HCPCS Index 2017

Waiver,   T2012 - T2050
Habilitation, educational waiver, per diem   T2012
Habilitation, educational, waiver per hour   T2013
Habilitation, prevocational, waiver per diem   T2014
Habilitation, prevocational, waiver per hour   T2015
Habilitation, residential, waiver per diem   T2016
Habilitation, residential, waiver 15 minutes   T2017
Habilitation, supported employment, waiver per diem   T2018
Habilitation, supported employment, waiver per 15 minutes   T2019
Day habilitation, waiver per diem   T2020
Day habilitation, waiver per 15 minutes   T2021
Case management, per month   T2022
Targeted case management per month   T2023
Service assessmentplan of care development, waiver   T2024
Waiver services not otherwise specified (nos)   T2025
Specialized childcare, waiver per diem   T2026
Specialized childcare, waiver per 15 minutes   T2027
Specialized supply, not otherwise specified, waiver   T2028
Specialized medical equipment, not otherwise specified, waiver   T2029
Assisted living, waiver per month   T2030
Assisted living waiver, per diem   T2031
Residential care, not otherwise specified (nos), waiver per month   T2032
Residential care, not otherwise specified (nos), waiver per diem   T2033
Crisis intervention, waiver per diem   T2034
Utility services to support medical equipment and assistive technologydevices, waiver   T2035
Therapeutic camping, overnight, waiver each session   T2036
Therapeutic camping, day, waiver each session   T2037
Community transition, waiver per service   T2038
Vehicle modifications, waiver per service   T2039
Financial management, self-directed, waiver per 15 minutes   T2040
Supports brokerage, self-directed, waiver per 15 minutes   T2041
Hospice routine home care per diem   T2042
Hospice continuous home care per hour   T2043
Hospice inpatient respite care per diem   T2044
Hospice general inpatient care per diem   T2045
Hospice long term care, room and board only per diem   T2046
Behavioral health long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem   T2048
Non-emergency transportation stretcher van, mileage per mile   T2049
Walker,   E0130 - E0149
Walker, rigid (pickup), adjustable or fixed height   E0130
Walker, folding (pickup), adjustable or fixed height   E0135
Walker, with trunk support, adjustable or fixed height, any type   E0140
Walker, rigid, wheeled, adjustable or fixed height   E0141
Walker, folding, wheeled, adjustable or fixed height   E0143
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat   E0144
Walker, heavy duty, multiple braking system, variable wheel resistance   E0147
Walker, heavy duty, without wheels, rigid or folding, any type, each   E0148
Walker, heavy duty, wheeled, rigid or folding, any type   E0149
accessories,   A4636, A4637
attachments,   E0153 - E0159
Platform attachment, forearm crutch, each   E0153
Platform attachment, walker, each   E0154
Wheel attachment, rigid pick-up walker, per pair   E0155
Seat attachment, walker   E0156
Crutch attachment, walker, each   E0157
Leg extensions for walker, per set of four (4)   E0158
Brake attachment for wheeled walker, replacement, each   E0159
Walking splint,   L4386
distilled (for nebulizer),   A7018
pressure padmattress,   E0187, E0198
purification system (ESRD),   E1610, E1615
softening system (ESRD),   E1625
sterile,   A4714
Wedges, shoe,   L3340 - L3420
Heel wedge, sach   L3340
Heel wedge   L3350
Sole wedge, outside sole   L3360
Sole wedge, between sole   L3370
Clubfoot wedge   L3380
Outflare wedge   L3390
Metatarsal bar wedge, rocker   L3400
Metatarsal bar wedge, between sole   L3410
Full sole and heel wedge, between sole   L3420
Wet mount,   Q0111
Wheel attachment, rigid pickup walker,   E0155
Wheelchair,   E0950 - E1298 , K0001 - K0108
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest   E1240
Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests   E1280
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
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests   E1130
Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1050
Rollabout chair, any and all types with casters 5 or greater   E1031
Wheelchair accessory, tray, each   E0950
Wheelchair specially sized or constructed, (indicate brand name, model number, if any) and justification   E1220
Wheelchair with fixed arm, footrests   E1221
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests   E1060
Heel loopholder, any type, with or without ankle strap, each   E0951
Lightweight wheelchair, fixed full length arms, swing away detachable footrest   E1250
Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest   E1110
Amputee wheelchair, fixed full length arms, without footrests or legrest   E1171
Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs   E1035
Wheelchair, detachable arms, desk or full length, swing away detachable footrests   E1140
Heavy duty wheelchair, fixed full length arms, swing away detachable footrest   E1285
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests   E1150
Toe loopholder, any type, each   E0952
Wheelchair with fixed arm, elevating legrests   E1222
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1070
Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs   E1036
Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1290
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest   E1260
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest   E1172
Wheelchair with detachable arms, footrests   E1223
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each   E0955
Wheelchair, fixed full length arms, swing away detachable elevating legrests   E1160
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests   E1180
Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests   E1270
Heavy duty wheelchair, fixed full length arms, elevating legrest   E1295
Transport chair, pediatric size   E1037
Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest   E1083
Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests   E1084
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests   E1190
Wheelchair with detachable arms, elevating legrests   E1224
Transport chair, adult size, patient weight capacity up to and including 300 pounds   E1038
Special wheelchair seat height from floor   E1296
Manual adult size wheelchair, includes tilt in space   E1161
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each   E0956
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each   E0957
Hemi-wheelchair, fixed full length arms, swing away detachable foot rests   E1085
Special wheelchair seat depth, by upholstery   E1297
Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds   E1039
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each   E1225
Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests   E1195
Manual wheelchair accessory, one-arm drive attachment, each   E0958
Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests   E1086
Special wheelchair seat depth andor width, by construction   E1298
Amputee wheelchair, fixed full length arms, swing away detachable footrest   E1200
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each   E1226
Manual wheelchair accessory, adapter for amputee, each   E0959
High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests   E1087
Special height arms for wheelchair   E1227
Wheelchair accessory, shoulder harnessstraps or chest strap, including any type mounting hardware   E0960
Special back height for wheelchair   E1228
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests   E1088
High strength lightweight wheelchair, fixed length arms, swing away detachable footrest   E1089
Wheelchair, pediatric size, not otherwise specified   E1229
Manual wheelchair accessory, wheel lock brake extension (handle), each   E0961
Power operated vehicle (three or four wheel nonhighway) specify brand name and model number   E1230
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests   E1090
Manual wheelchair accessory, headrest extension, each   E0966
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system   E1231
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
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system   E1232
Commode seat, wheelchair   E0968
Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests   E1093
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system   E1233
Narrowing device, wheelchair   E0969
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system   E1234
No 2 footplates, except for elevating leg rest   E0970
Wheelchair, pediatric size, rigid, adjustable, with seating system   E1235
Manual wheelchair accessory, anti-tipping device, each   E0971
Wheelchair, pediatric size, folding, adjustable, with seating system   E1236
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each   E0973
Manual wheelchair accessory, anti-rollback device, each   E0974
Wheelchair, pediatric size, rigid, adjustable, without seating system   E1237
Wheelchair accessory, positioning beltsafety beltpelvic strap, each   E0978
Wheelchair, pediatric size, folding, adjustable, without seating system   E1238
Power wheelchair, pediatric size, not otherwise specified   E1239
Safety vest, wheelchair   E0980
Wheelchair accessory, seat upholstery, replacement only, each   E0981
Wheelchair accessory, back upholstery, replacement only, each   E0982
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control   E0983
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control   E0984
Wheelchair accessory, seat lift mechanism   E0985
Manual wheelchair accessory, push-rim activated power assist system   E0986
Manual wheelchair accessory, lever-activated, wheel drive, pair   E0988
Wheelchair accessory, elevating leg rest, complete assembly, each   E0990
Manual wheelchair accessory, solid seat insert   E0992
Arm rest, each   E0994
Wheelchair accessory, calf restpad, replacement only, each   E0995
Wheelchair accessory, power seating system, tilt only   E1002
Wheelchair accessory, power seating system, recline only, without shear reduction   E1003
Wheelchair accessory, power seating system, recline only, with mechanical shear reduction   E1004
Wheelchair accessory, power seatng system, recline only, with power shear reduction   E1005
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
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction   E1008
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
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
Reclining back, addition to pediatric size wheelchair   E1014
Shock absorber for manual wheelchair, each   E1015
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
Standard wheelchair   K0001
Standard hemi (low seat) wheelchair   K0002
Lightweight wheelchair   K0003
High strength, lightweight wheelchair   K0004
Ultralightweight wheelchair   K0005
Heavy duty wheelchair   K0006
Extra heavy duty wheelchair   K0007
Custom manual wheelchairbase   K0008
Other manual wheelchairbase   K0009
Standard - weight frame motorizedpower wheelchair   K0010
Standard - weight frame motorizedpower wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking   K0011
Lightweight portable motorizedpower wheelchair   K0012
Custom motorizedpower wheelchair base   K0013
Other motorizedpower wheelchair base   K0014
Detachable, non-adjustable height armrest, replacement only, each   K0015
Detachable, adjustable height armrest, base, replacement only, each   K0017
Detachable, adjustable height armrest, upper portion, replacement only, each   K0018
Arm pad, replacement only, each   K0019
Fixed, adjustable height armrest, pair   K0020
High mount flip-up footrest, replacement only, each   K0037
Leg strap, each   K0038
Leg strap, h style, each   K0039
Adjustable angle footplate, each   K0040
Large size footplate, each   K0041
Standard size footplate, replacement only, each   K0042
Footrest, lower extension tube, replacement only, each   K0043
Footrest, upper hanger bracket, replacement only, each   K0044
Footrest, complete assembly, replacement only, each   K0045
Elevating legrest, lower extension tube, replacement only, each   K0046
Elevating legrest, upper hanger bracket, replacement only, each   K0047
Ratchet assembly, replacement only   K0050
Cam release assembly, footrest or legrest, replacement only, each   K0051
Swingaway, detachable footrests, replacement only, each   K0052
Elevating footrests, articulating (telescoping), each   K0053
Seat height less than 17 or equal to or greater than 21 for a high strength, lightweight, or ultralightweight wheelchair   K0056
Spoke protectors, each   K0065
Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each   K0069
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each   K0070
Front caster assembly, complete, with pneumatic tire, replacement only, each   K0071
Front caster assembly, complete, with semi-pneumatic tire, replacement only, each   K0072
Caster pin lock, each   K0073
Front caster assembly, complete, with solid tire, replacement only, each   K0077
Drive belt for power wheelchair, replacement only   K0098
Iv hanger, each   K0105
Wheelchair component or accessory, not otherwise specified   K0108
accessories,   E0192, E0950 - E1030 , E1065 - E1069 , E2211 - E2230 , E2300 - E2399
Wheelchair accessory, tray, each   E0950
Heel loopholder, any type, with or without ankle strap, each   E0951
Toe loopholder, any type, each   E0952
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each   E0955
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each   E0956
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each   E0957
Manual wheelchair accessory, one-arm drive attachment, each   E0958
Manual wheelchair accessory, adapter for amputee, each   E0959
Wheelchair accessory, shoulder harnessstraps or chest strap, including any type mounting hardware   E0960
Manual wheelchair accessory, wheel lock brake extension (handle), each   E0961
Manual wheelchair accessory, headrest extension, each   E0966
Manual wheelchair accessory, hand rim with projections, any type, replacement only, each   E0967
Commode seat, wheelchair   E0968
Narrowing device, wheelchair   E0969
No 2 footplates, except for elevating leg rest   E0970
Manual wheelchair accessory, anti-tipping device, each   E0971
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each   E0973
Manual wheelchair accessory, anti-rollback device, each   E0974
Wheelchair accessory, positioning beltsafety beltpelvic strap, each   E0978
Safety vest, wheelchair   E0980
Wheelchair accessory, seat upholstery, replacement only, each   E0981
Wheelchair accessory, back upholstery, replacement only, each   E0982
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control   E0983
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control   E0984
Wheelchair accessory, seat lift mechanism   E0985
Manual wheelchair accessory, push-rim activated power assist system   E0986
Manual wheelchair accessory, lever-activated, wheel drive, pair   E0988
Wheelchair accessory, elevating leg rest, complete assembly, each   E0990
Manual wheelchair accessory, solid seat insert   E0992
Arm rest, each   E0994
Wheelchair accessory, calf restpad, replacement only, each   E0995
Wheelchair accessory, power seating system, tilt only   E1002
Wheelchair accessory, power seating system, recline only, without shear reduction   E1003
Wheelchair accessory, power seating system, recline only, with mechanical shear reduction   E1004
Wheelchair accessory, power seatng system, recline only, with power shear reduction   E1005
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
Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction   E1008
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
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
Reclining back, addition to pediatric size wheelchair   E1014
Shock absorber for manual wheelchair, each   E1015
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
Manual wheelchair accessory, pneumatic propulsion tire, any size, each   E2211
Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each   E2212
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each   E2213
Manual wheelchair accessory, pneumatic caster tire, any size, each   E2214
Manual wheelchair accessory, tube for pneumatic caster tire, any size, each   E2215
Manual wheelchair accessory, foam filled propulsion tire, any size, each   E2216
Manual wheelchair accessory, foam filled caster tire, any size, each   E2217
Manual wheelchair accessory, foam propulsion tire, any size, each   E2218
Manual wheelchair accessory, foam caster tire, any size, each   E2219
Manual wheelchair accessory, solid (rubberplastic) propulsion tire, any size, replacement only, each   E2220
Manual wheelchair accessory, solid (rubberplastic) caster tire (removable), any size, replacement only, each   E2221
Manual wheelchair accessory, solid (rubberplastic) caster tire with integrated wheel, any size, replacement only, each   E2222
Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each   E2224
Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each   E2225
Manual wheelchair accessory, caster fork, any size, replacement only, each   E2226
Manual wheelchair accessory, gear reduction drive wheel, each   E2227
Manual wheelchair accessory, wheel braking system and lock, complete, each   E2228
Manual wheelchair accessory, manual standing system   E2230
Wheelchair accessory, power seat elevation system, any type   E2300
Wheelchair accessory, power standing system, any type   E2301
Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware   E2310
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware   E2311
Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware   E2312
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each   E2313
Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware   E2321
Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware   E2322
Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated   E2323
Power wheelchair accessory, chin cup for chin control interface   E2324
Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware   E2325
Power wheelchair accessory, breath tube kit for sip and puff interface   E2326
Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware   E2327
Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware   E2328
Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware   E2329
Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware   E2330
Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware   E2331
Power wheelchair accessory, nonstandard seat frame width, 20-23 inches   E2340
Power wheelchair accessory, nonstandard seat frame width, 24-27 inches   E2341
Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches   E2342
Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches   E2343
Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface   E2351
Power wheelchair accessory, group 34 non-sealed lead acid battery, each   E2358
Power wheelchair accessory, group 34 sealed lead acid battery, each (eg, gel cell, absorbed glassmat)   E2359
Power wheelchair accessory, 22nf non-sealed lead acid battery, each   E2360
Power wheelchair accessory, 22nf sealed lead acid battery, each, (eg, gel cell, absorbed glassmat)   E2361
Power wheelchair accessory, group 24 non-sealed lead acid battery, each   E2362
Power wheelchair accessory, group 24 sealed lead acid battery, each (eg, gel cell, absorbed glassmat)   E2363
Power wheelchair accessory, u-1 non-sealed lead acid battery, each   E2364
Power wheelchair accessory, u-1 sealed lead acid battery, each (eg, gel cell, absorbed glassmat)   E2365
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each   E2366
Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each   E2367
Power wheelchair component, drive wheel motor, replacement only   E2368
Power wheelchair component, drive wheel gear box, replacement only   E2369
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only   E2370
Power wheelchair accessory, group 27 sealed lead acid battery, (eg, gel cell, absorbed glassmat), each   E2371
Power wheelchair accessory, group 27 non-sealed lead acid battery, each   E2372
Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware   E2373
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only   E2374
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only   E2375
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only   E2376
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue   E2377
Power wheelchair component, actuator, replacement only   E2378
Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each   E2381
Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each   E2382
Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each   E2383
Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each   E2384
Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each   E2385
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each   E2386
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each   E2387
Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each   E2388
Power wheelchair accessory, foam caster tire, any size, replacement only, each   E2389
Power wheelchair accessory, solid (rubberplastic) drive wheel tire, any size, replacement only, each   E2390
Power wheelchair accessory, solid (rubberplastic) caster tire (removable), any size, replacement only, each   E2391
Power wheelchair accessory, solid (rubberplastic) caster tire with integrated wheel, any size, replacement only, each   E2392
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each   E2394
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each   E2395
Power wheelchair accessory, caster fork, any size, replacement only, each   E2396
Power wheelchair accessory, lithium-based battery, each   E2397
amputee,   E1170 - E1200
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests   E1170
Amputee wheelchair, fixed full length arms, without footrests or legrest   E1171
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest   E1172
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests   E1180
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests   E1190
Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests   E1195
Amputee wheelchair, fixed full length arms, swing away detachable footrest   E1200
back, fully reclining, manual,   E1226
   K0108
cushions,   E2601 - E2625
General use wheelchair seat cushion, width less than 22 inches, any depth   E2601
General use wheelchair seat cushion, width 22 inches or greater, any depth   E2602
Skin protection wheelchair seat cushion, width less than 22 inches, any depth   E2603
Skin protection wheelchair seat cushion, width 22 inches or greater, any depth   E2604
Positioning wheelchair seat cushion, width less than 22 inches, any depth   E2605
Positioning wheelchair seat cushion, width 22 inches or greater, any depth   E2606
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth   E2607
Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth   E2608
Custom fabricated wheelchair seat cushion, any size   E2609
Wheelchair seat cushion, powered   E2610
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware   E2611
General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware   E2612
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware   E2613
Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware   E2614
Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware   E2615
Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware   E2616
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware   E2617
Replacement cover for wheelchair seat cushion or back cushion, each   E2619
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware   E2620
Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware   E2621
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth   E2622
Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth   E2623
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth   E2624
Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth   E2625
narrowing device,   E0969
power add-on,   E0983 - E0984
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control   E0983
Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control   E0984
shock absorber,   E1015 - E1018
Shock absorber for manual wheelchair, each   E1015
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
specially sized,   E1220, E1230
stump support system,   K055
tire,   E099
transfer board or device,   E0705
tray,   K010
van, non-emergency,   A0130
youth,   E109
WHFO with inflatable air chamber,   L3807
WHO, wrist extension,   L391
Whirlpool equipment,   E1300 - E1310
Whirlpool, portable (overtub type)   E1300
Whirlpool, non-portable (built-in type)   E1310
Wig,   A9282
Wipes,   A4245, A4247
Wound cleanser,   A6260
alginate dressing,   A6196 - A6198
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
collagen dressing,   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
foam dressing,   A6209 - A6214
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
hydrocolloid dressing,   A6234 - A6239
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
hydrogel dressing,   A6242 - A6247
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
non-contact wound warming cover, and accessory,   E0231, E0232
specialty absorptive dressing,   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
alginate dressing,   A6199
collagen based,   A6010
foam dressing,   A6215
hydrocolloid dressing,   A6240, A6241
hydrogel dressing,   A6248
not elsewhere classified,   A6261, A6262
Wound pouch,   A6154
disarticulation prosthesis,   L6050, L6055
electronic wrist rotator,   L7259
handfinger orthosis (WHFO),   E1805, E1825, L3800 - L3954
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, custom fabricated, includes fitting and adjustment   L3806
Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each   L3891
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension flexion, finger flexionextension, wrist or finger driven, custom fabricated   L3900
Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3905
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise   L3807
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension flexion, finger flexionextension, cable driven, custom fabricated   L3901
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3906
Wrist hand finger orthosis, external powered, electric, custom fabricated   L3904
Wrist hand finger orthosis, rigid without joints, may include soft interface material straps, custom fabricated, includes fitting and adjustment   L3808
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf   L3908
Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf   L3912
Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3913
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise   L3915
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf   L3916
Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise   L3917
Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf   L3918
Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3919
Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3921
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise   L3923
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf   L3924
Finger orthosis, proximal interphalangeal (pip)distal interphalangeal (dip), non torsion jointspring, extensionflexion, may include soft interface material, prefabricated, off-the-shelf   L3925
Finger orthosis, proximal interphalangeal (pip)distal interphalangeal (dip), without jointspring, extensionflexion (eg, static or ring type), may include soft interface material, prefabricated, off-the-shelf   L3927
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type   L3809
Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise   L3929
Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, prefabricated, off-the-shelf   L3930
Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, prefabricated, includes fitting and adjustment   L3931
Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment   L3933
Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment   L3935