
Seat lift mechanism, electric, any type   E0627
Wheel attachment, rigid pick-up walker, per pair   E0155
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar   E0912
Dynamic adjustable forearm pronationsupination device, includes soft interface material   E1802
Pneumatic compressor, segmental home model with calibrated gradient pressure   E0652
Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours   E0780
Breast pump, manual, any type   E0602
Walker, with trunk support, adjustable or fixed height, any type   E0140
Traction stand, free standing, cervical traction   E0850
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1260
Wheelchair with fixed arm, elevating legrests   E1222
Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1290
Toe loopholder, any type, each   E0952
Sitz bath chair   E0162
Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery   E0560
Portable gaseous oxygen system, purchase includes regulator, flowmeter, humidifier, cannula or mask, and tubing   E0430
Dry pressure mattress   E0184
Standrack   E1355
Hospital bed, variable height, hi-lo, with any type side rails, with mattress   E0255
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest   E1172
Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs   E1036
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests   E1150
Bath tub rail, floor base   E0242
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each   E0955
Cervical traction equipment not requiring additional stand or frame   E0855
Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip   E0113
Walker, rigid, wheeled, adjustable or fixed height   E0141
Wheelchair, fixed full length arms, swing away detachable elevating legrests   E1160
Transport chair, pediatric size   E1037
Wheelchair with detachable arms, footrests   E1223
Gel or gel-like pressure pad for mattress, standard mattress length and width   E0185
Seat attachment, walker   E0156
Dynamic adjustable wrist extension flexion device, includes soft interface material   E1805
Humidifier, non-heated, used with positive airway pressure device   E0561
Portable gaseous oxygen system, rental includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing   E0431
Commode chair, mobile or stationary, with fixed arms   E0163
Breast pump, electric (ac andor dc), any type   E0603
Heat lamp, with stand, includes bulb, or infrared element   E0205
Non-implanted pelvic floor electrical stimulator, complete system   E0740
Toilet rail, each   E0243
Hospital bed, variable height, hi-lo, with any type side rails, without mattress   E0256
Oxygen accessory, battery packcartridge for portable concentrator, any type, replacement only, each   E1356
Air bubble detector for hemodialysis, each, replacement   E1530
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient   E0781
Heavy duty wheelchair, fixed full length arms, elevating legrest   E1295
Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests   E1270
External defibrillator with integrated electrocardiogram analysis   E0617
Non-segmental pneumatic appliance for use with pneumatic compressor, half arm   E0655
Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest   E1083
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests   E1180
Fracture frame, attached to bed, includes weights   E0920
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests   E1190
Transport chair, adult size, patient weight capacity up to and including 300 pounds   E1038
Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests   E1084
Manual adult size wheelchair, includes tilt in space   E1161
Electric heat pad, standard   E0210
Static progressive stretch wrist device, flexion andor extension, with or without range of motion adjustment, includes all components and accessories   E1806
Pressure alarm for hemodialysis, each, replacement   E1540
Commode chair, mobile or stationary, with detachable arms   E0165
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress   E0260
Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each   E1357
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each   E0956
Special wheelchair seat height from floor   E1296
Air pressure mattress   E0186
Cervical traction device, with inflatable air bladder(s)   E0856
Walker, folding, wheeled, adjustable or fixed height   E0143
Apnea monitor, without recording feature   E0618
Humidifier, heated, used with positive airway pressure device   E0562
Neuromuscular stimulator for scoliosis   E0744
Fracture frame, free standing, includes weights   E0930
Crutch attachment, walker, each   E0157
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips   E0114
Seat lift mechanism, non-electric, any type   E0629
Infusion pump, implantable, non-programmable (includes all components, eg, pump, catheter, connectors, etc)   E0782
Segmental pneumatic appliance for use with pneumatic compressor, trunk   E0656
Breast pump, hospital grade, electric (ac and or dc), any type   E0604
Portable liquid oxygen system, rental home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge   E0433
Wheelchair with detachable arms, elevating legrests   E1224
Raised toilet seat   E0244
Apnea monitor, with recording feature   E0619
Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds   E1039
Portable liquid oxygen system, rental includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing   E0434
Electric heat pad, moist   E0215
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)   E0630
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each   E1225
Continuous passive motion exercise device for use on knee only   E0935
Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests   E1195
Bath conductivity meter for hemodialysis, each   E1550
Infusion pump system, implantable, programmable (includes all components, eg, pump, catheter, connectors, etc)   E0783
Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each   E1358
Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each   E0116
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress   E0261
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each   E0957
Segmental pneumatic appliance for use with pneumatic compressor, chest   E0657
Compressor, air power source for equipment which is not self-contained or cylinder driven   E0565
Water pressure mattress   E0187
Dynamic adjustable knee extension flexion device, includes soft interface material   E1810
Special wheelchair seat depth, by upholstery   E1297
Pail or pan for use with commode chair, replacement only   E0167
Hemi-wheelchair, fixed full length arms, swing away detachable foot rests   E1085
Neuromuscular stimulator, electronic shock unit   E0745
Vaporizer, room type   E0605
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat   E0144
Leg extensions for walker, per set of four (4)   E0158
Tub stool or bench   E0245
Amputee wheelchair, fixed full length arms, swing away detachable footrest   E1200
External ambulatory infusion pump, insulin   E0784
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each   E1226
Continuous passive motion exercise device for use other than knee   E0936
Electromyography (emg), biofeedback device   E0746
Static progressive stretch knee device, extension andor flexion, with or without range of motion adjustment, includes all components and accessories   E1811
Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests   E1086
Blood leak detector for hemodialysis, each, replacement   E1560
Immersion external heater for nebulizer   E1372
Special wheelchair seat depth andor width, by construction   E1298
Manual wheelchair accessory, one-arm drive attachment, each   E0958
Nebulizer, with compressor   E0570
Postural drainage board   E0606
Portable liquid oxygen system, purchase includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor   E0435
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress   E0265
Transfer tub rail attachment   E0246
Water circulating heat pad with pump   E0217
Brake attachment for wheeled walker, replacement, each   E0159
Walker, heavy duty, multiple braking system, variable wheel resistance   E0147
Crutch, underarm, articulating, spring assisted, each   E0117
Non-segmental pneumatic appliance for use with pneumatic compressor, full leg   E0660
Patient lift, electric with seat or sling   E0635
Skin piercing device for collection of capillary blood, laser, each   E0620
Synthetic sheepskin pad   E0188
Commode chair, extra wide andor heavy duty, stationary or mobile, with or without arms, any type, each   E0168
High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1087
Implantable intraspinal (epiduralintrathecal) catheter used with implantable infusion pump, replacement   E0785
Commode chair with integrated seat lift mechanism, electric, any type   E0170
Non-segmental pneumatic appliance for use with pneumatic compressor, full arm   E0665
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress   E0266
Dynamic knee, extensionflexion device with active resistance control   E1812
Walker, heavy duty, without wheels, rigid or folding, any type, each   E0148
Crutch substitute, lower leg platform, with or without wheels, each   E0118
Lambswool sheepskin pad, any size   E0189
Trapeze bar, free standing, complete with grab bar   E0940
Manual wheelchair accessory, adapter for amputee, each   E0959
Osteogenesis stimulator, electrical, non-invasive, other than spinal applications   E0747
Transfer bench for tub or toilet with or without commode opening   E0247
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate   E1390
Aerosol compressor, adjustable pressure, light duty for intermittent use   E0572
Water circulating cold pad with pump   E0218
Stationary liquid oxygen system, rental includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, tubing   E0439
Special height arms for wheelchair   E1227
Adjustable chair, for esrd patients   E1570
Multipositional patient support system, with integrated lift, patient accessible controls   E0636
Transfer bench, heavy duty, for tub or toilet with or without commode opening   E0248
Positioning cushionpillowwedge, any shape or size, includes all components and accessories   E0190
Wheelchair accessory, shoulder harnessstraps or chest strap, including any type mounting hardware   E0960
Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)   E0786
Infrared heating pad system   E0221
Ultrasonicelectronic aerosol generator with small volume nebulizer   E0574
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests   E1088
Combination sit to stand frametable system, any size including pediatric, with seat lift feature, with or without wheels   E0637
Special back height for wheelchair   E1228
Non-segmental pneumatic appliance for use with pneumatic compressor, half leg   E0666
Gravity assisted traction device, any type   E0941
Osteogenesis stimulator, electrical, non-invasive, spinal applications   E0748
Walker, heavy duty, wheeled, rigid or folding, any type   E0149
Dynamic adjustable ankle extensionflexion device, includes soft interface material   E1815
Stationary liquid oxygen system, purchase includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing   E0440
Commode chair with integrated seat lift mechanism, non-electric, any type   E0171
Hospital bed, institutional type includes oscillating, circulating and stryker frame, with mattress   E0270
Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each   E1391
Transducer protectorsfluid barriers, for hemodialysis, any size, per 10   E1575
Standing frametable system, one position (eg, upright, supine or prone stander), any size including pediatric, with or without wheels   E0638
Static progressive stretch ankle device, flexion andor extension, with or without range of motion adjustment, includes all components and accessories   E1816
Unipuncture control system for hemodialysis   E1580
Heel or elbow protector, each   E0191
High strength lightweight wheelchair, fixed length arms, swing away detachable footrest   E1089
Seat lift mechanism placed over or on top of toilet, any type   E0172
Nebulizer, ultrasonic, large volume   E0575
Hydrocollator unit, includes pads   E0225
Stationary oxygen contents, gaseous, 1 month's supply 1 unit   E0441
Parenteral infusion pump, stationary, single or multi-channel   E0791
Mattress, innerspring   E0271
Manual wheelchair accessory, wheel lock brake extension (handle), each   E0961
Osteogenesis stimulator, electrical, surgically implanted   E0749
Cervical head harnesshalter   E0942
Pad for water circulating heat unit, for replacement only   E0249
Portable oxygen concentrator, rental   E1392
Segmental pneumatic appliance for use with pneumatic compressor, full leg   E0667
Wheelchair, pediatric size, not otherwise specified   E1229
Mattress, foam rubber   E0272
Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter   E0580
Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover   E0231
Stationary oxygen contents, liquid, 1 month's supply 1 unit   E0442
Durable medical equipment, miscellaneous   E1399
Hemodialysis machine   E1590
Static progressive stretch forearm pronation supination device, with or without range of motion adjustment, includes all components and accessories   E1818
Foot rest, for use with commode chair, each   E0175
Electronic salivary reflex stimulator (intra-oralnon-invasive)   E0755
Segmental pneumatic appliance for use with pneumatic compressor, full arm   E0668
Pelvic beltharnessboot   E0944
Power operated vehicle (three or four wheel nonhighway) specify brand name and model number   E1230
Patient lift, moveable from room to room with disassembly and reassembly, includes all componentsaccessories   E0639
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests   E1090
Powered air flotation bed (low air loss therapy)   E0193
Manual wheelchair accessory, headrest extension, each   E0966
Bed board   E0273
Automatic intermittent peritoneal dialysis system   E1592
Oxygen and water vapor enriching system with heated delivery   E1405
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system   E1231
Nebulizer, with compressor and heater   E0585
Segmental pneumatic appliance for use with pneumatic compressor, half leg   E0669
Extremity beltharness   E0945
Air fluidized bed   E0194
Osteogenesis stimulator, low intensity ultrasound, non-invasive   E0760
Replacement soft interface material, dynamic adjustable extensionflexion device   E1820
Manual wheelchair accessory, hand rim with projections, any type, replacement only, each   E0967
Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests   E1092
Portable oxygen contents, gaseous, 1 month's supply 1 unit   E0443
Warming card for use with the non contact wound warming device and non contact wound warming wound cover   E0232
Patient lift, fixed system, includes all componentsaccessories   E0640
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system   E1232
Gel pressure mattress   E0196
Over-bed table   E0274
Oxygen and water vapor enriching system without heated delivery   E1406
Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests   E1093
Portable oxygen contents, liquid, 1 month's supply 1 unit   E0444
Cycler dialysis machine for peritoneal dialysis   E1594
Paraffin bath unit, portable (see medical supply code a4265 for paraffin)   E0235
Commode seat, wheelchair   E0968
Replacement soft interface materialcuffs for bi-directional static progressive stretch device   E1821
Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device   E0761
Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk   E0670
Fracture, frame, dual with cross bars, attached to bed, (eg, balken, 4 poster)   E0946
Standing frametable system, multi-position (eg, three-way stander), any size including pediatric, with or without wheels   E0641
Narrowing device, wheelchair   E0969
Pump for water circulating pad   E0236
Standing frametable system, mobile (dynamic stander), any size including pediatric   E0642
Oximeter device for measuring blood oxygen levels non-invasively   E0445
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system   E1233
Fracture frame, attachments for complex pelvic traction   E0947
Delivery andor installation charges for hemodialysis equipment   E1600
Transcutaneous electrical joint stimulation device system, includes all accessories   E0762
Bed pan, standard, metal or plastic   E0275
Dynamic adjustable finger extensionflexion device, includes soft interface material   E1825
Air pressure pad for mattress, standard mattress length and width   E0197
Segmental gradient pressure pneumatic appliance, full leg   E0671
Reverse osmosis water purification system, for hemodialysis   E1610
No 2 footplates, except for elevating leg rest   E0970
Bed pan, fracture, metal or plastic   E0276
Fracture frame, attachments for complex cervical traction   E0948
Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories   E0446
Hydrocollator unit, portable   E0239
Dynamic adjustable toe extensionflexion device, includes soft interface material   E1830
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system   E1234
Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program   E0764
Segmental gradient pressure pneumatic appliance, full arm   E0672
Water pressure pad for mattress, standard mattress length and width   E0198
Manual wheelchair accessory, anti-tipping device, each   E0971
Fda approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting   E0765
Oxygen tent, excluding croup or pediatric tents   E0455
Dry pressure pad for mattress, standard mattress length and width   E0199
Wheelchair, pediatric size, rigid, adjustable, with seating system   E1235
Powered pressure-reducing air mattress   E0277
Segmental gradient pressure pneumatic appliance, half leg   E0673
Deionizer water purification system, for hemodialysis   E1615
Blood pump for hemodialysis, replacement   E1620
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each   E0973
Electrical stimulation device used for cancer treatment, includes all accessories, any type   E0766
Bed cradle, any type   E0280
Pneumatic compression device, high pressure, rapid inflationdeflation cycle, for arterial insufficiency (unilateral or bilateral system)   E0675
Chest shell (cuirass)   E0457
Wheelchair, pediatric size, folding, adjustable, with seating system   E1236
Chest wrap   E0459
Wheelchair, pediatric size, rigid, adjustable, without seating system   E1237
Water softening system, for hemodialysis   E1625
Hospital bed, fixed height, without side rails, with mattress   E0290
Intermittent limb compression device (includes all accessories), not otherwise specified   E0676
Manual wheelchair accessory, anti-rollback device, each   E0974
Electrical stimulation or electromagnetic wound treatment device, not otherwise classified   E0769
Rocking bed with or without side rails   E0462
Wheelchair, pediatric size, folding, adjustable, without seating system   E1238
Hospital bed, fixed height, without side rails, without mattress   E0291
Wheelchair accessory, positioning beltsafety beltpelvic strap, each   E0978
Reciprocating peritoneal dialysis system   E1630
Functional electrical stimulator, transcutaneous stimulation of nerve andor muscle groups, any type, complete system, not otherwise specified   E0770
Ultraviolet light therapy system, includes bulbslamps, timer and eye protection treatment area 2 square feet or less   E0691
Safety vest, wheelchair   E0980
Home ventilator, any type, used with invasive interface, (eg, tracheostomy tube)   E0465
Hospital bed, variable height, hi-lo, without side rails, with mattress   E0292
Power wheelchair, pediatric size, not otherwise specified   E1239
Ultraviolet light therapy system panel, includes bulbslamps, timer and eye protection, 4 foot panel   E0692
Wearable artificial kidney, each   E1632
Peritoneal dialysis clamps, each   E1634
Wheelchair accessory, seat upholstery, replacement only, each   E0981
Ultraviolet light therapy system panel, includes bulbslamps, timer and eye protection, 6 foot panel   E0693
Home ventilator, any type, used with non-invasive interface, (eg, mask, chest shell)   E0466
Hospital bed, variable height, hi-lo, without side rails, without mattress   E0293
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device)   E0470
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress   E0294
Compact (portable) travel hemodialyzer system   E1635
Wheelchair accessory, back upholstery, replacement only, each   E0982
Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbslamps, timer and eye protection   E0694
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control   E0983
Sorbent cartridges, for hemodialysis, per 10   E1636
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress   E0295
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device)   E0471
Hemostats, each   E1637
Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, eg, tracheostomy tube (intermittent assist device with continuous positive airway pressure device)   E0472
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control   E0984
Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress   E0296
Percussor, electric or pneumatic, home model   E0480
Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress   E0297
Wheelchair accessory, seat lift mechanism   E0985
Scale, each   E1639
Dialysis equipment, not otherwise specified   E1699
Manual wheelchair accessory, push-rim activated power assist system   E0986
Pediatric crib, hospital grade, fully enclosed, with or without top enclosure   E0300
Intrapulmonary percussive ventilation system and related accessories   E0481
Cough stimulating device, alternating positive and negative airway pressure   E0482
Manual wheelchair accessory, lever-activated, wheel drive, pair   E0988
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, without mattress   E0301
High frequency chest wall oscillation air-pulse generator system, (includes hoses and vest), each   E0483
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress   E0302
Wheelchair accessory, elevating leg rest, complete assembly, each   E0990
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   E0303
Oscillatory positive expiratory pressure device, non-electric, any type, each   E0484
Manual wheelchair accessory, solid seat insert   E0992
Arm rest, each   E0994
Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress   E0304
Oral deviceappliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment   E0485
Bed side rails, half length   E0305
Oral deviceappliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment   E0486
Wheelchair accessory, calf restpad, replacement only, each   E0995
Spirometer, electronic, includes all accessories   E0487
Bed side rails, full length   E0310
Wheelchair accessory, power seating system, tilt only   E1002
Bed accessory board, table, or support device, any type   E0315
Wheelchair accessory, power seating system, recline only, without shear reduction   E1003
Safety enclosure framecanopy for use with hospital bed, any type   E0316
Wheelchair accessory, power seating system, recline only, with mechanical shear reduction   E1004
Urinal male, jug-type, any material   E0325
Wheelchair accessory, power seatng system, recline only, with power shear reduction   E1005
Urinal female, jug-type, any material   E0326
Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction   E1006
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction   E1007
Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress   E0328
Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress   E0329
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction   E1008
Control unit for electronic bowel irrigationevacuation system   E0350
Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each   E1009
Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair   E1010
Disposable pack (water reservoir bag, speculum, valving mechanism and collection bagbox) for use with the electronic bowel irrigationevacuation system   E0352
Air pressure elevator for heel   E0370
Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)   E1011
Wheelchair accessory, addition to power seating system, center mount power elevating leg restplatform, complete system, any type, each   E1012
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width   E0371
Reclining back, addition to pediatric size wheelchair   E1014
Powered air overlay for mattress, standard mattress length and width   E0372
Shock absorber for manual wheelchair, each   E1015
Nonpowered advanced pressure reducing mattress   E0373
Shock absorber for power wheelchair, each   E1016
Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each   E1017
Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each   E1018
Residual limb support system for wheelchair, any type   E1020
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory   E1028
Wheelchair accessory, ventilator tray, fixed   E1029
Wheelchair accessory, ventilator tray, gimbaled   E1030
Dyphylline,   J1180