|
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 |
|
|
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, 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
| |
|
Wheelchair accessory, tray, each E0950
| |
|
Heel loopholder, any type, with or without ankle strap, each E0951
| |
|
Toe loopholder, any type, each E0952
| |
|
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each E0953
| |
|
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot E0954
| |
|
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
| |
|
component,or,accessory,not,otherwise,specified 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
| |
|
foot,box E0954
| |
|
lateral,thigh,or,knee,support E0953
| |
|
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 |
|
|
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
| |
|
Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests E1280
| |
|
Wheelchair accessory, tray, each E0950
| |
|
Rollabout chair, any and all types with casters 5 or greater E1031
| |
|
Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests E1100
| |
|
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests E1170
| |
|
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests E1130
| |
|
Wheelchair specially sized or constructed, (indicate brand name, model number, if any) and justification E1220
| |
|
Wheelchair with fixed arm, footrests E1221
| |
|
Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs E1035
| |
|
Amputee wheelchair, fixed full length arms, without footrests or legrest E1171
| |
|
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests E1060
| |
|
Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest E1110
| |
|
Wheelchair, detachable arms, desk or full length, swing away detachable footrests E1140
| |
|
Lightweight wheelchair, fixed full length arms, swing away detachable footrest E1250
| |
|
Heel loopholder, any type, with or without ankle strap, each E0951
| |
|
Heavy duty wheelchair, fixed full length arms, swing away detachable footrest E1285
| |
|
Wheelchair with fixed arm, elevating legrests E1222
| |
|
Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest E1172
| |
|
Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest E1290
| |
|
Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs E1036
| |
|
Toe loopholder, any type, each E0952
| |
|
Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest E1070
| |
|
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests E1150
| |
|
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest E1260
| |
|
Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest E1083
| |
|
Wheelchair, fixed full length arms, swing away detachable elevating legrests E1160
| |
|
Heavy duty wheelchair, fixed full length arms, elevating legrest E1295
| |
|
Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests E1270
| |
|
Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests E1180
| |
|
Transport chair, pediatric size E1037
| |
|
Wheelchair with detachable arms, footrests E1223
| |
|
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each E0953
| |
|
Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests E1084
| |
|
Wheelchair with detachable arms, elevating legrests E1224
| |
|
Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests E1190
| |
|
Manual adult size wheelchair, includes tilt in space E1161
| |
|
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot E0954
| |
|
Special wheelchair seat height from floor E1296
| |
|
Transport chair, adult size, patient weight capacity up to and including 300 pounds E1038
| |
|
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each E0955
| |
|
Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests E1195
| |
|
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each E1225
| |
|
Special wheelchair seat depth, by upholstery E1297
| |
|
Hemi-wheelchair, fixed full length arms, swing away detachable foot rests E1085
| |
|
Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds E1039
| |
|
Amputee wheelchair, fixed full length arms, swing away detachable footrest E1200
| |
|
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each E1226
| |
|
Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests E1086
| |
|
Special wheelchair seat depth andor width, by construction E1298
| |
|
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each E0956
| |
|
Special height arms for wheelchair E1227
| |
|
Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each E0957
| |
|
High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests E1087
| |
|
Special back height for wheelchair E1228
| |
|
Manual wheelchair accessory, one-arm drive attachment, each E0958
| |
|
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
| |
|
Manual wheelchair accessory, adapter for amputee, each E0959
| |
|
Wheelchair, pediatric size, not otherwise specified E1229
| |
|
Power operated vehicle (three or four wheel nonhighway) specify brand name and model number E1230
| |
|
Wheelchair accessory, shoulder harnessstraps or chest strap, including any type mounting hardware E0960
| |
|
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests E1090
| |
|
Manual wheelchair accessory, wheel lock brake extension (handle), each E0961
| |
|
Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system E1231
| |
|
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
| |
|
Manual wheelchair accessory, headrest extension, each E0966
| |
|
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
| |
|
Manual wheelchair accessory, hand rim with projections, any type, replacement only, each E0967
| |
|
Commode seat, wheelchair E0968
| |
|
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system E1234
| |
|
Wheelchair, pediatric size, rigid, adjustable, with seating system E1235
| |
|
Narrowing device, wheelchair E0969
| |
|
No 2 footplates, except for elevating leg rest E0970
| |
|
Wheelchair, pediatric size, folding, adjustable, with seating system E1236
| |
|
Manual wheelchair accessory, anti-tipping device, each E0971
| |
|
Wheelchair, pediatric size, rigid, adjustable, without seating system E1237
| |
|
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each E0973
| |
|
Wheelchair, pediatric size, folding, adjustable, without seating system E1238
| |
|
Manual wheelchair accessory, anti-rollback device, each E0974
| |
|
Power wheelchair, pediatric size, not otherwise specified E1239
| |
|
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
| |
|
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
| |
|
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
| |
|
Wound |
|
|
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
| |
|
Wound |
|
|
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 |
|
|
Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each L3891
| |
|
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, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, custom fabricated, includes fitting and adjustment L3806
| |
|
Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension flexion, finger flexionextension, wrist or finger driven, custom fabricated L3900
| |
|
Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3906
| |
|
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 finger orthosis, external powered, electric, custom fabricated L3904
| |
|
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf L3908
| |
|
Wrist hand finger orthosis, rigid without joints, may include soft interface material straps, custom fabricated, includes fitting and adjustment L3808
| |
|
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
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Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3919
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Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3921
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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
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Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf L3924
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Finger orthosis, proximal interphalangeal (pip)distal interphalangeal (dip), non torsion jointspring, extensionflexion, may include soft interface material, prefabricated, off-the-shelf L3925
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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
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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
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Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type L3809
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Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, prefabricated, off-the-shelf L3930
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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
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Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment L3933
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Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment L3935
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Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each L3891
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Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3905
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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
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Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension flexion, finger flexionextension, wrist or finger driven, custom fabricated L3900
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Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3906
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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
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Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension flexion, finger flexionextension, cable driven, custom fabricated L3901
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Wrist hand finger orthosis, external powered, electric, custom fabricated L3904
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Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf L3908
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Wrist hand finger orthosis, rigid without joints, may include soft interface material straps, custom fabricated, includes fitting and adjustment L3808
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Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf L3912
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Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3913
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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
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Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf L3916
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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
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Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf L3918
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Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3919
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Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment L3921
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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
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Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf L3924
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Finger orthosis, proximal interphalangeal (pip)distal interphalangeal (dip), non torsion jointspring, extensionflexion, may include soft interface material, prefabricated, off-the-shelf L3925
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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
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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
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Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type L3809
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Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bandssprings, may include soft interface material, straps, prefabricated, off-the-shelf L3930
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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
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Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment L3933
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Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment L3935
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