CCS Clinical Classifications - DME and supplies
The following table lists codes that belong to the DME and supplies Clinical Classification:
| Code | Description |
|---|---|
| HCPCS A4206 | Syringe with needle, sterile, 1 cc or less, each |
| HCPCS A4207 | Syringe with needle, sterile 2 cc, each |
| HCPCS A4208 | Syringe with needle, sterile 3 cc, each |
| HCPCS A4209 | Syringe with needle, sterile 5 cc or greater, each |
| HCPCS A4210 | Needle-free injection device, each |
| HCPCS A4211 | Supplies for self-administered injections |
| HCPCS A4212 | Non-coring needle or stylet with or without catheter |
| HCPCS A4213 | Syringe, sterile, 20 cc or greater, each |
| HCPCS A4215 | Needle, sterile, any size, each |
| HCPCS A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
| HCPCS A4217 | Sterile water/saline, 500 ml |
| HCPCS A4218 | Sterile saline or water, metered dose dispenser, 10 ml |
| HCPCS A4220 | Refill kit for implantable infusion pump |
| HCPCS A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
| HCPCS A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
| HCPCS A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
| HCPCS A4230 | Infusion set for external insulin pump, non needle cannula type |
| HCPCS A4231 | Infusion set for external insulin pump, needle type |
| HCPCS A4232 | Syringe with needle for external insulin pump, sterile, 3 cc |
| HCPCS A4233 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
| HCPCS A4234 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each |
| HCPCS A4235 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each |
| HCPCS A4236 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each |
| HCPCS A4244 | Alcohol or peroxide, per pint |
| HCPCS A4245 | Alcohol wipes, per box |
| HCPCS A4246 | Betadine or phisohex solution, per pint |
| HCPCS A4247 | Betadine or iodine swabs/wipes, per box |
| HCPCS A4248 | Chlorhexidine containing antiseptic, 1 ml |
| HCPCS A4250 | Urine test or reagent strips or tablets (100 tablets or strips) |
| HCPCS A4252 | Blood ketone test or reagent strip, each |
| HCPCS A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
| HCPCS A4254 | REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH |
| HCPCS A4255 | Platforms for home blood glucose monitor, 50 per box |
| HCPCS A4256 | Normal, low and high calibrator solution / chips |
| HCPCS A4257 | Replacement lens shield cartridge for use with laser skin piercing device, each |
| HCPCS A4258 | Spring-powered device for lancet, each |
| HCPCS A4259 | Lancets, per box of 100 |
| HCPCS A4260 | LEVONORGESTREL (CONTRACEPTIVE) IMPLANTS SYSTEM, INCLUDING IMPLANTS AND SUPPLIES |
| HCPCS A4261 | Cervical cap for contraceptive use |
| HCPCS A4262 | Temporary, absorbable lacrimal duct implant, each |
| HCPCS A4263 | Permanent, long term, non-dissolvable lacrimal duct implant, each |
| HCPCS A4264 | Permanent implantable contraceptive intratubal occlusion device(s) and delivery system |
| HCPCS A4265 | Paraffin, per pound |
| HCPCS A4266 | Diaphragm for contraceptive use |
| HCPCS A4267 | Contraceptive supply, condom, male, each |
| HCPCS A4268 | Contraceptive supply, condom, female, each |
| HCPCS A4269 | Contraceptive supply, spermicide (e.g., foam, gel), each |
| HCPCS A4270 | Disposable endoscope sheath, each |
| HCPCS A4280 | Adhesive skin support attachment for use with external breast prosthesis, each |
| HCPCS A4281 | Tubing for breast pump, replacement |
| HCPCS A4282 | Adapter for breast pump, replacement |
| HCPCS A4283 | Cap for breast pump bottle, replacement |
| HCPCS A4284 | Breast shield and splash protector for use with breast pump, replacement |
| HCPCS A4285 | Polycarbonate bottle for use with breast pump, replacement |
| HCPCS A4286 | Locking ring for breast pump, replacement |
| HCPCS A4290 | Sacral nerve stimulation test lead, each |
| HCPCS A4300 | Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access |
| HCPCS A4301 | Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) |
| HCPCS A4305 | Disposable drug delivery system, flow rate of 50 ml or greater per hour |
| HCPCS A4306 | Disposable drug delivery system, flow rate of less than 50 ml per hour |
| HCPCS A4310 | Insertion tray without drainage bag and without catheter (accessories only) |
| HCPCS A4311 | Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
| HCPCS A4312 | Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone |
| HCPCS A4313 | Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation |
| HCPCS A4314 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
| HCPCS A4315 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
| HCPCS A4316 | Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation |
| HCPCS A4320 | Irrigation tray with bulb or piston syringe, any purpose |
| HCPCS A4321 | Therapeutic agent for urinary catheter irrigation |
| HCPCS A4322 | Irrigation syringe, bulb or piston, each |
| HCPCS A4324 | MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH |
| HCPCS A4325 | MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH |
| HCPCS A4326 | Male external catheter with integral collection chamber, any type, each |
| HCPCS A4327 | Female external urinary collection device; meatal cup, each |
| HCPCS A4328 | Female external urinary collection device; pouch, each |
| HCPCS A4330 | Perianal fecal collection pouch with adhesive, each |
| HCPCS A4331 | Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
| HCPCS A4332 | Lubricant, individual sterile packet, each |
| HCPCS A4333 | Urinary catheter anchoring device, adhesive skin attachment, each |
| HCPCS A4334 | Urinary catheter anchoring device, leg strap, each |
| HCPCS A4335 | Incontinence supply; miscellaneous |
| HCPCS A4336 | Incontinence supply, urethral insert, any type, each |
| HCPCS A4338 | Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
| HCPCS A4340 | Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
| HCPCS A4344 | Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
| HCPCS A4346 | Indwelling catheter; foley type, three way for continuous irrigation, each |
| HCPCS A4347 | MALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX DEVICE; PER DOZEN |
| HCPCS A4348 | MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR, EACH (E.G., 2 PER MONTH) |
| HCPCS A4349 | Male external catheter, with or without adhesive, disposable, each |
| HCPCS A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
| HCPCS A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each |
| HCPCS A4353 | Intermittent urinary catheter, with insertion supplies |
| HCPCS A4354 | Insertion tray with drainage bag but without catheter |
| HCPCS A4355 | Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each |
| HCPCS A4356 | External urethral clamp or compression device (not to be used for catheter clamp), each |
| HCPCS A4357 | Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
| HCPCS A4358 | Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
| HCPCS A4359 | URINARY SUSPENSORY WITHOUT LEG BAG, EACH |
| HCPCS A4360 | Disposable external urethral clamp or compression device, with pad and/or pouch, each |
| HCPCS A4361 | Ostomy faceplate, each |
| HCPCS A4362 | Skin barrier; solid, 4 x 4 or equivalent; each |
| HCPCS A4363 | Ostomy clamp, any type, replacement only, each |
| HCPCS A4364 | Adhesive, liquid or equal, any type, per oz |
| HCPCS A4365 | ADHESIVE REMOVER WIPES, ANY TYPE, PER 50 |
| HCPCS A4366 | Ostomy vent, any type, each |
| HCPCS A4367 | Ostomy belt, each |
| HCPCS A4368 | Ostomy filter, any type, each |
| HCPCS A4369 | Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
| HCPCS A4371 | Ostomy skin barrier, powder, per oz |
| HCPCS A4372 | Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each |
| HCPCS A4373 | Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
| HCPCS A4375 | Ostomy pouch, drainable, with faceplate attached, plastic, each |
| HCPCS A4376 | Ostomy pouch, drainable, with faceplate attached, rubber, each |
| HCPCS A4377 | Ostomy pouch, drainable, for use on faceplate, plastic, each |
| HCPCS A4378 | Ostomy pouch, drainable, for use on faceplate, rubber, each |
| HCPCS A4379 | Ostomy pouch, urinary, with faceplate attached, plastic, each |
| HCPCS A4380 | Ostomy pouch, urinary, with faceplate attached, rubber, each |
| HCPCS A4381 | Ostomy pouch, urinary, for use on faceplate, plastic, each |
| HCPCS A4382 | Ostomy pouch, urinary, for use on faceplate, heavy plastic, each |
| HCPCS A4383 | Ostomy pouch, urinary, for use on faceplate, rubber, each |
| HCPCS A4384 | Ostomy faceplate equivalent, silicone ring, each |
| HCPCS A4385 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
| HCPCS A4387 | Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each |
| HCPCS A4388 | Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
| HCPCS A4389 | Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
| HCPCS A4390 | Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
| HCPCS A4391 | Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each |
| HCPCS A4392 | Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
| HCPCS A4393 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
| HCPCS A4394 | Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
| HCPCS A4395 | Ostomy deodorant for use in ostomy pouch, solid, per tablet |
| HCPCS A4396 | Ostomy belt with peristomal hernia support |
| HCPCS A4397 | Irrigation supply; sleeve, each |
| HCPCS A4398 | Ostomy irrigation supply; bag, each |
| HCPCS A4399 | Ostomy irrigation supply; cone/catheter, with or without brush |
| HCPCS A4400 | Ostomy irrigation set |
| HCPCS A4402 | Lubricant, per ounce |
| HCPCS A4404 | Ostomy ring, each |
| HCPCS A4405 | Ostomy skin barrier, non-pectin based, paste, per ounce |
| HCPCS A4406 | Ostomy skin barrier, pectin-based, paste, per ounce |
| HCPCS A4407 | Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
| HCPCS A4408 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
| HCPCS A4409 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
| HCPCS A4410 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
| HCPCS A4411 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
| HCPCS A4412 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
| HCPCS A4413 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
| HCPCS A4414 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
| HCPCS A4415 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
| HCPCS A4416 | Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
| HCPCS A4417 | Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each |
| HCPCS A4418 | Ostomy pouch, closed; without barrier attached, with filter (1 piece), each |
| HCPCS A4419 | Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
| HCPCS A4420 | Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each |
| HCPCS A4421 | Ostomy supply; miscellaneous |
| HCPCS A4422 | Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each |
| HCPCS A4423 | Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
| HCPCS A4424 | Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
| HCPCS A4425 | Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
| HCPCS A4426 | Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each |
| HCPCS A4427 | Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
| HCPCS A4428 | Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
| HCPCS A4429 | Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
| HCPCS A4430 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
| HCPCS A4431 | Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each |
| HCPCS A4432 | Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
| HCPCS A4433 | Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each |
| HCPCS A4434 | Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each |
| HCPCS A4435 | Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each |
| HCPCS A4450 | Tape, non-waterproof, per 18 square inches |
| HCPCS A4452 | Tape, waterproof, per 18 square inches |
| HCPCS A4455 | Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
| HCPCS A4456 | Adhesive remover, wipes, any type, each |
| HCPCS A4458 | Enema bag with tubing, reusable |
| HCPCS A4461 | Surgical dressing holder, non-reusable, each |
| HCPCS A4462 | ABDOMINAL DRESSING HOLDER, EACH |
| HCPCS A4463 | Surgical dressing holder, reusable, each |
| HCPCS A4465 | Non-elastic binder for extremity |
| HCPCS A4466 | Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each |
| HCPCS A4470 | Gravlee jet washer |
| HCPCS A4480 | Vabra aspirator |
| HCPCS A4481 | Tracheostoma filter, any type, any size, each |
| HCPCS A4483 | Moisture exchanger, disposable, for use with invasive mechanical ventilation |
| HCPCS A4490 | Surgical stockings above knee length, each |
| HCPCS A4495 | Surgical stockings thigh length, each |
| HCPCS A4500 | Surgical stockings below knee length, each |
| HCPCS A4510 | Surgical stockings full length, each |
| HCPCS A4520 | Incontinence garment, any type, (e.g., brief, diaper), each |
| HCPCS A4521 | ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL SIZE, EACH |
| HCPCS A4522 | ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, MEDIUM SIZE, EACH |
| HCPCS A4523 | ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH |
| HCPCS A4524 | ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, EXTRA LARGE SIZE, EACH |
| HCPCS A4525 | ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL SIZE, EACH |
| HCPCS A4526 | ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, MEDIUM SIZE, EACH |
| HCPCS A4527 | ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH |
| HCPCS A4528 | ADULT-SIZED INCONTINENCE PRODUCT, BRIEF, EXTRA-LARGE SIZE, EACH |
| HCPCS A4529 | CHILD-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL/MEDIUM SIZE, EACH |
| HCPCS A4530 | CHILD-SIZED INCONTINENCE PRODUCT, DIAPER, LARGE SIZE, EACH |
| HCPCS A4531 | CHILD-SIZED INCONTINENCE PRODUCT, BRIEF, SMALL/MEDIUM SIZE, EACH |
| HCPCS A4532 | CHILD-SIZED INCONTINENCE PRODUCT, BRIEF, LARGE SIZE, EACH |
| HCPCS A4533 | YOUTH-SIZED INCONTINENCE PRODUCT, DIAPER, EACH |
| HCPCS A4534 | YOUTH-SIZED INCONTINENCE PRODUCT, BRIEF, EACH |
| HCPCS A4535 | DISPOSABLE LINER/SHIELD FOR INCONTINENCE, EACH |
| HCPCS A4536 | PROTECTIVE UNDERWEAR, WASHABLE, ANY SIZE, EACH |
| HCPCS A4537 | UNDER PAD, REUSABLE/WASHABLE, ANY SIZE, EACH |
| HCPCS A4538 | DIAPER, REUSABLE, PROVIDED BY A DIAPER SERVICE, EACH DIAPER |
| HCPCS A4550 | Surgical trays |
| HCPCS A4554 | Disposable underpads, all sizes |
| HCPCS A4556 | Electrodes, (e.g., apnea monitor), per pair |
| HCPCS A4557 | Lead wires, (e.g., apnea monitor), per pair |
| HCPCS A4558 | Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz |
| HCPCS A4559 | Coupling gel or paste, for use with ultrasound device, per oz |
| HCPCS A4561 | Pessary, reusable, rubber, any type |
| HCPCS A4562 | Pessary, reusable, non rubber, any type |
| HCPCS A4565 | Slings |
| HCPCS A4566 | Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment |
| HCPCS A4570 | Splint |
| HCPCS A4575 | Topical hyperbaric oxygen chamber, disposable |
| HCPCS A4580 | Cast supplies (e.g., plaster) |
| HCPCS A4590 | Special casting material (e.g., fiberglass) |
| HCPCS A4595 | Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
| HCPCS A4600 | Sleeve for intermittent limb compression device, replacement only, each |
| HCPCS A4601 | Lithium ion battery, rechargeable, for non-prosthetic use, replacement |
| HCPCS A4604 | Tubing with integrated heating element for use with positive airway pressure device |
| HCPCS A4605 | Tracheal suction catheter, closed system, each |
| HCPCS A4606 | Oxygen probe for use with oximeter device, replacement |
| HCPCS A4608 | Transtracheal oxygen catheter, each |
| HCPCS A4609 | TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR LESS THAN 72 HOURS OF USE, EACH |
| HCPCS A4610 | TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR 72 OR MORE HOURS OF USE, EACH |
| HCPCS A4611 | Battery, heavy duty; replacement for patient owned ventilator |
| HCPCS A4612 | Battery cables; replacement for patient-owned ventilator |
| HCPCS A4613 | Battery charger; replacement for patient-owned ventilator |
| HCPCS A4614 | Peak expiratory flow rate meter, hand held |
| HCPCS A4615 | Cannula, nasal |
| HCPCS A4616 | Tubing (oxygen), per foot |
| HCPCS A4617 | Mouth piece |
| HCPCS A4618 | Breathing circuits |
| HCPCS A4619 | Face tent |
| HCPCS A4620 | Variable concentration mask |
| HCPCS A4623 | Tracheostomy, inner cannula |
| HCPCS A4624 | Tracheal suction catheter, any type other than closed system, each |
| HCPCS A4625 | Tracheostomy care kit for new tracheostomy |
| HCPCS A4626 | Tracheostomy cleaning brush, each |
| HCPCS A4627 | Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
| HCPCS A4628 | Oral and/or oropharyngeal suction catheter, each |
| HCPCS A4629 | Tracheostomy care kit for established tracheostomy |
| HCPCS A4630 | Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient |
| HCPCS A4632 | REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH |
| HCPCS A4633 | Replacement bulb/lamp for ultraviolet light therapy system, each |
| HCPCS A4634 | Replacement bulb for therapeutic light box, tabletop model |
| HCPCS A4635 | Underarm pad, crutch, replacement, each |
| HCPCS A4636 | Replacement, handgrip, cane, crutch, or walker, each |
| HCPCS A4637 | Replacement, tip, cane, crutch, walker, each. |
| HCPCS A4638 | Replacement battery for patient-owned ear pulse generator, each |
| HCPCS A4639 | Replacement pad for infrared heating pad system, each |
| HCPCS A4640 | Replacement pad for use with medically necessary alternating pressure pad owned by patient |
| HCPCS A4641 | Radiopharmaceutical, diagnostic, not otherwise classified |
| HCPCS A4642 | Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries |
| HCPCS A4643 | SUPPLY OF ADDITIONAL HIGH DOSE CONTRAST MATERIAL(S) DURING MAGNETIC RESONANCE IMAGING, E.G., GADOTERIDOL INJECTION |
| HCPCS A4644 | SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (100-199 MGS OF IODINE) |
| HCPCS A4645 | SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (200-299 MGS OF IODINE) |
| HCPCS A4646 | SUPPLY OF LOW OSMOLAR CONTRAST MATERIAL (300-399 MGS OF IODINE) |
| HCPCS A4647 | SUPPLY OF PARAMAGNETIC CONTRAST MATERIAL, EG., GADOLINIUM |
| HCPCS A4648 | Tissue marker, implantable, any type, each |
| HCPCS A4649 | Surgical supply; miscellaneous |
| HCPCS A4650 | Implantable radiation dosimeter, each |
| HCPCS A4651 | Calibrated microcapillary tube, each |
| HCPCS A4652 | Microcapillary tube sealant |
| HCPCS A4653 | Peritoneal dialysis catheter anchoring device, belt, each |
| HCPCS A4656 | NEEDLE, ANY SIZE, EACH |
| HCPCS A4657 | Syringe, with or without needle, each |
| HCPCS A4660 | Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
| HCPCS A4663 | Blood pressure cuff only |
| HCPCS A4670 | Automatic blood pressure monitor |
| HCPCS A4671 | Disposable cycler set used with cycler dialysis machine, each |
| HCPCS A4672 | Drainage extension line, sterile, for dialysis, each |
| HCPCS A4673 | Extension line with easy lock connectors, used with dialysis |
| HCPCS A4674 | Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz |
| HCPCS A4680 | Activated carbon filter for hemodialysis, each |
| HCPCS A4690 | Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each |
| HCPCS A4706 | Bicarbonate concentrate, solution, for hemodialysis, per gallon |
| HCPCS A4707 | Bicarbonate concentrate, powder, for hemodialysis, per packet |
| HCPCS A4708 | Acetate concentrate solution, for hemodialysis, per gallon |
| HCPCS A4709 | Acid concentrate, solution, for hemodialysis, per gallon |
| HCPCS A4714 | Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon |
| HCPCS A4719 | "y set" tubing for peritoneal dialysis |
| HCPCS A4720 | Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis |
| HCPCS A4721 | Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis |
| HCPCS A4722 | Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis |
| HCPCS A4723 | Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis |
| HCPCS A4724 | Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis |
| HCPCS A4725 | Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis |
| HCPCS A4726 | Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis |
| HCPCS A4728 | Dialysate solution, non-dextrose containing, 500 ml |
| HCPCS A4730 | Fistula cannulation set for hemodialysis, each |
| HCPCS A4736 | Topical anesthetic, for dialysis, per gram |
| HCPCS A4737 | Injectable anesthetic, for dialysis, per 10 ml |
| HCPCS A4740 | Shunt accessory, for hemodialysis, any type, each |
| HCPCS A4750 | Blood tubing, arterial or venous, for hemodialysis, each |
| HCPCS A4755 | Blood tubing, arterial and venous combined, for hemodialysis, each |
| HCPCS A4760 | Dialysate solution test kit, for peritoneal dialysis, any type, each |
| HCPCS A4765 | Dialysate concentrate, powder, additive for peritoneal dialysis, per packet |
| HCPCS A4766 | Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml |
| HCPCS A4770 | Blood collection tube, vacuum, for dialysis, per 50 |
| HCPCS A4771 | Serum clotting time tube, for dialysis, per 50 |
| HCPCS A4772 | Blood glucose test strips, for dialysis, per 50 |
| HCPCS A4773 | Occult blood test strips, for dialysis, per 50 |
| HCPCS A4774 | Ammonia test strips, for dialysis, per 50 |
| HCPCS A4860 | Disposable catheter tips for peritoneal dialysis, per 10 |
| HCPCS A4870 | Plumbing and/or electrical work for home hemodialysis equipment |
| HCPCS A4890 | Contracts, repair and maintenance, for hemodialysis equipment |
| HCPCS A4911 | Drain bag/bottle, for dialysis, each |
| HCPCS A4913 | Miscellaneous dialysis supplies, not otherwise specified |
| HCPCS A4918 | Venous pressure clamp, for hemodialysis, each |
| HCPCS A4927 | Gloves, non-sterile, per 100 |
| HCPCS A4928 | Surgical mask, per 20 |
| HCPCS A4929 | Tourniquet for dialysis, each |
| HCPCS A4930 | Gloves, sterile, per pair |
| HCPCS A4931 | Oral thermometer, reusable, any type, each |
| HCPCS A4932 | Rectal thermometer, reusable, any type, each |
| HCPCS A5051 | Ostomy pouch, closed; with barrier attached (1 piece), each |
| HCPCS A5052 | Ostomy pouch, closed; without barrier attached (1 piece), each |
| HCPCS A5053 | Ostomy pouch, closed; for use on faceplate, each |
| HCPCS A5054 | Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
| HCPCS A5055 | Stoma cap |
| HCPCS A5056 | Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
| HCPCS A5057 | Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
| HCPCS A5061 | Ostomy pouch, drainable; with barrier attached, (1 piece), each |
| HCPCS A5062 | Ostomy pouch, drainable; without barrier attached (1 piece), each |
| HCPCS A5063 | Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
| HCPCS A5071 | Ostomy pouch, urinary; with barrier attached (1 piece), each |
| HCPCS A5072 | Ostomy pouch, urinary; without barrier attached (1 piece), each |
| HCPCS A5073 | Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
| HCPCS A5081 | Stoma plug or seal, any type |
| HCPCS A5082 | Continent device; catheter for continent stoma |
| HCPCS A5083 | Continent device, stoma absorptive cover for continent stoma |
| HCPCS A5093 | Ostomy accessory; convex insert |
| HCPCS A5102 | Bedside drainage bottle with or without tubing, rigid or expandable, each |
| HCPCS A5105 | Urinary suspensory with leg bag, with or without tube, each |
| HCPCS A5112 | Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
| HCPCS A5113 | Leg strap; latex, replacement only, per set |
| HCPCS A5114 | Leg strap; foam or fabric, replacement only, per set |
| HCPCS A5119 | SKIN BARRIER, WIPES OR SWABS, PER BOX 50 |
| HCPCS A5120 | Skin barrier, wipes or swabs, each |
| HCPCS A5121 | Skin barrier; solid, 6 x 6 or equivalent, each |
| HCPCS A5122 | Skin barrier; solid, 8 x 8 or equivalent, each |
| HCPCS A5126 | Adhesive or non-adhesive; disk or foam pad |
| HCPCS A5131 | Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
| HCPCS A5200 | Percutaneous catheter/tube anchoring device, adhesive skin attachment |
| HCPCS A5500 | For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
| HCPCS A5501 | For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe |
| HCPCS A5503 | For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe |
| HCPCS A5504 | For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe |
| HCPCS A5505 | For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe |
| HCPCS A5506 | For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe |
| HCPCS A5507 | For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe |
| HCPCS A5508 | For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe |
| HCPCS A5509 | FOR DIABETICS ONLY, DIRECT FORMED, MOLDED TO FOOT WITH EXTERNAL HEAT SOURCE (I.E. HEAT GUN) MULTIPLE DENSITY INSERT (S), PREFABRICATED, PER SHOE |
| HCPCS A5510 | For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe |
| HCPCS A5511 | FOR DIABETICS ONLY, CUSTOM-MOLDED FROM MODEL OF PATIENT'S FOOT, MULTIPLE DENSITY INSERT(S), CUSTOM-FABRICATED, PER SHOE |
| HCPCS A5512 | For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
| HCPCS A5513 | For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
| HCPCS A6000 | Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card |
| HCPCS A6010 | Collagen based wound filler, dry form, sterile, per gram of collagen |
| HCPCS A6011 | Collagen based wound filler, gel/paste, per gram of collagen |
| HCPCS A6021 | Collagen dressing, sterile, size 16 sq. in. or less, each |
| HCPCS A6022 | Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
| HCPCS A6023 | Collagen dressing, sterile, size more than 48 sq. in., each |
| HCPCS A6024 | Collagen dressing wound filler, sterile, per 6 inches |
| HCPCS A6025 | Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each |
| HCPCS A6154 | Wound pouch, each |
| HCPCS A6196 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
| HCPCS A6197 | 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 |
| HCPCS A6198 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing |
| HCPCS A6199 | Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
| HCPCS A6200 | COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING |
| HCPCS A6201 | COMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING |
| HCPCS A6202 | COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING |
| HCPCS A6203 | Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
| HCPCS A6204 | Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6205 | Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6206 | Contact layer, sterile, 16 sq. in. or less, each dressing |
| HCPCS A6207 | Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
| HCPCS A6208 | Contact layer, sterile, more than 48 sq. in., each dressing |
| HCPCS A6209 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6210 | 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 |
| HCPCS A6211 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6212 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
| HCPCS A6213 | 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 |
| HCPCS A6214 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6215 | Foam dressing, wound filler, sterile, per gram |
| HCPCS A6216 | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6217 | Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
| HCPCS A6218 | Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6219 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
| HCPCS A6220 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6221 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6222 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6223 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
| HCPCS A6224 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6228 | Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6229 | Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
| HCPCS A6230 | Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6231 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing |
| HCPCS A6232 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing |
| HCPCS A6233 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing |
| HCPCS A6234 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6235 | 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 |
| HCPCS A6236 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6237 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
| HCPCS A6238 | 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 |
| HCPCS A6239 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6240 | Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
| HCPCS A6241 | Hydrocolloid dressing, wound filler, dry form, sterile, per gram |
| HCPCS A6242 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6243 | 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 |
| HCPCS A6244 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6245 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
| HCPCS A6246 | 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 |
| HCPCS A6247 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6248 | Hydrogel dressing, wound filler, gel, per fluid ounce |
| HCPCS A6250 | Skin sealants, protectants, moisturizers, ointments, any type, any size |
| HCPCS A6251 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6252 | 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 |
| HCPCS A6253 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6254 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
| HCPCS A6255 | 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 |
| HCPCS A6256 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
| HCPCS A6257 | Transparent film, sterile, 16 sq. in. or less, each dressing |
| HCPCS A6258 | Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
| HCPCS A6259 | Transparent film, sterile, more than 48 sq. in., each dressing |
| HCPCS A6260 | Wound cleansers, any type, any size |
| HCPCS A6261 | Wound filler, gel/paste, per fluid ounce, not otherwise specified |
| HCPCS A6262 | Wound filler, dry form, per gram, not otherwise specified |
| HCPCS A6266 | Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
| HCPCS A6402 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
| HCPCS A6403 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
| HCPCS A6404 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
| HCPCS A6407 | Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
| HCPCS A6410 | Eye pad, sterile, each |
| HCPCS A6411 | Eye pad, non-sterile, each |
| HCPCS A6412 | Eye patch, occlusive, each |
| HCPCS A6413 | Adhesive bandage, first-aid type, any size, each |
| HCPCS A6441 | Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6442 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
| HCPCS A6443 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6444 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard |
| HCPCS A6445 | Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
| HCPCS A6446 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6447 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
| HCPCS A6448 | Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
| HCPCS A6449 | Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6450 | Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
| HCPCS A6451 | Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6452 | High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6453 | Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
| HCPCS A6454 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6455 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard |
| HCPCS A6456 | Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
| HCPCS A6457 | Tubular dressing with or without elastic, any width, per linear yard |
| HCPCS A6501 | Compression burn garment, bodysuit (head to foot), custom fabricated |
| HCPCS A6502 | Compression burn garment, chin strap, custom fabricated |
| HCPCS A6503 | Compression burn garment, facial hood, custom fabricated |
| HCPCS A6504 | Compression burn garment, glove to wrist, custom fabricated |
| HCPCS A6505 | Compression burn garment, glove to elbow, custom fabricated |
| HCPCS A6506 | Compression burn garment, glove to axilla, custom fabricated |
| HCPCS A6507 | Compression burn garment, foot to knee length, custom fabricated |
| HCPCS A6508 | Compression burn garment, foot to thigh length, custom fabricated |
| HCPCS A6509 | Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated |
| HCPCS A6510 | Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated |
| HCPCS A6511 | Compression burn garment, lower trunk including leg openings (panty), custom fabricated |
| HCPCS A6512 | Compression burn garment, not otherwise classified |
| HCPCS A6513 | Compression burn mask, face and/or neck, plastic or equal, custom fabricated |
| HCPCS A6530 | Gradient compression stocking, below knee, 18-30 mmhg, each |
| HCPCS A6531 | Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
| HCPCS A6532 | Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each |
| HCPCS A6533 | Gradient compression stocking, thigh length, 18-30 mmhg, each |
| HCPCS A6534 | Gradient compression stocking, thigh length, 30-40 mmhg, each |
| HCPCS A6535 | Gradient compression stocking, thigh length, 40 mmhg or greater, each |
| HCPCS A6536 | Gradient compression stocking, full length/chap style, 18-30 mmhg, each |
| HCPCS A6537 | Gradient compression stocking, full length/chap style, 30-40 mmhg, each |
| HCPCS A6538 | Gradient compression stocking, full length/chap style, 40 mmhg or greater, each |
| HCPCS A6539 | Gradient compression stocking, waist length, 18-30 mmhg, each |
| HCPCS A6540 | Gradient compression stocking, waist length, 30-40 mmhg, each |
| HCPCS A6541 | Gradient compression stocking, waist length, 40 mmhg or greater, each |
| HCPCS A6542 | GRADIENT COMPRESSION STOCKING, CUSTOM MADE |
| HCPCS A6543 | GRADIENT COMPRESSION STOCKING, LYMPHEDEMA |
| HCPCS A6544 | Gradient compression stocking, garter belt |
| HCPCS A6545 | Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
| HCPCS A6549 | Gradient compression garment, not otherwise specified, for daytime use, each |
| HCPCS A6550 | Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
| HCPCS A6551 | CANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE, EACH |
| HCPCS A7000 | Canister, disposable, used with suction pump, each |
| HCPCS A7001 | Canister, non-disposable, used with suction pump, each |
| HCPCS A7002 | Tubing, used with suction pump, each |
| HCPCS A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
| HCPCS A7004 | Small volume nonfiltered pneumatic nebulizer, disposable |
| HCPCS A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
| HCPCS A7006 | Administration set, with small volume filtered pneumatic nebulizer |
| HCPCS A7007 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
| HCPCS A7008 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor |
| HCPCS A7009 | Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer |
| HCPCS A7010 | Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
| HCPCS A7011 | Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet |
| HCPCS A7012 | Water collection device, used with large volume nebulizer |
| HCPCS A7013 | Filter, disposable, used with aerosol compressor or ultrasonic generator |
| HCPCS A7014 | Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
| HCPCS A7015 | Aerosol mask, used with dme nebulizer |
| HCPCS A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer |
| HCPCS A7017 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen |
| HCPCS A7018 | Water, distilled, used with large volume nebulizer, 1000 ml |
| HCPCS A7020 | Interface for cough stimulating device, includes all components, replacement only |
| HCPCS A7025 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each |
| HCPCS A7026 | High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each |
| HCPCS A7027 | Combination oral/nasal mask, used with continuous positive airway pressure device, each |
| HCPCS A7028 | Oral cushion for combination oral/nasal mask, replacement only, each |
| HCPCS A7029 | Nasal pillows for combination oral/nasal mask, replacement only, pair |
| HCPCS A7030 | Full face mask used with positive airway pressure device, each |
| HCPCS A7031 | Face mask interface, replacement for full face mask, each |
| HCPCS A7032 | Cushion for use on nasal mask interface, replacement only, each |
| HCPCS A7033 | Pillow for use on nasal cannula type interface, replacement only, pair |
| HCPCS A7034 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
| HCPCS A7035 | Headgear used with positive airway pressure device |
| HCPCS A7036 | Chinstrap used with positive airway pressure device |
| HCPCS A7037 | Tubing used with positive airway pressure device |
| HCPCS A7038 | Filter, disposable, used with positive airway pressure device |
| HCPCS A7039 | Filter, non disposable, used with positive airway pressure device |
| HCPCS A7040 | One way chest drain valve |
| HCPCS A7041 | Water seal drainage container and tubing for use with implanted chest tube |
| HCPCS A7042 | Implanted pleural catheter, each |
| HCPCS A7043 | Vacuum drainage bottle and tubing for use with implanted catheter |
| HCPCS A7044 | Oral interface used with positive airway pressure device, each |
| HCPCS A7045 | Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
| HCPCS A7046 | Water chamber for humidifier, used with positive airway pressure device, replacement, each |
| HCPCS A7501 | Tracheostoma valve, including diaphragm, each |
| HCPCS A7502 | Replacement diaphragm/faceplate for tracheostoma valve, each |
| HCPCS A7503 | Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each |
| HCPCS A7504 | Filter for use in a tracheostoma heat and moisture exchange system, each |
| HCPCS A7505 | Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each |
| HCPCS A7506 | Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each |
| HCPCS A7507 | Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
| HCPCS A7508 | Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
| HCPCS A7509 | Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
| HCPCS A7520 | Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
| HCPCS A7521 | Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
| HCPCS A7522 | Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each |
| HCPCS A7523 | Tracheostomy shower protector, each |
| HCPCS A7524 | Tracheostoma stent/stud/button, each |
| HCPCS A7525 | Tracheostomy mask, each |
| HCPCS A7526 | Tracheostomy tube collar/holder, each |
| HCPCS A7527 | Tracheostomy/laryngectomy tube plug/stop, each |
| HCPCS A8000 | Helmet, protective, soft, prefabricated, includes all components and accessories |
| HCPCS A8001 | Helmet, protective, hard, prefabricated, includes all components and accessories |
| HCPCS A8002 | Helmet, protective, soft, custom fabricated, includes all components and accessories |
| HCPCS A8003 | Helmet, protective, hard, custom fabricated, includes all components and accessories |
| HCPCS A8004 | Soft interface for helmet, replacement only |
| HCPCS A9155 | Artificial saliva, 30 ml |
| HCPCS A9180 | Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker |
| HCPCS A9270 | Non-covered item or service |
| HCPCS A9272 | Wound suction, disposable, includes dressing, all accessories and components, any type, each |
| HCPCS A9273 | Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type |
| HCPCS A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
| HCPCS A9275 | Home glucose disposable monitor, includes test strips |
| HCPCS A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
| HCPCS A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
| HCPCS A9278 | Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
| HCPCS A9279 | Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
| HCPCS A9280 | Alert or alarm device, not otherwise classified |
| HCPCS A9281 | Reaching/grabbing device, any type, any length, each |
| HCPCS A9282 | Wig, any type, each |
| HCPCS A9283 | Foot pressure off loading/supportive device, any type, each |
| HCPCS A9284 | Spirometer, non-electronic, includes all accessories |
| HCPCS A9300 | Exercise equipment |
| HCPCS A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose |
| HCPCS A9501 | Technetium tc-99m teboroxime, diagnostic, per study dose |
| HCPCS A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose |
| HCPCS A9503 | Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries |
| HCPCS A9504 | Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries |
| HCPCS A9505 | Thallium tl-201 thallous chloride, diagnostic, per millicurie |
| HCPCS A9507 | Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries |
| HCPCS A9508 | Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie |
| HCPCS A9509 | Iodine i-123 sodium iodide, diagnostic, per millicurie |
| HCPCS A9510 | Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries |
| HCPCS A9511 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M, DEPREOTIDE, PER MCI |
| HCPCS A9512 | Technetium tc-99m pertechnetate, diagnostic, per millicurie |
| HCPCS A9513 | Lutetium lu 177, dotatate, therapeutic, 1 millicurie |
| HCPCS A9514 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M PYROPHOSPHATE, PER MCI |
| HCPCS A9515 | Choline c-11, diagnostic, per study dose up to 20 millicuries |
| HCPCS A9516 | Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries |
| HCPCS A9517 | Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie |
| HCPCS A9519 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, PER MCI |
| HCPCS A9520 | Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries |
| HCPCS A9521 | Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries |
| HCPCS A9522 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB TIUXETAN, PER MCI |
| HCPCS A9523 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB TIUXETAN, PER MCI |
| HCPCS A9524 | Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries |
| HCPCS A9525 | SUPPLY OF LOW OR ISO-OSMOLAR CONTRAST MATERIAL, 10 MG OF IODINE |
| HCPCS A9526 | Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries |
| HCPCS A9527 | Iodine i-125, sodium iodide solution, therapeutic, per millicurie |
| HCPCS A9528 | Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie |
| HCPCS A9529 | Iodine i-131 sodium iodide solution, diagnostic, per millicurie |
| HCPCS A9530 | Iodine i-131 sodium iodide solution, therapeutic, per millicurie |
| HCPCS A9531 | Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) |
| HCPCS A9532 | Iodine i-125 serum albumin, diagnostic, per 5 microcuries |
| HCPCS A9533 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER MILLICURIE |
| HCPCS A9534 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER MILLICURIE |
| HCPCS A9535 | INJECTION, METHYLENE BLUE, 1 ML |
| HCPCS A9536 | Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries |
| HCPCS A9537 | Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
| HCPCS A9538 | Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries |
| HCPCS A9539 | Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries |
| HCPCS A9540 | Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries |
| HCPCS A9541 | Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
| HCPCS A9542 | Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries |
| HCPCS A9543 | Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries |
| HCPCS A9544 | Iodine i-131 tositumomab, diagnostic, per study dose |
| HCPCS A9545 | Iodine i-131 tositumomab, therapeutic, per treatment dose |
| HCPCS A9546 | Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie |
| HCPCS A9547 | Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie |
| HCPCS A9548 | Indium in-111 pentetate, diagnostic, per 0.5 millicurie |
| HCPCS A9549 | TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES |
| HCPCS A9550 | Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie |
| HCPCS A9551 | Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries |
| HCPCS A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
| HCPCS A9553 | Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries |
| HCPCS A9554 | Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries |
| HCPCS A9555 | Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries |
| HCPCS A9556 | Gallium ga-67 citrate, diagnostic, per millicurie |
| HCPCS A9557 | Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries |
| HCPCS A9558 | Xenon xe-133 gas, diagnostic, per 10 millicuries |
| HCPCS A9559 | Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie |
| HCPCS A9560 | Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries |
| HCPCS A9561 | Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries |
| HCPCS A9562 | Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries |
| HCPCS A9563 | Sodium phosphate p-32, therapeutic, per millicurie |
| HCPCS A9564 | Chromic phosphate p-32 suspension, therapeutic, per millicurie |
| HCPCS A9565 | INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER MILLICURIE |
| HCPCS A9566 | Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries |
| HCPCS A9567 | Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries |
| HCPCS A9568 | Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries |
| HCPCS A9569 | Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose |
| HCPCS A9570 | Indium in-111 labeled autologous white blood cells, diagnostic, per study dose |
| HCPCS A9571 | Indium in-111 labeled autologous platelets, diagnostic, per study dose |
| HCPCS A9572 | Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries |
| HCPCS A9576 | Injection, gadoteridol, (prohance multipack), per ml |
| HCPCS A9577 | Injection, gadobenate dimeglumine (multihance), per ml |
| HCPCS A9578 | Injection, gadobenate dimeglumine (multihance multipack), per ml |
| HCPCS A9579 | Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
| HCPCS A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries |
| HCPCS A9584 | Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries |
| HCPCS A9585 | Injection, gadobutrol, 0.1 ml |
| HCPCS A9586 | Florbetapir f18, diagnostic, per study dose, up to 10 millicuries |
| HCPCS A9600 | Strontium sr-89 chloride, therapeutic, per millicurie |
| HCPCS A9605 | SAMARIUM SM-153 LEXIDRONAMM, THERAPEUTIC, PER 50 MILLICURIES |
| HCPCS A9698 | Non-radioactive contrast imaging material, not otherwise classified, per study |
| HCPCS A9699 | Radiopharmaceutical, therapeutic, not otherwise classified |
| HCPCS A9700 | Supply of injectable contrast material for use in echocardiography, per study |
| HCPCS A9900 | Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
| HCPCS A9999 | Miscellaneous dme supply or accessory, not otherwise specified |
| HCPCS B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| HCPCS B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| HCPCS B4036 | Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| HCPCS B4081 | Nasogastric tubing with stylet |
| HCPCS B4082 | Nasogastric tubing without stylet |
| HCPCS B4083 | Stomach tube - levine type |
| HCPCS B4086 | GASTROSTOMY / JEJUNOSTOMY TUBE, ANY MATERIAL, ANY TYPE, (STANDARD OR LOW PROFILE), EACH |
| HCPCS B4087 | Gastrostomy/jejunostomy tube, standard, any material, any type, each |
| HCPCS B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
| HCPCS B4100 | Food thickener, administered orally, per ounce |
| HCPCS B9000 | Enteral nutrition infusion pump - without alarm |
| HCPCS B9002 | Enteral nutrition infusion pump, any type |
| HCPCS B9004 | Parenteral nutrition infusion pump, portable |
| HCPCS B9006 | Parenteral nutrition infusion pump, stationary |
| HCPCS B9998 | Noc for enteral supplies |
| HCPCS B9999 | Noc for parenteral supplies |
| HCPCS C1079 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN CO 57/58, PER 0.5 MICROCURIE |
| HCPCS C1080 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER DOSE |
| HCPCS C1081 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER DOSE |
| HCPCS C1082 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB TIUXETAN, PER DOSE |
| HCPCS C1083 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB TIUXETAN, PER DOSE |
| HCPCS C1091 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 OXYQUINOLINE, PER 0.5 MILLICURIE |
| HCPCS C1092 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 PENTETATE, PER 0.5 MILLICURIE |
| HCPCS C1093 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M FANOLESOMAB, PER DOSE (10 - 20 MCI) |
| HCPCS C1122 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M ARCITUMOMAB, PER VIAL |
| HCPCS C1200 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M SODIUM GLUCOHEPTONATE, PER VIAL |
| HCPCS C1201 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M SUCCIMER, PER VIAL |
| HCPCS C1305 | GRAFTSKIN, PER 44 SQUARE CENTIMETERS |
| HCPCS C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
| HCPCS C1714 | Catheter, transluminal atherectomy, directional |
| HCPCS C1715 | Brachytherapy needle |
| HCPCS C1716 | Brachytherapy source, non-stranded, gold-198, per source |
| HCPCS C1717 | Brachytherapy source, non-stranded, high dose rate iridium-192, per source |
| HCPCS C1718 | BRACHYTHERAPY SOURCE, IODINE 125, PER SOURCE |
| HCPCS C1719 | Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source |
| HCPCS C1720 | BRACHYTHERAPY SOURCE, PALLADIUM 103, PER SOURCE |
| HCPCS C1721 | Cardioverter-defibrillator, dual chamber (implantable) |
| HCPCS C1722 | Cardioverter-defibrillator, single chamber (implantable) |
| HCPCS C1724 | Catheter, transluminal atherectomy, rotational |
| HCPCS C1725 | Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) |
| HCPCS C1726 | Catheter, balloon dilatation, non-vascular |
| HCPCS C1727 | Catheter, balloon tissue dissector, non-vascular (insertable) |
| HCPCS C1728 | Catheter, brachytherapy seed administration |
| HCPCS C1729 | Catheter, drainage |
| HCPCS C1730 | Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes) |
| HCPCS C1731 | Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes) |
| HCPCS C1732 | Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping |
| HCPCS C1733 | Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip |
| HCPCS C1750 | Catheter, hemodialysis/peritoneal, long-term |
| HCPCS C1751 | Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) |
| HCPCS C1752 | Catheter, hemodialysis/peritoneal, short-term |
| HCPCS C1753 | Catheter, intravascular ultrasound |
| HCPCS C1754 | Catheter, intradiscal |
| HCPCS C1755 | Catheter, intraspinal |
| HCPCS C1756 | Catheter, pacing, transesophageal |
| HCPCS C1757 | Catheter, thrombectomy/embolectomy |
| HCPCS C1758 | Catheter, ureteral |
| HCPCS C1759 | Catheter, intracardiac echocardiography |
| HCPCS C1760 | Closure device, vascular (implantable/insertable) |
| HCPCS C1762 | Connective tissue, human (includes fascia lata) |
| HCPCS C1763 | Connective tissue, non-human (includes synthetic) |
| HCPCS C1764 | Event recorder, cardiac (implantable) |
| HCPCS C1765 | Adhesion barrier |
| HCPCS C1766 | Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away |
| HCPCS C1767 | Generator, neurostimulator (implantable), non-rechargeable |
| HCPCS C1768 | Graft, vascular |
| HCPCS C1769 | Guide wire |
| HCPCS C1770 | Imaging coil, magnetic resonance (insertable) |
| HCPCS C1771 | Repair device, urinary, incontinence, with sling graft |
| HCPCS C1772 | Infusion pump, programmable (implantable) |
| HCPCS C1773 | Retrieval device, insertable (used to retrieve fractured medical devices) |
| HCPCS C1775 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, FLUORODEOXYGLUCOSE F18 (2-DEOXY-2-[18F]FLUORO-D-GLUCOSE), PER DOSE (4-40 MCI/ML) |
| HCPCS C1776 | Joint device (implantable) |
| HCPCS C1777 | Lead, cardioverter-defibrillator, endocardial single coil (implantable) |
| HCPCS C1778 | Lead, neurostimulator (implantable) |
| HCPCS C1779 | Lead, pacemaker, transvenous vdd single pass |
| HCPCS C1780 | Lens, intraocular (new technology) |
| HCPCS C1781 | Mesh (implantable) |
| HCPCS C1782 | Morcellator |
| HCPCS C1783 | Ocular implant, aqueous drainage assist device |
| HCPCS C1784 | Ocular device, intraoperative, detached retina |
| HCPCS C1785 | Pacemaker, dual chamber, rate-responsive (implantable) |
| HCPCS C1786 | Pacemaker, single chamber, rate-responsive (implantable) |
| HCPCS C1787 | Patient programmer, neurostimulator |
| HCPCS C1788 | Port, indwelling (implantable) |
| HCPCS C1789 | Prosthesis, breast (implantable) |
| HCPCS C1813 | Prosthesis, penile, inflatable |
| HCPCS C1814 | Retinal tamponade device, silicone oil |
| HCPCS C1815 | Prosthesis, urinary sphincter (implantable) |
| HCPCS C1816 | Receiver and/or transmitter, neurostimulator (implantable) |
| HCPCS C1817 | Septal defect implant system, intracardiac |
| HCPCS C1818 | Integrated keratoprosthesis |
| HCPCS C1819 | Surgical tissue localization and excision device (implantable) |
| HCPCS C1821 | Interspinous process distraction device (implantable) |
| HCPCS C1830 | Powered bone marrow biopsy needle |
| HCPCS C1840 | Lens, intraocular (telescopic) |
| HCPCS C1874 | Stent, coated/covered, with delivery system |
| HCPCS C1875 | Stent, coated/covered, without delivery system |
| HCPCS C1876 | Stent, non-coated/non-covered, with delivery system |
| HCPCS C1877 | Stent, non-coated/non-covered, without delivery system |
| HCPCS C1878 | Material for vocal cord medialization, synthetic (implantable) |
| HCPCS C1879 | Tissue marker (implantable) |
| HCPCS C1880 | Vena cava filter |
| HCPCS C1881 | Dialysis access system (implantable) |
| HCPCS C1882 | Cardioverter-defibrillator, other than single or dual chamber (implantable) |
| HCPCS C1883 | Adapter/extension, pacing lead or neurostimulator lead (implantable) |
| HCPCS C1884 | Embolization protective system |
| HCPCS C1885 | Catheter, transluminal angioplasty, laser |
| HCPCS C1886 | Catheter, extravascular tissue ablation, any modality (insertable) |
| HCPCS C1887 | Catheter, guiding (may include infusion/perfusion capability) |
| HCPCS C1888 | Catheter, ablation, non-cardiac, endovascular (implantable) |
| HCPCS C1891 | Infusion pump, non-programmable, permanent (implantable) |
| HCPCS C1892 | Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away |
| HCPCS C1893 | Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away |
| HCPCS C1894 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
| HCPCS C1895 | Lead, cardioverter-defibrillator, endocardial dual coil (implantable) |
| HCPCS C1896 | Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) |
| HCPCS C1897 | Lead, neurostimulator test kit (implantable) |
| HCPCS C1898 | Lead, pacemaker, other than transvenous vdd single pass |
| HCPCS C1899 | Lead, pacemaker/cardioverter-defibrillator combination (implantable) |
| HCPCS C1900 | Lead, left ventricular coronary venous system |
| HCPCS C2614 | Probe, percutaneous lumbar discectomy |
| HCPCS C2615 | Sealant, pulmonary, liquid |
| HCPCS C2616 | Brachytherapy source, non-stranded, yttrium-90, per source |
| HCPCS C2617 | Stent, non-coronary, temporary, without delivery system |
| HCPCS C2618 | Probe/needle, cryoablation |
| HCPCS C2619 | Pacemaker, dual chamber, non rate-responsive (implantable) |
| HCPCS C2620 | Pacemaker, single chamber, non rate-responsive (implantable) |
| HCPCS C2621 | Pacemaker, other than single or dual chamber (implantable) |
| HCPCS C2622 | Prosthesis, penile, non-inflatable |
| HCPCS C2625 | Stent, non-coronary, temporary, with delivery system |
| HCPCS C2626 | Infusion pump, non-programmable, temporary (implantable) |
| HCPCS C2627 | Catheter, suprapubic/cystoscopic |
| HCPCS C2628 | Catheter, occlusion |
| HCPCS C2629 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, laser |
| HCPCS C2630 | Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, cool-tip |
| HCPCS C2631 | Repair device, urinary, incontinence, without sling graft |
| HCPCS C2632 | BRACHYTHERAPY SOLUTION, IODINE-125, PER MCI |
| HCPCS C2633 | BRACHYTHERAPY SOURCE, CESIUM-131, PER SOURCE |
| HCPCS C2634 | Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source |
| HCPCS C2635 | Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source |
| HCPCS C2636 | Brachytherapy linear source, non-stranded, palladium-103, per 1 mm |
| HCPCS C2637 | Brachytherapy source, non-stranded, ytterbium-169, per source |
| HCPCS C9013 | SUPPLY OF CO 57 COBALTOUS CHLORIDE, RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT |
| HCPCS C9102 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, 51 SODIUM CHROMATE, PER 50 MCI |
| HCPCS C9103 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM IOTHALAMATE I-125 INJECTION, PER 10 UCI |
| HCPCS C9123 | HUMAN FIBROBLAST DERIVED TEMPORARY SKIN SUBSTITUTE, PER 247 SQUARE CENTIMETERS |
| HCPCS C9200 | BILAYERED CELLULAR MATRIX, PER 36 SQUARE CENTIMETERS |
| HCPCS C9201 | HUMAN FIBROBLAST-DERIVED DERMAL SUBSTITUTE, PER 37.5 SQUARE CENTIMETERS |
| HCPCS C9206 | COLLAGEN-GLYCOSAMINOGLYCAN BILAYER MATRIX, PER CM2 |
| HCPCS C9221 | ACELLULAR DERMAL TISSUE MATRIX, PER 16CM2 |
| HCPCS C9222 | DECELLULARIZED SOFT TISSUE SCAFFOLD, PER 1 CC |
| HCPCS C9250 | Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml |
| HCPCS C9350 | MICROPOROUS COLLAGEN TUBE OF NON-HUMAN ORIGIN, PER CENTIMETER LENGTH |
| HCPCS C9351 | ACELLULAR DERMAL TISSUE MATRIX OF NON-HUMAN ORIGIN, PER SQUARE CENTIMETER (DO NOT REPORT C9351 IN CONJUNCTION WITH J7345) |
| HCPCS C9352 | Microporous collagen implantable tube (neuragen nerve guide), per centimeter length |
| HCPCS C9353 | Microporous collagen implantable slit tube (neurawrap nerve protector), per centimeter length |
| HCPCS C9354 | Acellular pericardial tissue matrix of non-human origin (veritas), per square centimeter |
| HCPCS C9355 | Collagen nerve cuff (neuromatrix), per 0.5 centimeter length |
| HCPCS C9356 | Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix (tenoglide tendon protector sheet), per square centimeter |
| HCPCS C9357 | DERMAL SUBSTITUTE, GRANULATED CROSS-LINKED COLLAGEN AND GLYCOSAMINOGLYCAN |
| HCPCS C9358 | Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters |
| HCPCS C9359 | Porous purified collagen matrix bone void filler (integra mozaik osteoconductive scaffold putty, integra os osteoconductive scaffold putty), per 0.5 cc |
| HCPCS C9360 | Dermal substitute, native, non-denatured collagen, neonatal bovine origin (surgimend collagen matrix), per 0.5 square centimeters |
| HCPCS C9361 | Collagen matrix nerve wrap (neuromend collagen nerve wrap), per 0.5 centimeter length |
| HCPCS C9362 | Porous purified collagen matrix bone void filler (integra mozaik osteoconductive scaffold strip), per 0.5 cc |
| HCPCS C9363 | Skin substitute, integra meshed bilayer wound matrix, per square centimeter |
| HCPCS C9364 | Porcine implant, permacol, per square centimeter |
| HCPCS C9365 | Oasis ultra tri-layer matrix, per square centimeter |
| HCPCS C9366 | Epifix, per square centimeter |
| HCPCS C9367 | Skin substitute, endoform dermal template, per square centimeter |
| HCPCS C9368 | Grafix core, per square centimeter |
| HCPCS C9369 | Grafix prime, per square centimeter |
| HCPCS C9400 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL 201, BRAND NAME, PER MCI |
| HCPCS C9401 | SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, STRONTIUM-89 CHLORIDE, BRAND NAME, PER MCI |
| HCPCS C9402 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 SODIUM IODIDE CAPSULE, BRAND NAME, PER MCI |
| HCPCS C9403 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, I-131 SODIUM IODIDE CAPSULE, BRAND NAME, PER MILLICURIE |
| HCPCS C9404 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC AGENT, I-131 SODIUM IODIDE SOLUTION, BRAND NAME, PER MILLICURIE |
| HCPCS C9405 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC AGENT, I-131 SODIUM IODIDE SOLUTION, BRAND NAME, PER MILLICURIE |
| HCPCS C9406 | Iodine i-123 ioflupane, diagnostic, per study dose, up to 5 millicuries |
| HCPCS C9703 | BARD ENDOSCOPIC SUTURING SYSTEM |
| HCPCS C9722 | STEREOSCOPIC KV X-RAY IMAGING WITH INFRARED TRACKING FOR LOCALIZATION OF TARGET |
| HCPCS C9800 | Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies |
| HCPCS C9898 | Radiolabeled product provided during a hospital inpatient stay |
| HCPCS C9899 | Implanted prosthetic device, payable only for inpatients who do not have inpatient coverage |
| HCPCS E0100 | Cane, includes canes of all materials, adjustable or fixed, with tip |
| HCPCS E0105 | Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
| HCPCS E0110 | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips |
| HCPCS E0111 | Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips |
| HCPCS E0112 | Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips |
| HCPCS E0113 | Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip |
| HCPCS E0114 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
| HCPCS E0116 | Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each |
| HCPCS E0117 | Crutch, underarm, articulating, spring assisted, each |
| HCPCS E0118 | Crutch substitute, lower leg platform, with or without wheels, each |
| HCPCS E0130 | Walker, rigid (pickup), adjustable or fixed height |
| HCPCS E0135 | Walker, folding (pickup), adjustable or fixed height |
| HCPCS E0140 | Walker, with trunk support, adjustable or fixed height, any type |
| HCPCS E0141 | Walker, rigid, wheeled, adjustable or fixed height |
| HCPCS E0143 | Walker, folding, wheeled, adjustable or fixed height |
| HCPCS E0144 | Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
| HCPCS E0147 | Walker, heavy duty, multiple braking system, variable wheel resistance |
| HCPCS E0148 | Walker, heavy duty, without wheels, rigid or folding, any type, each |
| HCPCS E0149 | Walker, heavy duty, wheeled, rigid or folding, any type |
| HCPCS E0153 | Platform attachment, forearm crutch, each |
| HCPCS E0154 | Platform attachment, walker, each |
| HCPCS E0155 | Wheel attachment, rigid pick-up walker, per pair |
| HCPCS E0156 | Seat attachment, walker |
| HCPCS E0157 | Crutch attachment, walker, each |
| HCPCS E0158 | Leg extensions for walker, per set of four (4) |
| HCPCS E0159 | Brake attachment for wheeled walker, replacement, each |
| HCPCS E0160 | Sitz type bath or equipment, portable, used with or without commode |
| HCPCS E0161 | Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s |
| HCPCS E0162 | Sitz bath chair |
| HCPCS E0163 | Commode chair, mobile or stationary, with fixed arms |
| HCPCS E0164 | COMMODE CHAIR, MOBILE, WITH FIXED ARMS |
| HCPCS E0165 | Commode chair, mobile or stationary, with detachable arms |
| HCPCS E0166 | COMMODE CHAIR, MOBILE, WITH DETACHABLE ARMS |
| HCPCS E0167 | Pail or pan for use with commode chair, replacement only |
| HCPCS E0168 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
| HCPCS E0169 | COMMODE CHAIR WITH SEAT LIFT MECHANISM |
| HCPCS E0170 | Commode chair with integrated seat lift mechanism, electric, any type |
| HCPCS E0171 | Commode chair with integrated seat lift mechanism, non-electric, any type |
| HCPCS E0172 | Seat lift mechanism placed over or on top of toilet, any type |
| HCPCS E0175 | Foot rest, for use with commode chair, each |
| HCPCS E0176 | AIR PRESSURE PAD OR CUSHION, NONPOSITIONING |
| HCPCS E0177 | WATER PRESSURE PAD OR CUSHION, NONPOSITIONING |
| HCPCS E0178 | GEL OR GEL-LIKE PRESSURE PAD OR CUSHION, NONPOSITIONING |
| HCPCS E0179 | DRY PRESSURE PAD OR CUSHION, NONPOSITIONING |
| HCPCS E0180 | PRESSURE PAD, ALTERNATING WITH PUMP |
| HCPCS E0181 | Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
| HCPCS E0182 | Pump for alternating pressure pad, for replacement only |
| HCPCS E0184 | Dry pressure mattress |
| HCPCS E0185 | Gel or gel-like pressure pad for mattress, standard mattress length and width |
| HCPCS E0186 | Air pressure mattress |
| HCPCS E0187 | Water pressure mattress |
| HCPCS E0188 | Synthetic sheepskin pad |
| HCPCS E0189 | Lambswool sheepskin pad, any size |
| HCPCS E0190 | Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
| HCPCS E0191 | Heel or elbow protector, each |
| HCPCS E0192 | LOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR |
| HCPCS E0193 | Powered air flotation bed (low air loss therapy) |
| HCPCS E0194 | Air fluidized bed |
| HCPCS E0196 | Gel pressure mattress |
| HCPCS E0197 | Air pressure pad for mattress, standard mattress length and width |
| HCPCS E0198 | Water pressure pad for mattress, standard mattress length and width |
| HCPCS E0199 | Dry pressure pad for mattress, standard mattress length and width |
| HCPCS E0200 | Heat lamp, without stand (table model), includes bulb, or infrared element |
| HCPCS E0202 | Phototherapy (bilirubin) light with photometer |
| HCPCS E0203 | Therapeutic lightbox, minimum 10,000 lux, table top model |
| HCPCS E0205 | Heat lamp, with stand, includes bulb, or infrared element |
| HCPCS E0210 | Electric heat pad, standard |
| HCPCS E0215 | Electric heat pad, moist |
| HCPCS E0217 | Water circulating heat pad with pump |
| HCPCS E0218 | Fluid circulating cold pad with pump, any type |
| HCPCS E0220 | Hot water bottle |
| HCPCS E0221 | Infrared heating pad system |
| HCPCS E0225 | Hydrocollator unit, includes pads |
| HCPCS E0230 | Ice cap or collar |
| HCPCS E0231 | Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover |
| HCPCS E0232 | Warming card for use with the non contact wound warming device and non contact wound warming wound cover |
| HCPCS E0235 | Paraffin bath unit, portable (see medical supply code a4265 for paraffin) |
| HCPCS E0236 | Pump for water circulating pad |
| HCPCS E0238 | Non-electric heat pad, moist |
| HCPCS E0239 | Hydrocollator unit, portable |
| HCPCS E0240 | Bath/shower chair, with or without wheels, any size |
| HCPCS E0241 | Bath tub wall rail, each |
| HCPCS E0242 | Bath tub rail, floor base |
| HCPCS E0243 | Toilet rail, each |
| HCPCS E0244 | Raised toilet seat |
| HCPCS E0245 | Tub stool or bench |
| HCPCS E0246 | Transfer tub rail attachment |
| HCPCS E0247 | Transfer bench for tub or toilet with or without commode opening |
| HCPCS E0248 | Transfer bench, heavy duty, for tub or toilet with or without commode opening |
| HCPCS E0249 | Pad for water circulating heat unit, for replacement only |
| HCPCS E0250 | Hospital bed, fixed height, with any type side rails, with mattress |
| HCPCS E0251 | Hospital bed, fixed height, with any type side rails, without mattress |
| HCPCS E0255 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
| HCPCS E0256 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress |
| HCPCS E0260 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
| HCPCS E0261 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
| HCPCS E0265 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
| HCPCS E0266 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress |
| HCPCS E0270 | Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress |
| HCPCS E0271 | Mattress, innerspring |
| HCPCS E0272 | Mattress, foam rubber |
| HCPCS E0273 | Bed board |
| HCPCS E0274 | Over-bed table |
| HCPCS E0275 | Bed pan, standard, metal or plastic |
| HCPCS E0276 | Bed pan, fracture, metal or plastic |
| HCPCS E0277 | Powered pressure-reducing air mattress |
| HCPCS E0280 | Bed cradle, any type |
| HCPCS E0290 | Hospital bed, fixed height, without side rails, with mattress |
| HCPCS E0291 | Hospital bed, fixed height, without side rails, without mattress |
| HCPCS E0292 | Hospital bed, variable height, hi-lo, without side rails, with mattress |
| HCPCS E0293 | Hospital bed, variable height, hi-lo, without side rails, without mattress |
| HCPCS E0294 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
| HCPCS E0295 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
| HCPCS E0296 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress |
| HCPCS E0297 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress |
| HCPCS E0300 | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure |
| HCPCS E0301 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress |
| HCPCS E0302 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress |
| HCPCS E0303 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
| HCPCS E0304 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress |
| HCPCS E0305 | Bed side rails, half length |
| HCPCS E0310 | Bed side rails, full length |
| HCPCS E0315 | Bed accessory: board, table, or support device, any type |
| HCPCS E0316 | Safety enclosure frame/canopy for use with hospital bed, any type |
| HCPCS E0325 | Urinal; male, jug-type, any material |
| HCPCS E0326 | Urinal; female, jug-type, any material |
| HCPCS E0328 | Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress |
| HCPCS E0329 | Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress |
| HCPCS E0350 | Control unit for electronic bowel irrigation/evacuation system |
| HCPCS E0352 | Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system |
| HCPCS E0370 | Air pressure elevator for heel |
| HCPCS E0371 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width |
| HCPCS E0372 | Powered air overlay for mattress, standard mattress length and width |
| HCPCS E0373 | Nonpowered advanced pressure reducing mattress |
| HCPCS E0424 | Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
| HCPCS E0425 | Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
| HCPCS E0430 | Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
| HCPCS E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
| HCPCS E0433 | Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge |
| HCPCS E0434 | Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
| HCPCS E0435 | Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor |
| HCPCS E0439 | Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
| HCPCS E0440 | Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
| HCPCS E0441 | Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
| HCPCS E0442 | Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
| HCPCS E0443 | Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
| HCPCS E0444 | Portable oxygen contents, liquid, 1 month's supply = 1 unit |
| HCPCS E0445 | Oximeter device for measuring blood oxygen levels non-invasively |
| HCPCS E0446 | Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories |
| HCPCS E0450 | Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) |
| HCPCS E0454 | PRESSURE VENTILATOR WITH PRESSURE CONTROL, PRESSURE SUPPORT AND FLOW TRIGGERING |
| HCPCS E0455 | Oxygen tent, excluding croup or pediatric tents |
| HCPCS E0457 | Chest shell (cuirass) |
| HCPCS E0459 | Chest wrap |
| HCPCS E0460 | Negative pressure ventilator; portable or stationary |
| HCPCS E0461 | Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask) |
| HCPCS E0462 | Rocking bed with or without side rails |
| HCPCS E0463 | Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) |
| HCPCS E0464 | Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask) |
| HCPCS E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
| HCPCS E0471 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
| HCPCS E0472 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device) |
| HCPCS E0480 | Percussor, electric or pneumatic, home model |
| HCPCS E0481 | Intrapulmonary percussive ventilation system and related accessories |
| HCPCS E0482 | Cough stimulating device, alternating positive and negative airway pressure |
| HCPCS E0483 | High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
| HCPCS E0484 | Oscillatory positive expiratory pressure device, non-electric, any type, each |
| HCPCS E0485 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment |
| HCPCS E0486 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment |
| HCPCS E0487 | Spirometer, electronic, includes all accessories |
| HCPCS E0500 | Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source |
| HCPCS E0550 | Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
| HCPCS E0555 | Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter |
| HCPCS E0560 | Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery |
| HCPCS E0561 | Humidifier, non-heated, used with positive airway pressure device |
| HCPCS E0562 | Humidifier, heated, used with positive airway pressure device |
| HCPCS E0565 | Compressor, air power source for equipment which is not self-contained or cylinder driven |
| HCPCS E0570 | Nebulizer, with compressor |
| HCPCS E0571 | Aerosol compressor, battery powered, for use with small volume nebulizer |
| HCPCS E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use |
| HCPCS E0574 | Ultrasonic/electronic aerosol generator with small volume nebulizer |
| HCPCS E0575 | Nebulizer, ultrasonic, large volume |
| HCPCS E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter |
| HCPCS E0585 | Nebulizer, with compressor and heater |
| HCPCS E0590 | DISPENSING FEE COVERED DRUG ADMINISTERED THROUGH DME NEBULIZER |
| HCPCS E0600 | Respiratory suction pump, home model, portable or stationary, electric |
| HCPCS E0601 | Continuous positive airway pressure (cpap) device |
| HCPCS E0602 | Breast pump, manual, any type |
| HCPCS E0603 | Breast pump, electric (ac and/or dc), any type |
| HCPCS E0604 | Breast pump, hospital grade, electric (ac and / or dc), any type |
| HCPCS E0605 | Vaporizer, room type |
| HCPCS E0606 | Postural drainage board |
| HCPCS E0607 | Home blood glucose monitor |
| HCPCS E0610 | Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) |
| HCPCS E0615 | Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems |
| HCPCS E0616 | Implantable cardiac event recorder with memory, activator and programmer |
| HCPCS E0617 | External defibrillator with integrated electrocardiogram analysis |
| HCPCS E0618 | Apnea monitor, without recording feature |
| HCPCS E0619 | Apnea monitor, with recording feature |
| HCPCS E0621 | Sling or seat, patient lift, canvas or nylon |
| HCPCS E0625 | Patient lift, bathroom or toilet, not otherwise classified |
| HCPCS E0627 | Seat lift mechanism, electric, any type |
| HCPCS E0628 | Separate seat lift mechanism for use with patient owned furniture-electric |
| HCPCS E0629 | Seat lift mechanism, non-electric, any type |
| HCPCS E0630 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
| HCPCS E0635 | Patient lift, electric with seat or sling |
| HCPCS E0636 | Multipositional patient support system, with integrated lift, patient accessible controls |
| HCPCS E0637 | Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels |
| HCPCS E0638 | Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels |
| HCPCS E0639 | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories |
| HCPCS E0640 | Patient lift, fixed system, includes all components/accessories |
| HCPCS E0641 | Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels |
| HCPCS E0642 | Standing frame/table system, mobile (dynamic stander), any size including pediatric |
| HCPCS E0650 | Pneumatic compressor, non-segmental home model |
| HCPCS E0651 | Pneumatic compressor, segmental home model without calibrated gradient pressure |
| HCPCS E0652 | Pneumatic compressor, segmental home model with calibrated gradient pressure |
| HCPCS E0655 | Non-segmental pneumatic appliance for use with pneumatic compressor, half arm |
| HCPCS E0656 | Segmental pneumatic appliance for use with pneumatic compressor, trunk |
| HCPCS E0657 | Segmental pneumatic appliance for use with pneumatic compressor, chest |
| HCPCS E0660 | Non-segmental pneumatic appliance for use with pneumatic compressor, full leg |
| HCPCS E0665 | Non-segmental pneumatic appliance for use with pneumatic compressor, full arm |
| HCPCS E0666 | Non-segmental pneumatic appliance for use with pneumatic compressor, half leg |
| HCPCS E0667 | Segmental pneumatic appliance for use with pneumatic compressor, full leg |
| HCPCS E0668 | Segmental pneumatic appliance for use with pneumatic compressor, full arm |
| HCPCS E0669 | Segmental pneumatic appliance for use with pneumatic compressor, half leg |
| HCPCS E0671 | Segmental gradient pressure pneumatic appliance, full leg |
| HCPCS E0672 | Segmental gradient pressure pneumatic appliance, full arm |
| HCPCS E0673 | Segmental gradient pressure pneumatic appliance, half leg |
| HCPCS E0675 | Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) |
| HCPCS E0676 | Intermittent limb compression device (includes all accessories), not otherwise specified |
| HCPCS E0691 | Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less |
| HCPCS E0692 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel |
| HCPCS E0693 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel |
| HCPCS E0694 | Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection |
| HCPCS E0700 | Safety equipment, device or accessory, any type |
| HCPCS E0701 | HELMET WITH FACE GUARD AND SOFT INTERFACE MATERIAL, PREFABRICATED |
| HCPCS E0705 | Transfer device, any type, each |
| HCPCS E0710 | Restraints, any type (body, chest, wrist or ankle) |
| HCPCS E0720 | Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
| HCPCS E0730 | Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
| HCPCS E0731 | Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) |
| HCPCS E0740 | Non-implanted pelvic floor electrical stimulator, complete system |
| HCPCS E0744 | Neuromuscular stimulator for scoliosis |
| HCPCS E0745 | Neuromuscular stimulator, electronic shock unit |
| HCPCS E0746 | Electromyography (emg), biofeedback device |
| HCPCS E0747 | Osteogenesis stimulator, electrical, non-invasive, other than spinal applications |
| HCPCS E0748 | Osteogenesis stimulator, electrical, non-invasive, spinal applications |
| HCPCS E0749 | Osteogenesis stimulator, electrical, surgically implanted |
| HCPCS E0752 | IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH |
| HCPCS E0754 | PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE NEUROSTIMULATOR PULSE GENERATOR |
| HCPCS E0755 | Electronic salivary reflex stimulator (intra-oral/non-invasive) |
| HCPCS E0756 | IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR |
| HCPCS E0757 | IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER |
| HCPCS E0758 | RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER |
| HCPCS E0759 | RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT |
| HCPCS E0760 | Osteogenesis stimulator, low intensity ultrasound, non-invasive |
| HCPCS E0761 | Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device |
| HCPCS E0762 | Transcutaneous electrical joint stimulation device system, includes all accessories |
| HCPCS E0764 | Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program |
| HCPCS E0765 | Fda approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting |
| HCPCS E0769 | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified |
| HCPCS E0770 | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified |
| HCPCS E0776 | Iv pole |
| HCPCS E0779 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
| HCPCS E0780 | Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours |
| HCPCS E0781 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
| HCPCS E0782 | Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) |
| HCPCS E0783 | Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) |
| HCPCS E0784 | External ambulatory infusion pump, insulin |
| HCPCS E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement |
| HCPCS E0786 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) |
| HCPCS E0791 | Parenteral infusion pump, stationary, single or multi-channel |
| HCPCS E0830 | Ambulatory traction device, all types, each |
| HCPCS E0840 | Traction frame, attached to headboard, cervical traction |
| HCPCS E0849 | Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible |
| HCPCS E0850 | Traction stand, free standing, cervical traction |
| HCPCS E0855 | Cervical traction equipment not requiring additional stand or frame |
| HCPCS E0856 | Cervical traction device, with inflatable air bladder(s) |
| HCPCS E0860 | Traction equipment, overdoor, cervical |
| HCPCS E0870 | Traction frame, attached to footboard, extremity traction, (e.g., buck's) |
| HCPCS E0880 | Traction stand, free standing, extremity traction |
| HCPCS E0890 | Traction frame, attached to footboard, pelvic traction |
| HCPCS E0900 | Traction stand, free standing, pelvic traction, (e.g., buck's) |
| HCPCS E0910 | Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
| HCPCS E0911 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar |
| HCPCS E0912 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar |
| HCPCS E0920 | Fracture frame, attached to bed, includes weights |
| HCPCS E0930 | Fracture frame, free standing, includes weights |
| HCPCS E0935 | Continuous passive motion exercise device for use on knee only |
| HCPCS E0936 | Continuous passive motion exercise device for use other than knee |
| HCPCS E0940 | Trapeze bar, free standing, complete with grab bar |
| HCPCS E0941 | Gravity assisted traction device, any type |
| HCPCS E0942 | Cervical head harness/halter |
| HCPCS E0944 | Pelvic belt/harness/boot |
| HCPCS E0945 | Extremity belt/harness |
| HCPCS E0946 | Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster) |
| HCPCS E0947 | Fracture frame, attachments for complex pelvic traction |
| HCPCS E0948 | Fracture frame, attachments for complex cervical traction |
| HCPCS E0950 | Wheelchair accessory, tray, each |
| HCPCS E0951 | Heel loop/holder, any type, with or without ankle strap, each |
| HCPCS E0952 | Toe loop/holder, any type, each |
| HCPCS E0953 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
| HCPCS E0954 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot |
| HCPCS E0955 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
| HCPCS E0956 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
| HCPCS E0957 | Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each |
| HCPCS E0958 | Manual wheelchair accessory, one-arm drive attachment, each |
| HCPCS E0959 | Manual wheelchair accessory, adapter for amputee, each |
| HCPCS E0960 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
| HCPCS E0961 | Manual wheelchair accessory, wheel lock brake extension (handle), each |
| HCPCS E0962 | 1" CUSHION, FOR WHEELCHAIR |
| HCPCS E0963 | 2" CUSHION, FOR WHEELCHAIR |
| HCPCS E0964 | 3" CUSHION, FOR WHEELCHAIR |
| HCPCS E0965 | 4" CUSHION, FOR WHEELCHAIR |
| HCPCS E0966 | Manual wheelchair accessory, headrest extension, each |
| HCPCS E0967 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each |
| HCPCS E0968 | Commode seat, wheelchair |
| HCPCS E0969 | Narrowing device, wheelchair |
| HCPCS E0970 | No. 2 footplates, except for elevating leg rest |
| HCPCS E0971 | Manual wheelchair accessory, anti-tipping device, each |
| HCPCS E0972 | WHEELCHAIR ACCESSORY, TRANSFER BOARD OR DEVICE, EACH |
| HCPCS E0973 | Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
| HCPCS E0974 | Manual wheelchair accessory, anti-rollback device, each |
| HCPCS E0977 | WEDGE CUSHION, WHEELCHAIR |
| HCPCS E0978 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
| HCPCS E0980 | Safety vest, wheelchair |
| HCPCS E0981 | Wheelchair accessory, seat upholstery, replacement only, each |
| HCPCS E0982 | Wheelchair accessory, back upholstery, replacement only, each |
| HCPCS E0983 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control |
| HCPCS E0984 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control |
| HCPCS E0985 | Wheelchair accessory, seat lift mechanism |
| HCPCS E0986 | Manual wheelchair accessory, push-rim activated power assist system |
| HCPCS E0988 | Manual wheelchair accessory, lever-activated, wheel drive, pair |
| HCPCS E0990 | Wheelchair accessory, elevating leg rest, complete assembly, each |
| HCPCS E0992 | Manual wheelchair accessory, solid seat insert |
| HCPCS E0994 | Arm rest, each |
| HCPCS E0995 | Wheelchair accessory, calf rest/pad, replacement only, each |
| HCPCS E0996 | TIRE, SOLID, EACH |
| HCPCS E0997 | CASTER WITH A FORK |
| HCPCS E0998 | CASTER WITHOUT FORK |
| HCPCS E0999 | PNEUMATIC TIRE WITH WHEEL |
| HCPCS E1000 | TIRE, PNEUMATIC CASTER |
| HCPCS E1001 | WHEEL, SINGLE |
| HCPCS E1002 | Wheelchair accessory, power seating system, tilt only |
| HCPCS E1003 | Wheelchair accessory, power seating system, recline only, without shear reduction |
| HCPCS E1004 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction |
| HCPCS E1005 | Wheelchair accessory, power seating system, recline only, with power shear reduction |
| HCPCS E1006 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction |
| HCPCS E1007 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
| HCPCS E1008 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction |
| HCPCS E1009 | Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each |
| HCPCS E1010 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair |
| HCPCS E1011 | Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) |
| HCPCS E1012 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
| HCPCS E1013 | INTEGRATED SEATING SYSTEM, CONTOURED, FOR PEDIATRIC WHEELCHAIR |
| HCPCS E1014 | Reclining back, addition to pediatric size wheelchair |
| HCPCS E1015 | Shock absorber for manual wheelchair, each |
| HCPCS E1016 | Shock absorber for power wheelchair, each |
| HCPCS E1017 | Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each |
| HCPCS E1018 | Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each |
| HCPCS E1019 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, HEAVY DUTY FEATURE, PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS AND LESS THAN OR EQUAL TO 400 POUNDS |
| HCPCS E1020 | Residual limb support system for wheelchair, any type |
| HCPCS E1021 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, EXTRA HEAVY DUTY FEATURE, WEIGHT CAPACITY GREATER THAN 400 POUNDS |
| HCPCS E1025 | LATERAL THORACIC SUPPORT, NON-CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE) |
| HCPCS E1026 | LATERAL THORACIC SUPPORT, CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE) |
| HCPCS E1027 | LATERAL/ANTERIOR SUPPORT, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE) |
| HCPCS E1028 | Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
| HCPCS E1029 | Wheelchair accessory, ventilator tray, fixed |
| HCPCS E1030 | Wheelchair accessory, ventilator tray, gimbaled |
| HCPCS E1031 | Rollabout chair, any and all types with casters 5" or greater |
| HCPCS E1035 | Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs |
| HCPCS E1036 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs |
| HCPCS E1037 | Transport chair, pediatric size |
| HCPCS E1038 | Transport chair, adult size, patient weight capacity up to and including 300 pounds |
| HCPCS E1039 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds |
| HCPCS E1050 | Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests |
| HCPCS E1060 | Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
| HCPCS E1070 | Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest |
| HCPCS E1083 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest |
| HCPCS E1084 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests |
| HCPCS E1085 | Hemi-wheelchair, fixed full length arms, swing away detachable foot rests |
| HCPCS E1086 | Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests |
| HCPCS E1087 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests |
| HCPCS E1088 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests |
| HCPCS E1089 | High strength lightweight wheelchair, fixed length arms, swing away detachable footrest |
| HCPCS E1090 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests |
| HCPCS E1092 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests |
| HCPCS E1093 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests |
| HCPCS E1100 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests |
| HCPCS E1110 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest |
| HCPCS E1130 | Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests |
| HCPCS E1140 | Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
| HCPCS E1150 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
| HCPCS E1160 | Wheelchair, fixed full length arms, swing away detachable elevating legrests |
| HCPCS E1161 | Manual adult size wheelchair, includes tilt in space |
| HCPCS E1170 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests |
| HCPCS E1171 | Amputee wheelchair, fixed full length arms, without footrests or legrest |
| HCPCS E1172 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest |
| HCPCS E1180 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests |
| HCPCS E1190 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests |
| HCPCS E1195 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests |
| HCPCS E1200 | Amputee wheelchair, fixed full length arms, swing away detachable footrest |
| HCPCS E1210 | MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG RESTS |
| HCPCS E1211 | MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH SWING AWAY,DETACHABLE ELEVATING LEG REST |
| HCPCS E1212 | MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS |
| HCPCS E1213 | MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE FOOT RESTS |
| HCPCS E1220 | Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification |
| HCPCS E1221 | Wheelchair with fixed arm, footrests |
| HCPCS E1222 | Wheelchair with fixed arm, elevating legrests |
| HCPCS E1223 | Wheelchair with detachable arms, footrests |
| HCPCS E1224 | Wheelchair with detachable arms, elevating legrests |
| HCPCS E1225 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
| HCPCS E1226 | Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
| HCPCS E1227 | Special height arms for wheelchair |
| HCPCS E1228 | Special back height for wheelchair |
| HCPCS E1229 | Wheelchair, pediatric size, not otherwise specified |
| HCPCS E1230 | Power operated vehicle (three or four wheel nonhighway) specify brand name and model number |
| HCPCS E1231 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system |
| HCPCS E1232 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system |
| HCPCS E1233 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system |
| HCPCS E1234 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system |
| HCPCS E1235 | Wheelchair, pediatric size, rigid, adjustable, with seating system |
| HCPCS E1236 | Wheelchair, pediatric size, folding, adjustable, with seating system |
| HCPCS E1237 | Wheelchair, pediatric size, rigid, adjustable, without seating system |
| HCPCS E1238 | Wheelchair, pediatric size, folding, adjustable, without seating system |
| HCPCS E1239 | Power wheelchair, pediatric size, not otherwise specified |
| HCPCS E1240 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest |
| HCPCS E1250 | Lightweight wheelchair, fixed full length arms, swing away detachable footrest |
| HCPCS E1260 | Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest |
| HCPCS E1270 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests |
| HCPCS E1280 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests |
| HCPCS E1285 | Heavy duty wheelchair, fixed full length arms, swing away detachable footrest |
| HCPCS E1290 | Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest |
| HCPCS E1295 | Heavy duty wheelchair, fixed full length arms, elevating legrest |
| HCPCS E1296 | Special wheelchair seat height from floor |
| HCPCS E1297 | Special wheelchair seat depth, by upholstery |
| HCPCS E1298 | Special wheelchair seat depth and/or width, by construction |
| HCPCS E1300 | Whirlpool, portable (overtub type) |
| HCPCS E1310 | Whirlpool, non-portable (built-in type) |
| HCPCS E1340 | REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES |
| HCPCS E1353 | Regulator |
| HCPCS E1354 | Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each |
| HCPCS E1355 | Stand/rack |
| HCPCS E1356 | Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each |
| HCPCS E1357 | Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each |
| HCPCS E1358 | Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each |
| HCPCS E1372 | Immersion external heater for nebulizer |
| HCPCS E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
| HCPCS E1391 | Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each |
| HCPCS E1392 | Portable oxygen concentrator, rental |
| HCPCS E1399 | Durable medical equipment, miscellaneous |
| HCPCS E1405 | Oxygen and water vapor enriching system with heated delivery |
| HCPCS E1406 | Oxygen and water vapor enriching system without heated delivery |
| HCPCS E1500 | Centrifuge, for dialysis |
| HCPCS E1510 | Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i.v. poles, pressure gauge, concentrate container |
| HCPCS E1520 | Heparin infusion pump for hemodialysis |
| HCPCS E1530 | Air bubble detector for hemodialysis, each, replacement |
| HCPCS E1540 | Pressure alarm for hemodialysis, each, replacement |
| HCPCS E1550 | Bath conductivity meter for hemodialysis, each |
| HCPCS E1560 | Blood leak detector for hemodialysis, each, replacement |
| HCPCS E1570 | Adjustable chair, for esrd patients |
| HCPCS E1575 | Transducer protectors/fluid barriers, for hemodialysis, any size, per 10 |
| HCPCS E1580 | Unipuncture control system for hemodialysis |
| HCPCS E1590 | Hemodialysis machine |
| HCPCS E1592 | Automatic intermittent peritoneal dialysis system |
| HCPCS E1594 | Cycler dialysis machine for peritoneal dialysis |
| HCPCS E1600 | Delivery and/or installation charges for hemodialysis equipment |
| HCPCS E1610 | Reverse osmosis water purification system, for hemodialysis |
| HCPCS E1615 | Deionizer water purification system, for hemodialysis |
| HCPCS E1620 | Blood pump for hemodialysis, replacement |
| HCPCS E1625 | Water softening system, for hemodialysis |
| HCPCS E1630 | Reciprocating peritoneal dialysis system |
| HCPCS E1632 | Wearable artificial kidney, each |
| HCPCS E1634 | Peritoneal dialysis clamps, each |
| HCPCS E1635 | Compact (portable) travel hemodialyzer system |
| HCPCS E1636 | Sorbent cartridges, for hemodialysis, per 10 |
| HCPCS E1637 | Hemostats, each |
| HCPCS E1639 | Scale, each |
| HCPCS E1699 | Dialysis equipment, not otherwise specified |
| HCPCS E1700 | Jaw motion rehabilitation system |
| HCPCS E1701 | Replacement cushions for jaw motion rehabilitation system, pkg. of 6 |
| HCPCS E1702 | Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200 |
| HCPCS E1800 | Dynamic adjustable elbow extension and flexion device, includes soft interface material |
| HCPCS E1801 | Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1802 | Dynamic adjustable forearm pronation/supination device, includes soft interface material |
| HCPCS E1805 | Dynamic adjustable wrist extension and flexion device, includes soft interface material |
| HCPCS E1806 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1810 | Dynamic adjustable knee extension and flexion device, includes soft interface material |
| HCPCS E1811 | Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1812 | Dynamic knee, extension/flexion device with active resistance control |
| HCPCS E1815 | Dynamic adjustable ankle extension and flexion device, includes soft interface material |
| HCPCS E1816 | Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1818 | Static progressive stretch/patient actualized serial stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1820 | Replacement soft interface material, dynamic adjustable extension/flexion device |
| HCPCS E1821 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device |
| HCPCS E1825 | Dynamic adjustable finger extension and flexion device, includes soft interface material |
| HCPCS E1830 | Dynamic adjustable toe extension and flexion device, includes soft interface material |
| HCPCS E1831 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1840 | Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material |
| HCPCS E1841 | Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories |
| HCPCS E1902 | Communication board, non-electronic augmentative or alternative communication device |
| HCPCS E2000 | Gastric suction pump, home model, portable or stationary, electric |
| HCPCS E2100 | Blood glucose monitor with integrated voice synthesizer |
| HCPCS E2101 | Blood glucose monitor with integrated lancing/blood sample |
| HCPCS E2120 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid |
| HCPCS E2201 | Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
| HCPCS E2202 | Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches |
| HCPCS E2203 | Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches |
| HCPCS E2204 | Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches |
| HCPCS E2205 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each |
| HCPCS E2206 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each |
| HCPCS E2207 | Wheelchair accessory, crutch and cane holder, each |
| HCPCS E2208 | Wheelchair accessory, cylinder tank carrier, each |
| HCPCS E2209 | Accessory, arm trough, with or without hand support, each |
| HCPCS E2210 | Wheelchair accessory, bearings, any type, replacement only, each |
| HCPCS E2211 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
| HCPCS E2212 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each |
| HCPCS E2213 | Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
| HCPCS E2214 | Manual wheelchair accessory, pneumatic caster tire, any size, each |
| HCPCS E2215 | Manual wheelchair accessory, tube for pneumatic caster tire, any size, each |
| HCPCS E2216 | Manual wheelchair accessory, foam filled propulsion tire, any size, each |
| HCPCS E2217 | Manual wheelchair accessory, foam filled caster tire, any size, each |
| HCPCS E2218 | Manual wheelchair accessory, foam propulsion tire, any size, each |
| HCPCS E2219 | Manual wheelchair accessory, foam caster tire, any size, each |
| HCPCS E2220 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each |
| HCPCS E2221 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each |
| HCPCS E2222 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
| HCPCS E2223 | MANUAL WHEELCHAIR ACCESSORY, VALVE, ANY TYPE, REPLACEMENT ONLY, EACH |
| HCPCS E2224 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each |
| HCPCS E2225 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
| HCPCS E2226 | Manual wheelchair accessory, caster fork, any size, replacement only, each |
| HCPCS E2227 | Manual wheelchair accessory, gear reduction drive wheel, each |
| HCPCS E2228 | Manual wheelchair accessory, wheel braking system and lock, complete, each |
| HCPCS E2230 | Manual wheelchair accessory, manual standing system |
| HCPCS E2231 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
| HCPCS E2291 | Back, planar, for pediatric size wheelchair including fixed attaching hardware |
| HCPCS E2292 | Seat, planar, for pediatric size wheelchair including fixed attaching hardware |
| HCPCS E2293 | Back, contoured, for pediatric size wheelchair including fixed attaching hardware |
| HCPCS E2294 | Seat, contoured, for pediatric size wheelchair including fixed attaching hardware |
| HCPCS E2295 | Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features |
| HCPCS E2300 | Wheelchair accessory, power seat elevation system, any type |
| HCPCS E2301 | Wheelchair accessory, power standing system, any type |
| HCPCS E2310 | 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 |
| HCPCS E2311 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
| HCPCS E2312 | Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware |
| HCPCS E2313 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
| HCPCS E2320 | POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, REMOTE JOYSTICK OR TOUCHPAD, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, AND FIXED MOUNTING HARDWARE |
| HCPCS E2321 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware |
| HCPCS E2322 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware |
| HCPCS E2323 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated |
| HCPCS E2324 | Power wheelchair accessory, chin cup for chin control interface |
| HCPCS E2325 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware |
| HCPCS E2326 | Power wheelchair accessory, breath tube kit for sip and puff interface |
| HCPCS E2327 | Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware |
| HCPCS E2328 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware |
| HCPCS E2329 | 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 |
| HCPCS E2330 | 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 |
| HCPCS E2331 | Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware |
| HCPCS E2340 | Power wheelchair accessory, nonstandard seat frame width, 20-23 inches |
| HCPCS E2341 | Power wheelchair accessory, nonstandard seat frame width, 24-27 inches |
| HCPCS E2342 | Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches |
| HCPCS E2343 | Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches |
| HCPCS E2351 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface |
| HCPCS E2358 | Power wheelchair accessory, group 34 non-sealed lead acid battery, each |
| HCPCS E2359 | Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| HCPCS E2360 | Power wheelchair accessory, 22nf non-sealed lead acid battery, each |
| HCPCS E2361 | Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
| HCPCS E2362 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each |
| HCPCS E2363 | Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| HCPCS E2364 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each |
| HCPCS E2365 | Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| HCPCS E2366 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
| HCPCS E2367 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each |
| HCPCS E2368 | Power wheelchair component, drive wheel motor, replacement only |
| HCPCS E2369 | Power wheelchair component, drive wheel gear box, replacement only |
| HCPCS E2370 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
| HCPCS E2371 | Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each |
| HCPCS E2372 | Power wheelchair accessory, group 27 non-sealed lead acid battery, each |
| HCPCS E2373 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware |
| HCPCS E2374 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
| HCPCS E2375 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only |
| HCPCS E2376 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only |
| HCPCS E2377 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
| HCPCS E2378 | Power wheelchair component, actuator, replacement only |
| HCPCS E2381 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each |
| HCPCS E2382 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each |
| HCPCS E2383 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each |
| HCPCS E2384 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each |
| HCPCS E2385 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each |
| HCPCS E2386 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
| HCPCS E2387 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
| HCPCS E2388 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each |
| HCPCS E2389 | Power wheelchair accessory, foam caster tire, any size, replacement only, each |
| HCPCS E2390 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each |
| HCPCS E2391 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each |
| HCPCS E2392 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
| HCPCS E2393 | POWER WHEELCHAIR ACCESSORY, VALVE FOR PNEUMATIC TIRE TUBE, ANY TYPE, REPLACEMENT ONLY, EACH |
| HCPCS E2394 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
| HCPCS E2395 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
| HCPCS E2396 | Power wheelchair accessory, caster fork, any size, replacement only, each |
| HCPCS E2397 | Power wheelchair accessory, lithium-based battery, each |
| HCPCS E2399 | POWER WHEELCHAIR ACCESSORY, NOT OTHERWISE CLASSIFIED INTERFACE, INCLUDING ALL RELATED ELECTRONICS AND ANY TYPE MOUNTING HARDWARE |
| HCPCS E2402 | Negative pressure wound therapy electrical pump, stationary or portable |
| HCPCS E2500 | Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time |
| HCPCS E2502 | Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time |
| HCPCS E2504 | Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time |
| HCPCS E2506 | Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time |
| HCPCS E2508 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device |
| HCPCS E2510 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
| HCPCS E2511 | Speech generating software program, for personal computer or personal digital assistant |
| HCPCS E2512 | Accessory for speech generating device, mounting system |
| HCPCS E2599 | Accessory for speech generating device, not otherwise classified |
| HCPCS E2601 | General use wheelchair seat cushion, width less than 22 inches, any depth |
| HCPCS E2602 | General use wheelchair seat cushion, width 22 inches or greater, any depth |
| HCPCS E2603 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
| HCPCS E2604 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth |
| HCPCS E2605 | Positioning wheelchair seat cushion, width less than 22 inches, any depth |
| HCPCS E2606 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth |
| HCPCS E2607 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
| HCPCS E2608 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth |
| HCPCS E2609 | Custom fabricated wheelchair seat cushion, any size |
| HCPCS E2610 | Wheelchair seat cushion, powered |
| HCPCS E2611 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
| HCPCS E2612 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware |
| HCPCS E2613 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
| HCPCS E2614 | Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware |
| HCPCS E2615 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware |
| HCPCS E2616 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware |
| HCPCS E2617 | Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
| HCPCS E2618 | WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), FOR USE WITH MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, INCLUDES ANY TYPE MOUNTING HARDWARE |
| HCPCS E2619 | Replacement cover for wheelchair seat cushion or back cushion, each |
| HCPCS E2620 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
| HCPCS E2621 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware |
| HCPCS E2622 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
| HCPCS E2623 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth |
| HCPCS E2624 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
| HCPCS E2625 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth |
| HCPCS E2626 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable |
| HCPCS E2627 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type |
| HCPCS E2628 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining |
| HCPCS E2629 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) |
| HCPCS E2630 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support |
| HCPCS E2631 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm |
| HCPCS E2632 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control |
| HCPCS E2633 | Wheelchair accessory, addition to mobile arm support, supinator |
| HCPCS E8000 | Gait trainer, pediatric size, posterior support, includes all accessories and components |
| HCPCS E8001 | Gait trainer, pediatric size, upright support, includes all accessories and components |
| HCPCS E8002 | Gait trainer, pediatric size, anterior support, includes all accessories and components |
| HCPCS J7341 | DERMAL (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER |
| HCPCS J7342 | Instillation, ciprofloxacin otic suspension, 6 mg |
| HCPCS J7343 | DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER |
| HCPCS J7344 | DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER |
| HCPCS K0001 | Standard wheelchair |
| HCPCS K0002 | Standard hemi (low seat) wheelchair |
| HCPCS K0003 | Lightweight wheelchair |
| HCPCS K0004 | High strength, lightweight wheelchair |
| HCPCS K0005 | Ultralightweight wheelchair |
| HCPCS K0006 | Heavy duty wheelchair |
| HCPCS K0007 | Extra heavy duty wheelchair |
| HCPCS K0008 | Custom manual wheelchair/base |
| HCPCS K0009 | Other manual wheelchair/base |
| HCPCS K0010 | Standard - weight frame motorized/power wheelchair |
| HCPCS K0011 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking |
| HCPCS K0012 | Lightweight portable motorized/power wheelchair |
| HCPCS K0013 | Custom motorized/power wheelchair base |
| HCPCS K0014 | Other motorized/power wheelchair base |
| HCPCS K0015 | Detachable, non-adjustable height armrest, replacement only, each |
| HCPCS K0017 | Detachable, adjustable height armrest, base, replacement only, each |
| HCPCS K0018 | Detachable, adjustable height armrest, upper portion, replacement only, each |
| HCPCS K0019 | Arm pad, replacement only, each |
| HCPCS K0020 | Fixed, adjustable height armrest, pair |
| HCPCS K0023 | SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, ATTACHED WITH STRAPS |
| HCPCS K0024 | SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, WITH ADJUSTABLE HOOK-ON HARDWARE |
| HCPCS K0037 | High mount flip-up footrest, each |
| HCPCS K0038 | Leg strap, each |
| HCPCS K0039 | Leg strap, h style, each |
| HCPCS K0040 | Adjustable angle footplate, each |
| HCPCS K0041 | Large size footplate, each |
| HCPCS K0042 | Standard size footplate, replacement only, each |
| HCPCS K0043 | Footrest, lower extension tube, replacement only, each |
| HCPCS K0044 | Footrest, upper hanger bracket, replacement only, each |
| HCPCS K0045 | Footrest, complete assembly, replacement only, each |
| HCPCS K0046 | Elevating legrest, lower extension tube, replacement only, each |
| HCPCS K0047 | Elevating legrest, upper hanger bracket, replacement only, each |
| HCPCS K0050 | Ratchet assembly, replacement only |
| HCPCS K0051 | Cam release assembly, footrest or legrest, replacement only, each |
| HCPCS K0052 | Swingaway, detachable footrests, replacement only, each |
| HCPCS K0053 | Elevating footrests, articulating (telescoping), each |
| HCPCS K0056 | Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair |
| HCPCS K0059 | PLASTIC COATED HANDRIM, EACH |
| HCPCS K0060 | STEEL HANDRIM, EACH |
| HCPCS K0061 | ALUMINUM HANDRIM, EACH |
| HCPCS K0064 | ZERO PRESSURE TUBE (FLAT FREE INSERTS), ANY SIZE, EACH |
| HCPCS K0065 | Spoke protectors, each |
| HCPCS K0066 | SOLID TIRE, ANY SIZE, EACH |
| HCPCS K0067 | PNEUMATIC TIRE, ANY SIZE, EACH |
| HCPCS K0068 | PNEUMATIC TIRE TUBE, EACH |
| HCPCS K0069 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each |
| HCPCS K0070 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
| HCPCS K0071 | Front caster assembly, complete, with pneumatic tire, replacement only, each |
| HCPCS K0072 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each |
| HCPCS K0073 | Caster pin lock, each |
| HCPCS K0074 | PNEUMATIC CASTER TIRE, ANY SIZE, EACH |
| HCPCS K0075 | SEMI-PNEUMATIC CASTER TIRE, ANY SIZE, EACH |
| HCPCS K0076 | SOLID CASTER TIRE, ANY SIZE, EACH |
| HCPCS K0077 | Front caster assembly, complete, with solid tire, replacement only, each |
| HCPCS K0078 | PNEUMATIC CASTER TIRE TUBE, EACH |
| HCPCS K0081 | WHEEL LOCK ASSEMBLY, COMPLETE, EACH |
| HCPCS K0090 | REAR WHEEL TIRE FOR POWER WHEELCHAIR, ANY SIZE, EACH |
| HCPCS K0091 | REAR WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR POWER WHEELCHAIR, ANY SIZE,EACH |
| HCPCS K0092 | REAR WHEEL ASSEMBLY FOR POWER WHEELCHAIR, COMPLETE, EACH |
| HCPCS K0093 | REAR WHEEL, ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER WHEELCHAIR, ANY SIZE, EACH |
| HCPCS K0094 | WHEEL TIRE FOR POWER BASE, ANY SIZE, EACH |
| HCPCS K0095 | WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR EACH BASE, ANY SIZE, EACH |
| HCPCS K0096 | WHEEL ASSEMBLY FOR POWER BASE, COMPLETE, EACH |
| HCPCS K0097 | WHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER BASE, ANY SIZE, EACH |
| HCPCS K0098 | Drive belt for power wheelchair, replacement only |
| HCPCS K0099 | FRONT CASTER FOR POWER WHEELCHAIR, EACH |
| HCPCS K0102 | CRUTCH AND CANE HOLDER, EACH |
| HCPCS K0104 | CYLINDER TANK CARRIER, EACH |
| HCPCS K0105 | Iv hanger, each |
| HCPCS K0106 | ARM TROUGH, EACH |
| HCPCS K0108 | Wheelchair component or accessory, not otherwise specified |
| HCPCS K0114 | BACK SUPPORT SYSTEM FOR USE WITH A WHEELCHAIR, WITH INNER FRAME, PREFABRICATED |
| HCPCS K0115 | SEATING SYSTEM, BACK MODULE, POSTERIORLATERAL CONTROL, WITH OR WITHOUT LATERAL SUPPORTS, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE |
| HCPCS K0116 | SEATING SYSTEM, COMBINED BACK AND SEAT MODULE, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE |
| HCPCS K0195 | Elevating leg rests, pair (for use with capped rental wheelchair base) |
| HCPCS K0452 | WHEELCHAIR BEARINGS, ANY TYPE |
| HCPCS K0455 | Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol) |
| HCPCS K0462 | Temporary replacement for patient owned equipment being repaired, any type |
| HCPCS K0552 | Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
| HCPCS K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
| HCPCS K0554 | Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
| HCPCS K0555 | NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR |
| HCPCS K0600 | FUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF AMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED, ENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM |
| HCPCS K0601 | Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each |
| HCPCS K0602 | Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each |
| HCPCS K0603 | Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each |
| HCPCS K0604 | Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each |
| HCPCS K0605 | Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each |
| HCPCS K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type |
| HCPCS K0607 | Replacement battery for automated external defibrillator, garment type only, each |
| HCPCS K0608 | Replacement garment for use with automated external defibrillator, each |
| HCPCS K0609 | Replacement electrodes for use with automated external defibrillator, garment type only, each |
| HCPCS K0618 | TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, TWO RIGID PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, SOF |
| HCPCS K0619 | TLSO, SAGITTAL-CORONAL CONTROL, MODULAR SEGMENTED SPINAL SYSTEM, THREE RIGID PLASTIC SHELLS, POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE, ANTERIOR EXTENDS FROM THE SYMPHYSIS PUBIS TO THE XIPHOID, S |
| HCPCS K0620 | TUBULAR ELASTIC DRESSING, ANY WIDTH, PER LINEAR YARD |
| HCPCS K0627 | TRACTION EQUIPMENT, CERVICAL, FREE-STANDING, PNEUMATIC, APPLYING TRACTION FORCE TO OTHER THAN MANDIBLE |
| HCPCS K0628 | FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT AFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF SHORE A 35 DUROMETER O |
| HCPCS K0629 | FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF PATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 3/16 INCH MATERIAL OF SHORE A 35 DUROMETER OR HIGHER, INCLUDES ARCH FILLER AND OTHER SHAPING |
| HCPCS K0630 | SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS K0631 | SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED |
| HCPCS K0632 | SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PANELS OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING A |
| HCPCS K0633 | SACROILIAC ORTHOSIS, PROVIDES PELVIC-SACRAL SUPPORT, WITH RIGID OR SEMI-RIGID PANELS PLACED OVER THE SACRUM AND ABDOMEN, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED |
| HCPCS K0634 | LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, SHOULDER STRA |
| HCPCS K0635 | LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTENDS FROM L1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, STAYS, SHOULDER |
| HCPCS K0636 | LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOU |
| HCPCS K0637 | LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE STAYS, SHOU |
| HCPCS K0638 | LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE STAYS, SHOU |
| HCPCS K0639 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID POSTERIOR PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PAD |
| HCPCS K0640 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, PENDULOUS ABDO |
| HCPCS K0641 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY |
| HCPCS K0642 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD |
| HCPCS K0643 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR FRAME/PANEL(S), POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD |
| HCPCS K0644 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERA |
| HCPCS K0645 | LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERA |
| HCPCS K0646 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO R |
| HCPCS K0647 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO R |
| HCPCS K0648 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S) POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XYPHOID, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRA |
| HCPCS K0649 | LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, RIGID SHELL(S)/PANEL(S) POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRA |
| HCPCS K0650 | GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH |
| HCPCS K0651 | GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH |
| HCPCS K0652 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH |
| HCPCS K0653 | SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH |
| HCPCS K0654 | POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH |
| HCPCS K0655 | POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH |
| HCPCS K0656 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH |
| HCPCS K0657 | SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH |
| HCPCS K0658 | CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE |
| HCPCS K0659 | WHEELCHAIR SEAT CUSHION, POWERED |
| HCPCS K0660 | GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0661 | GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0662 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0663 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0664 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0665 | POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0666 | CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE MOUNTING HARDWARE |
| HCPCS K0667 | MOUNTING HARDWARE, ANY TYPE, FOR SEAT CUSHION OR SEAT SUPPORT BASE ATTACHED TO A MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, PER CUSHION/BASE |
| HCPCS K0668 | REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH |
| HCPCS K0669 | Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac |
| HCPCS K0670 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE |
| HCPCS K0671 | PORTABLE OXYGEN CONCENTRATOR, RENTAL |
| HCPCS K0730 | Controlled dose inhalation drug delivery system |
| HCPCS K0731 | LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, OTHER THAN EAR LEVEL, REPLACEMENT, EACH |
| HCPCS K0732 | LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR LEVEL, REPLACEMENT, EACH |
| HCPCS K0733 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
| HCPCS K0734 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
| HCPCS K0735 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth |
| HCPCS K0736 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
| HCPCS K0737 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth |
| HCPCS K0738 | Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
| HCPCS K0739 | Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
| HCPCS K0740 | Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
| HCPCS K0741 | Portable gaseous oxygen system, rental, includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing, for cluster headaches |
| HCPCS K0742 | Portable oxygen contents, gaseous, 1 month's supply = 1 unit, for cluster headaches, for initial months supply or to replace used contents |
| HCPCS K0743 | Suction pump, home model, portable, for use on wounds |
| HCPCS K0744 | Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less |
| HCPCS K0745 | Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches |
| HCPCS K0746 | Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches |
| HCPCS K0800 | Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
| HCPCS K0801 | Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds |
| HCPCS K0802 | Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds |
| HCPCS K0806 | Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds |
| HCPCS K0807 | Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds |
| HCPCS K0808 | Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds |
| HCPCS K0812 | Power operated vehicle, not otherwise classified |
| HCPCS K0813 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
| HCPCS K0814 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0815 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
| HCPCS K0816 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0820 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0821 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0822 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0824 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0825 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
| HCPCS K0826 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| HCPCS K0827 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds |
| HCPCS K0828 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more |
| HCPCS K0829 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more |
| HCPCS K0830 | Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0831 | Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0835 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0836 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0837 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0838 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds |
| HCPCS K0839 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| HCPCS K0840 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more |
| HCPCS K0841 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0842 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0843 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0848 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0849 | Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0850 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0851 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
| HCPCS K0852 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| HCPCS K0853 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds |
| HCPCS K0854 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more |
| HCPCS K0855 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more |
| HCPCS K0856 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0857 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0858 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds |
| HCPCS K0859 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds |
| HCPCS K0860 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| HCPCS K0861 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0862 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0863 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| HCPCS K0864 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more |
| HCPCS K0868 | Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0869 | Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0870 | Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0871 | Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds |
| HCPCS K0877 | Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0878 | Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0879 | Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0880 | Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds |
| HCPCS K0884 | Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
| HCPCS K0885 | Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds |
| HCPCS K0886 | Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
| HCPCS K0890 | Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds |
| HCPCS K0891 | Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds |
| HCPCS K0898 | Power wheelchair, not otherwise classified |
| HCPCS K0899 | Power mobility device, not coded by dme pdac or does not meet criteria |
| HCPCS L0100 | CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE, MOLDED TO PATIENT MODEL |
| HCPCS L0110 | CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED |
| HCPCS L0112 | Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated |
| HCPCS L0113 | Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment |
| HCPCS L0120 | Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
| HCPCS L0130 | Cervical, flexible, thermoplastic collar, molded to patient |
| HCPCS L0140 | Cervical, semi-rigid, adjustable (plastic collar) |
| HCPCS L0150 | Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece) |
| HCPCS L0160 | Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf |
| HCPCS L0170 | Cervical, collar, molded to patient model |
| HCPCS L0172 | Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf |
| HCPCS L0174 | Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
| HCPCS L0180 | Cervical, multiple post collar, occipital/mandibular supports, adjustable |
| HCPCS L0190 | Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types) |
| HCPCS L0200 | Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension |
| HCPCS L0210 | THORACIC, RIB BELT |
| HCPCS L0220 | Thoracic, rib belt, custom fabricated |
| HCPCS L0430 | Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (dewall posture protector only) |
| HCPCS L0450 | Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf |
| HCPCS L0452 | Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated |
| HCPCS L0454 | Tlso flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0456 | Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0458 | Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| HCPCS L0460 | Tlso, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0462 | Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| HCPCS L0464 | Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| HCPCS L0466 | Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0468 | Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0470 | Tlso, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, provides intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment |
| HCPCS L0472 | Tlso, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment |
| HCPCS L0476 | TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC SHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, USUALLY LA |
| HCPCS L0478 | TLSO, SAGITTAL-CORONAL CONTROL, FLEXION COMPRESSION JACKET, TWO RIGID PLASTIC SHELLS WITH SOFT LINER, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION AND TERMINATES AT OR BEFORE THE T-9 VERTEBRA, ANTERIOR EXTENDS FROM SYMPHYSIS PUBIS TO XIPHOID, USUALLY LA |
| HCPCS L0480 | Tlso, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| HCPCS L0482 | Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| HCPCS L0484 | Tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| HCPCS L0486 | Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated |
| HCPCS L0488 | Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment |
| HCPCS L0490 | Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the t-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment |
| HCPCS L0491 | Tlso, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| HCPCS L0492 | Tlso, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
| HCPCS L0500 | LUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT) |
| HCPCS L0510 | LSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED |
| HCPCS L0515 | LSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED |
| HCPCS L0520 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH APRON FRONT |
| HCPCS L0530 | LSO, ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT |
| HCPCS L0540 | LSO, LUMBAR FLEXION (WILLIAMS FLEXION TYPE) |
| HCPCS L0550 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL |
| HCPCS L0560 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL |
| HCPCS L0561 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED |
| HCPCS L0565 | LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED |
| HCPCS L0600 | SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT) |
| HCPCS L0610 | SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED |
| HCPCS L0620 | SACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT |
| HCPCS L0621 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
| HCPCS L0622 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated |
| HCPCS L0623 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
| HCPCS L0624 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated |
| HCPCS L0625 | Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
| HCPCS L0626 | Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0627 | Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0628 | Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
| HCPCS L0629 | Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated |
| HCPCS L0630 | Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0631 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0632 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated |
| HCPCS L0633 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0634 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated |
| HCPCS L0635 | Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment |
| HCPCS L0636 | Lumbar sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated |
| HCPCS L0637 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0638 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated |
| HCPCS L0639 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L0640 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated |
| HCPCS L0700 | Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type) |
| HCPCS L0710 | Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type) |
| HCPCS L0810 | Halo procedure, cervical halo incorporated into jacket vest |
| HCPCS L0820 | Halo procedure, cervical halo incorporated into plaster body jacket |
| HCPCS L0830 | Halo procedure, cervical halo incorporated into milwaukee type orthosis |
| HCPCS L0859 | Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material |
| HCPCS L0860 | ADDITION TO HALO PROCEDURES, MAGNETIC REASONANCE IMAGE COMPATIBLE SYSTEM |
| HCPCS L0861 | Addition to halo procedure, replacement liner/interface material |
| HCPCS L0960 | TORSO SUPPORT, POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT |
| HCPCS L0970 | Tlso, corset front |
| HCPCS L0972 | Lso, corset front |
| HCPCS L0974 | Tlso, full corset |
| HCPCS L0976 | Lso, full corset |
| HCPCS L0978 | Axillary crutch extension |
| HCPCS L0980 | Peroneal straps, prefabricated, off-the-shelf, pair |
| HCPCS L0982 | Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) |
| HCPCS L0984 | Protective body sock, prefabricated, off-the-shelf, each |
| HCPCS L0999 | Addition to spinal orthosis, not otherwise specified |
| HCPCS L1000 | Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model |
| HCPCS L1001 | Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment |
| HCPCS L1005 | Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment |
| HCPCS L1010 | Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling |
| HCPCS L1020 | Addition to ctlso or scoliosis orthosis, kyphosis pad |
| HCPCS L1025 | Addition to ctlso or scoliosis orthosis, kyphosis pad, floating |
| HCPCS L1030 | Addition to ctlso or scoliosis orthosis, lumbar bolster pad |
| HCPCS L1040 | Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad |
| HCPCS L1050 | Addition to ctlso or scoliosis orthosis, sternal pad |
| HCPCS L1060 | Addition to ctlso or scoliosis orthosis, thoracic pad |
| HCPCS L1070 | Addition to ctlso or scoliosis orthosis, trapezius sling |
| HCPCS L1080 | Addition to ctlso or scoliosis orthosis, outrigger |
| HCPCS L1085 | Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions |
| HCPCS L1090 | Addition to ctlso or scoliosis orthosis, lumbar sling |
| HCPCS L1100 | Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather |
| HCPCS L1110 | Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model |
| HCPCS L1120 | Addition to ctlso, scoliosis orthosis, cover for upright, each |
| HCPCS L1200 | Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only |
| HCPCS L1210 | Addition to tlso, (low profile), lateral thoracic extension |
| HCPCS L1220 | Addition to tlso, (low profile), anterior thoracic extension |
| HCPCS L1230 | Addition to tlso, (low profile), milwaukee type superstructure |
| HCPCS L1240 | Addition to tlso, (low profile), lumbar derotation pad |
| HCPCS L1250 | Addition to tlso, (low profile), anterior asis pad |
| HCPCS L1260 | Addition to tlso, (low profile), anterior thoracic derotation pad |
| HCPCS L1270 | Addition to tlso, (low profile), abdominal pad |
| HCPCS L1280 | Addition to tlso, (low profile), rib gusset (elastic), each |
| HCPCS L1290 | Addition to tlso, (low profile), lateral trochanteric pad |
| HCPCS L1300 | Other scoliosis procedure, body jacket molded to patient model |
| HCPCS L1310 | Other scoliosis procedure, post-operative body jacket |
| HCPCS L1499 | Spinal orthosis, not otherwise specified |
| HCPCS L1500 | Thoracic-hip-knee-ankle orthosis (thkao), mobility frame (newington, parapodium types) |
| HCPCS L1510 | Thkao, standing frame, with or without tray and accessories |
| HCPCS L1520 | Thkao, swivel walker |
| HCPCS L1600 | Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an inidividual with expertise |
| HCPCS L1610 | Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1620 | Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1630 | Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated |
| HCPCS L1640 | Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated |
| HCPCS L1650 | Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment |
| HCPCS L1652 | Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1660 | Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment |
| HCPCS L1680 | Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated |
| HCPCS L1685 | Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated |
| HCPCS L1686 | Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment |
| HCPCS L1690 | Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment |
| HCPCS L1700 | Legg perthes orthosis, (toronto type), custom fabricated |
| HCPCS L1710 | Legg perthes orthosis, (newington type), custom fabricated |
| HCPCS L1720 | Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated |
| HCPCS L1730 | Legg perthes orthosis, (scottish rite type), custom fabricated |
| HCPCS L1750 | LEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L1755 | Legg perthes orthosis, (patten bottom type), custom fabricated |
| HCPCS L1800 | KNEE ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L1810 | Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1815 | KNEE ORTHOSIS, ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L1820 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1825 | KNEE ORTHOSIS, ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L1830 | Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
| HCPCS L1831 | Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment |
| HCPCS L1832 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1834 | Knee orthosis, without knee joint, rigid, custom fabricated |
| HCPCS L1836 | Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf |
| HCPCS L1840 | Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated |
| HCPCS L1843 | Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1844 | Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
| HCPCS L1845 | Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1846 | Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
| HCPCS L1847 | Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1850 | Knee orthosis, swedish type, prefabricated, off-the-shelf |
| HCPCS L1855 | KNEE ORTHOSIS, MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT KNEE JOINTS, CUSTOM-FABRICATED |
| HCPCS L1858 | KNEE ORTHOSIS, MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS (CTI), CUSTOM-FABRICATED |
| HCPCS L1860 | Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk) |
| HCPCS L1870 | KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED |
| HCPCS L1880 | KNEE ORTHOSIS, DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED |
| HCPCS L1900 | Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated |
| HCPCS L1901 | ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) |
| HCPCS L1902 | Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
| HCPCS L1904 | Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated |
| HCPCS L1906 | Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
| HCPCS L1907 | Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
| HCPCS L1910 | Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment |
| HCPCS L1920 | Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated |
| HCPCS L1930 | Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
| HCPCS L1932 | Ankle foot orthosis, rigid anterior tibial section, total carbon fiber or equal material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1940 | Ankle foot orthosis, plastic or other material, custom fabricated |
| HCPCS L1945 | Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated |
| HCPCS L1950 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated |
| HCPCS L1951 | Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L1960 | Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
| HCPCS L1970 | Ankle foot orthosis, plastic with ankle joint, custom fabricated |
| HCPCS L1971 | Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
| HCPCS L1980 | Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated |
| HCPCS L1990 | Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated |
| HCPCS L2000 | Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated |
| HCPCS L2005 | Knee ankle foot orthosis, any material, single or double upright, stance control, automatic lock and swing phase release, any type activation, includes ankle joint, any type, custom fabricated |
| HCPCS L2010 | Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated |
| HCPCS L2020 | Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated |
| HCPCS L2030 | Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated |
| HCPCS L2034 | Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated |
| HCPCS L2035 | Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment |
| HCPCS L2036 | Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated |
| HCPCS L2037 | Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated |
| HCPCS L2038 | Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated |
| HCPCS L2039 | KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED |
| HCPCS L2040 | Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated |
| HCPCS L2050 | Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated |
| HCPCS L2060 | Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated |
| HCPCS L2070 | Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated |
| HCPCS L2080 | Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated |
| HCPCS L2090 | Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated |
| HCPCS L2106 | Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated |
| HCPCS L2108 | Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated |
| HCPCS L2112 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
| HCPCS L2114 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
| HCPCS L2116 | Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment |
| HCPCS L2126 | Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated |
| HCPCS L2128 | Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated |
| HCPCS L2132 | Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment |
| HCPCS L2134 | Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
| HCPCS L2136 | Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment |
| HCPCS L2180 | Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints |
| HCPCS L2182 | Addition to lower extremity fracture orthosis, drop lock knee joint |
| HCPCS L2184 | Addition to lower extremity fracture orthosis, limited motion knee joint |
| HCPCS L2186 | Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type |
| HCPCS L2188 | Addition to lower extremity fracture orthosis, quadrilateral brim |
| HCPCS L2190 | Addition to lower extremity fracture orthosis, waist belt |
| HCPCS L2192 | Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt |
| HCPCS L2200 | Addition to lower extremity, limited ankle motion, each joint |
| HCPCS L2210 | Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
| HCPCS L2220 | Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
| HCPCS L2230 | Addition to lower extremity, split flat caliper stirrups and plate attachment |
| HCPCS L2232 | Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only |
| HCPCS L2240 | Addition to lower extremity, round caliper and plate attachment |
| HCPCS L2250 | Addition to lower extremity, foot plate, molded to patient model, stirrup attachment |
| HCPCS L2260 | Addition to lower extremity, reinforced solid stirrup (scott-craig type) |
| HCPCS L2265 | Addition to lower extremity, long tongue stirrup |
| HCPCS L2270 | Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
| HCPCS L2275 | Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
| HCPCS L2280 | Addition to lower extremity, molded inner boot |
| HCPCS L2300 | Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable |
| HCPCS L2310 | Addition to lower extremity, abduction bar-straight |
| HCPCS L2320 | Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only |
| HCPCS L2330 | Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
| HCPCS L2335 | Addition to lower extremity, anterior swing band |
| HCPCS L2340 | Addition to lower extremity, pre-tibial shell, molded to patient model |
| HCPCS L2350 | Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses) |
| HCPCS L2360 | Addition to lower extremity, extended steel shank |
| HCPCS L2370 | Addition to lower extremity, patten bottom |
| HCPCS L2375 | Addition to lower extremity, torsion control, ankle joint and half solid stirrup |
| HCPCS L2380 | Addition to lower extremity, torsion control, straight knee joint, each joint |
| HCPCS L2385 | Addition to lower extremity, straight knee joint, heavy duty, each joint |
| HCPCS L2387 | Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint |
| HCPCS L2390 | Addition to lower extremity, offset knee joint, each joint |
| HCPCS L2395 | Addition to lower extremity, offset knee joint, heavy duty, each joint |
| HCPCS L2397 | Addition to lower extremity orthosis, suspension sleeve |
| HCPCS L2405 | Addition to knee joint, drop lock, each |
| HCPCS L2415 | Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint |
| HCPCS L2425 | Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint |
| HCPCS L2430 | Addition to knee joint, ratchet lock for active and progressive knee extension, each joint |
| HCPCS L2435 | ADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT |
| HCPCS L2492 | Addition to knee joint, lift loop for drop lock ring |
| HCPCS L2500 | Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring |
| HCPCS L2510 | Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model |
| HCPCS L2520 | Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted |
| HCPCS L2525 | Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model |
| HCPCS L2526 | Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted |
| HCPCS L2530 | Addition to lower extremity, thigh-weight bearing, lacer, non-molded |
| HCPCS L2540 | Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model |
| HCPCS L2550 | Addition to lower extremity, thigh/weight bearing, high roll cuff |
| HCPCS L2570 | Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each |
| HCPCS L2580 | Addition to lower extremity, pelvic control, pelvic sling |
| HCPCS L2600 | Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each |
| HCPCS L2610 | Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each |
| HCPCS L2620 | Addition to lower extremity, pelvic control, hip joint, heavy duty, each |
| HCPCS L2622 | Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each |
| HCPCS L2624 | Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each |
| HCPCS L2627 | Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables |
| HCPCS L2628 | Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables |
| HCPCS L2630 | Addition to lower extremity, pelvic control, band and belt, unilateral |
| HCPCS L2640 | Addition to lower extremity, pelvic control, band and belt, bilateral |
| HCPCS L2650 | Addition to lower extremity, pelvic and thoracic control, gluteal pad, each |
| HCPCS L2660 | Addition to lower extremity, thoracic control, thoracic band |
| HCPCS L2670 | Addition to lower extremity, thoracic control, paraspinal uprights |
| HCPCS L2680 | Addition to lower extremity, thoracic control, lateral support uprights |
| HCPCS L2750 | Addition to lower extremity orthosis, plating chrome or nickel, per bar |
| HCPCS L2755 | Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
| HCPCS L2760 | Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth) |
| HCPCS L2768 | Orthotic side bar disconnect device, per bar |
| HCPCS L2770 | ADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT |
| HCPCS L2780 | Addition to lower extremity orthosis, non-corrosive finish, per bar |
| HCPCS L2785 | Addition to lower extremity orthosis, drop lock retainer, each |
| HCPCS L2795 | Addition to lower extremity orthosis, knee control, full kneecap |
| HCPCS L2800 | Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only |
| HCPCS L2810 | Addition to lower extremity orthosis, knee control, condylar pad |
| HCPCS L2820 | Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
| HCPCS L2830 | Addition to lower extremity orthosis, soft interface for molded plastic, above knee section |
| HCPCS L2840 | Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
| HCPCS L2850 | Addition to lower extremity orthosis, femoral length sock, fracture or equal, each |
| HCPCS L2860 | ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM, EACH |
| HCPCS L2861 | Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each |
| HCPCS L2999 | Lower extremity orthoses, not otherwise specified |
| HCPCS L3000 | Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
| HCPCS L3001 | Foot, insert, removable, molded to patient model, spenco, each |
| HCPCS L3002 | Foot, insert, removable, molded to patient model, plastazote or equal, each |
| HCPCS L3003 | Foot, insert, removable, molded to patient model, silicone gel, each |
| HCPCS L3010 | Foot, insert, removable, molded to patient model, longitudinal arch support, each |
| HCPCS L3020 | Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
| HCPCS L3030 | Foot, insert, removable, formed to patient foot, each |
| HCPCS L3031 | Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each |
| HCPCS L3040 | Foot, arch support, removable, premolded, longitudinal, each |
| HCPCS L3050 | Foot, arch support, removable, premolded, metatarsal, each |
| HCPCS L3060 | Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
| HCPCS L3070 | Foot, arch support, non-removable attached to shoe, longitudinal, each |
| HCPCS L3080 | Foot, arch support, non-removable attached to shoe, metatarsal, each |
| HCPCS L3090 | Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each |
| HCPCS L3100 | Hallus-valgus night dynamic splint, prefabricated, off-the-shelf |
| HCPCS L3140 | Foot, abduction rotation bar, including shoes |
| HCPCS L3150 | Foot, abduction rotation bar, without shoes |
| HCPCS L3160 | Foot, adjustable shoe-styled positioning device |
| HCPCS L3170 | Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
| HCPCS L3201 | Orthopedic shoe, oxford with supinator or pronator, infant |
| HCPCS L3202 | Orthopedic shoe, oxford with supinator or pronator, child |
| HCPCS L3203 | Orthopedic shoe, oxford with supinator or pronator, junior |
| HCPCS L3204 | Orthopedic shoe, hightop with supinator or pronator, infant |
| HCPCS L3206 | Orthopedic shoe, hightop with supinator or pronator, child |
| HCPCS L3207 | Orthopedic shoe, hightop with supinator or pronator, junior |
| HCPCS L3208 | Surgical boot, each, infant |
| HCPCS L3209 | Surgical boot, each, child |
| HCPCS L3211 | Surgical boot, each, junior |
| HCPCS L3212 | Benesch boot, pair, infant |
| HCPCS L3213 | Benesch boot, pair, child |
| HCPCS L3214 | Benesch boot, pair, junior |
| HCPCS L3215 | Orthopedic footwear, ladies shoe, oxford, each |
| HCPCS L3216 | Orthopedic footwear, ladies shoe, depth inlay, each |
| HCPCS L3217 | Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
| HCPCS L3219 | Orthopedic footwear, mens shoe, oxford, each |
| HCPCS L3221 | Orthopedic footwear, mens shoe, depth inlay, each |
| HCPCS L3222 | Orthopedic footwear, mens shoe, hightop, depth inlay, each |
| HCPCS L3224 | Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
| HCPCS L3225 | Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
| HCPCS L3230 | Orthopedic footwear, custom shoe, depth inlay, each |
| HCPCS L3250 | Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each |
| HCPCS L3251 | Foot, shoe molded to patient model, silicone shoe, each |
| HCPCS L3252 | Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each |
| HCPCS L3253 | Foot, molded shoe plastazote (or similar) custom fitted, each |
| HCPCS L3254 | Non-standard size or width |
| HCPCS L3255 | Non-standard size or length |
| HCPCS L3257 | Orthopedic footwear, additional charge for split size |
| HCPCS L3260 | Surgical boot/shoe, each |
| HCPCS L3265 | Plastazote sandal, each |
| HCPCS L3300 | Lift, elevation, heel, tapered to metatarsals, per inch |
| HCPCS L3310 | Lift, elevation, heel and sole, neoprene, per inch |
| HCPCS L3320 | Lift, elevation, heel and sole, cork, per inch |
| HCPCS L3330 | Lift, elevation, metal extension (skate) |
| HCPCS L3332 | Lift, elevation, inside shoe, tapered, up to one-half inch |
| HCPCS L3334 | Lift, elevation, heel, per inch |
| HCPCS L3340 | Heel wedge, sach |
| HCPCS L3350 | Heel wedge |
| HCPCS L3360 | Sole wedge, outside sole |
| HCPCS L3370 | Sole wedge, between sole |
| HCPCS L3380 | Clubfoot wedge |
| HCPCS L3390 | Outflare wedge |
| HCPCS L3400 | Metatarsal bar wedge, rocker |
| HCPCS L3410 | Metatarsal bar wedge, between sole |
| HCPCS L3420 | Full sole and heel wedge, between sole |
| HCPCS L3430 | Heel, counter, plastic reinforced |
| HCPCS L3440 | Heel, counter, leather reinforced |
| HCPCS L3450 | Heel, sach cushion type |
| HCPCS L3455 | Heel, new leather, standard |
| HCPCS L3460 | Heel, new rubber, standard |
| HCPCS L3465 | Heel, thomas with wedge |
| HCPCS L3470 | Heel, thomas extended to ball |
| HCPCS L3480 | Heel, pad and depression for spur |
| HCPCS L3485 | Heel, pad, removable for spur |
| HCPCS L3500 | Orthopedic shoe addition, insole, leather |
| HCPCS L3510 | Orthopedic shoe addition, insole, rubber |
| HCPCS L3520 | Orthopedic shoe addition, insole, felt covered with leather |
| HCPCS L3530 | Orthopedic shoe addition, sole, half |
| HCPCS L3540 | Orthopedic shoe addition, sole, full |
| HCPCS L3550 | Orthopedic shoe addition, toe tap standard |
| HCPCS L3560 | Orthopedic shoe addition, toe tap, horseshoe |
| HCPCS L3570 | Orthopedic shoe addition, special extension to instep (leather with eyelets) |
| HCPCS L3580 | Orthopedic shoe addition, convert instep to velcro closure |
| HCPCS L3590 | Orthopedic shoe addition, convert firm shoe counter to soft counter |
| HCPCS L3595 | Orthopedic shoe addition, march bar |
| HCPCS L3600 | Transfer of an orthosis from one shoe to another, caliper plate, existing |
| HCPCS L3610 | Transfer of an orthosis from one shoe to another, caliper plate, new |
| HCPCS L3620 | Transfer of an orthosis from one shoe to another, solid stirrup, existing |
| HCPCS L3630 | Transfer of an orthosis from one shoe to another, solid stirrup, new |
| HCPCS L3640 | Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes |
| HCPCS L3649 | Orthopedic shoe, modification, addition or transfer, not otherwise specified |
| HCPCS L3650 | Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
| HCPCS L3651 | SHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) |
| HCPCS L3652 | SHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) |
| HCPCS L3660 | Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
| HCPCS L3670 | Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
| HCPCS L3671 | Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3672 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may inlcude soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3673 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, includes nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3674 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3675 | Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf |
| HCPCS L3677 | Shoulder orthosis, shoulder joint design, 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 |
| HCPCS L3700 | ELBOW ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3701 | ELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) |
| HCPCS L3702 | Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3710 | Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf |
| HCPCS L3720 | Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated |
| HCPCS L3730 | Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated |
| HCPCS L3740 | Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated |
| HCPCS L3760 | Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L3762 | Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf |
| HCPCS L3763 | Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3764 | Elbow wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3765 | Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3766 | Elbow wrist hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3800 | WRIST HAND FINGER ORTHOSIS, SHORT OPPONENS, NO ATTACHMENTS, CUSTOM-FABRICATED |
| HCPCS L3805 | WRIST HAND FINGER ORTHOSIS, LONG OPPONENS, NO ATTACHMENT, CUSTOM-FABRICATED |
| HCPCS L3806 | Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3807 | 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 |
| HCPCS L3808 | Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3810 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ('C') BAR |
| HCPCS L3815 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION ASSIST |
| HCPCS L3820 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, I.P. EXTENSION ASSIST, WITH M.P. EXTENSION STOP |
| HCPCS L3825 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP |
| HCPCS L3830 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST |
| HCPCS L3835 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION ASSIST |
| HCPCS L3840 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB |
| HCPCS L3845 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASSIST, WITH M.P. STOP |
| HCPCS L3850 | WHO, ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION ASSIST |
| HCPCS L3855 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL |
| HCPCS L3860 | WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL AND I.P. |
| HCPCS L3890 | ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM, EACH |
| HCPCS L3891 | Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each |
| HCPCS L3900 | Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated |
| HCPCS L3901 | Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated |
| HCPCS L3902 | WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, COMPRESSED GAS, CUSTOM-FABRICATED |
| HCPCS L3904 | Wrist hand finger orthosis, external powered, electric, custom fabricated |
| HCPCS L3905 | Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3906 | Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3907 | WRIST HAND FINGER ORTHOSIS, WRIST GAUNTLET WITH THUMB SPICA, CUSTOM-FABRICATED |
| HCPCS L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
| HCPCS L3909 | WRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) |
| HCPCS L3910 | WRIST HAND FINGER ORTHOSIS, SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3911 | WRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA) |
| HCPCS L3912 | Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf |
| HCPCS L3913 | Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3914 | WRIST HAND ORTHOSIS, WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES FITTING/ADJUSTMENT |
| HCPCS L3915 | 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 |
| HCPCS L3916 | Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
| HCPCS L3917 | 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 |
| HCPCS L3918 | Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf |
| HCPCS L3919 | Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3920 | HAND FINGER ORTHOSIS, KNUCKLE BENDER WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3921 | Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3922 | HAND FINGER ORTHOSIS, KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3923 | 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 |
| HCPCS L3924 | Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf |
| HCPCS L3925 | Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf |
| HCPCS L3926 | WRIST HAND FINGER ORTHOSIS, THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3927 | Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf |
| HCPCS L3928 | HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3929 | Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, 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 |
| HCPCS L3930 | Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf |
| HCPCS L3931 | Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment |
| HCPCS L3932 | FINGER ORTHOSIS, SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3933 | Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment |
| HCPCS L3934 | FINGER ORTHOSIS, SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3935 | Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment |
| HCPCS L3936 | WRIST HAND FINGER ORTHOSIS, PALMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3938 | WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3940 | WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, WITH OUTRIGGER ATTACHMENT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3942 | HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3944 | HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3946 | HAND FINGER ORTHOSIS, COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3948 | FINGER ORTHOSIS, FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3950 | WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3952 | WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3954 | HAND FINGER ORTHOSIS, SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| HCPCS L3956 | Addition of joint to upper extremity orthosis, any material; per joint |
| HCPCS L3960 | Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
| HCPCS L3961 | Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3962 | Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment |
| HCPCS L3963 | SHOULDER ELBOW WRIST HAND ORTHOSIS, MOLDED SHOULDER, ARM, FOREARM AND WRIST, WITH ARTICULATING ELBOW JOINT, CUSTOM-FABRICATED |
| HCPCS L3964 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, adjustable, prefabricated, includes fitting and adjustment |
| HCPCS L3965 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, adjustable rancho type, prefabricated, includes fitting and adjustment |
| HCPCS L3966 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, reclining, prefabricated, includes fitting and adjustment |
| HCPCS L3967 | Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3968 | Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints), prefabricated, includes fitting and adjustment |
| HCPCS L3969 | Shoulder elbow orthosis, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support, prefabricated, includes fitting and adjustment |
| HCPCS L3970 | Seo, addition to mobile arm support, elevating proximal arm |
| HCPCS L3971 | Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3972 | Seo, addition to mobile arm support, offset or lateral rocker arm with elastic balance control |
| HCPCS L3973 | Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3974 | Seo, addition to mobile arm support, supinator |
| HCPCS L3975 | Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3976 | Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3977 | Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3978 | Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| HCPCS L3980 | Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment |
| HCPCS L3982 | Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment |
| HCPCS L3984 | Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
| HCPCS L3985 | UPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE, CUSTOM-FABRICATED |
| HCPCS L3986 | UPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST, (EXAMPLE--COLLES' FRACTURE), CUSTOM FABRICATED |
| HCPCS L3995 | Addition to upper extremity orthosis, sock, fracture or equal, each |
| HCPCS L3999 | Upper limb orthosis, not otherwise specified |
| HCPCS L4000 | Replace girdle for spinal orthosis (ctlso or so) |
| HCPCS L4002 | Replacement strap, any orthosis, includes all components, any length, any type |
| HCPCS L4010 | Replace trilateral socket brim |
| HCPCS L4020 | Replace quadrilateral socket brim, molded to patient model |
| HCPCS L4030 | Replace quadrilateral socket brim, custom fitted |
| HCPCS L4040 | Replace molded thigh lacer, for custom fabricated orthosis only |
| HCPCS L4045 | Replace non-molded thigh lacer, for custom fabricated orthosis only |
| HCPCS L4050 | Replace molded calf lacer, for custom fabricated orthosis only |
| HCPCS L4055 | Replace non-molded calf lacer, for custom fabricated orthosis only |
| HCPCS L4060 | Replace high roll cuff |
| HCPCS L4070 | Replace proximal and distal upright for kafo |
| HCPCS L4080 | Replace metal bands kafo, proximal thigh |
| HCPCS L4090 | Replace metal bands kafo-afo, calf or distal thigh |
| HCPCS L4100 | Replace leather cuff kafo, proximal thigh |
| HCPCS L4110 | Replace leather cuff kafo-afo, calf or distal thigh |
| HCPCS L4130 | Replace pretibial shell |
| HCPCS L4205 | Repair of orthotic device, labor component, per 15 minutes |
| HCPCS L4210 | Repair of orthotic device, repair or replace minor parts |
| HCPCS L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
| HCPCS L4360 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L4370 | Pneumatic full leg splint, prefabricated, off-the-shelf |
| HCPCS L4380 | Pneumatic knee splint, prefabricated, includes fitting and adjustment |
| HCPCS L4386 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L4392 | Replacement, soft interface material, static afo |
| HCPCS L4394 | Replace soft interface material, foot drop splint |
| HCPCS L4396 | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| HCPCS L4398 | Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf |
| HCPCS L4631 | Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated |
| HCPCS L5000 | Partial foot, shoe insert with longitudinal arch, toe filler |
| HCPCS L5010 | Partial foot, molded socket, ankle height, with toe filler |
| HCPCS L5020 | Partial foot, molded socket, tibial tubercle height, with toe filler |
| HCPCS L5050 | Ankle, symes, molded socket, sach foot |
| HCPCS L5060 | Ankle, symes, metal frame, molded leather socket, articulated ankle/foot |
| HCPCS L5100 | Below knee, molded socket, shin, sach foot |
| HCPCS L5105 | Below knee, plastic socket, joints and thigh lacer, sach foot |
| HCPCS L5150 | Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot |
| HCPCS L5160 | Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot |
| HCPCS L5200 | Above knee, molded socket, single axis constant friction knee, shin, sach foot |
| HCPCS L5210 | Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each |
| HCPCS L5220 | Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each |
| HCPCS L5230 | Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot |
| HCPCS L5250 | Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot |
| HCPCS L5270 | Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot |
| HCPCS L5280 | Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot |
| HCPCS L5301 | Below knee, molded socket, shin, sach foot, endoskeletal system |
| HCPCS L5311 | Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot, endoskeletal system |
| HCPCS L5312 | Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system |
| HCPCS L5321 | Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee |
| HCPCS L5331 | Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot |
| HCPCS L5341 | Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot |
| HCPCS L5400 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee |
| HCPCS L5410 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment |
| HCPCS L5420 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation |
| HCPCS L5430 | Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment |
| HCPCS L5450 | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee |
| HCPCS L5460 | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee |
| HCPCS L5500 | Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed |
| HCPCS L5505 | Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed |
| HCPCS L5510 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model |
| HCPCS L5520 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed |
| HCPCS L5530 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model |
| HCPCS L5535 | Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket |
| HCPCS L5540 | Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model |
| HCPCS L5560 | Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model |
| HCPCS L5570 | Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed |
| HCPCS L5580 | Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model |
| HCPCS L5585 | Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket |
| HCPCS L5590 | Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model |
| HCPCS L5595 | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model |
| HCPCS L5600 | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model |
| HCPCS L5610 | Addition to lower extremity, endoskeletal system, above knee, hydracadence system |
| HCPCS L5611 | Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control |
| HCPCS L5613 | Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control |
| HCPCS L5614 | Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control |
| HCPCS L5616 | Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control |
| HCPCS L5617 | Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each |
| HCPCS L5618 | Addition to lower extremity, test socket, symes |
| HCPCS L5620 | Addition to lower extremity, test socket, below knee |
| HCPCS L5622 | Addition to lower extremity, test socket, knee disarticulation |
| HCPCS L5624 | Addition to lower extremity, test socket, above knee |
| HCPCS L5626 | Addition to lower extremity, test socket, hip disarticulation |
| HCPCS L5628 | Addition to lower extremity, test socket, hemipelvectomy |
| HCPCS L5629 | Addition to lower extremity, below knee, acrylic socket |
| HCPCS L5630 | Addition to lower extremity, symes type, expandable wall socket |
| HCPCS L5631 | Addition to lower extremity, above knee or knee disarticulation, acrylic socket |
| HCPCS L5632 | Addition to lower extremity, symes type, 'ptb' brim design socket |
| HCPCS L5634 | Addition to lower extremity, symes type, posterior opening (canadian) socket |
| HCPCS L5636 | Addition to lower extremity, symes type, medial opening socket |
| HCPCS L5637 | Addition to lower extremity, below knee, total contact |
| HCPCS L5638 | Addition to lower extremity, below knee, leather socket |
| HCPCS L5639 | Addition to lower extremity, below knee, wood socket |
| HCPCS L5640 | Addition to lower extremity, knee disarticulation, leather socket |
| HCPCS L5642 | Addition to lower extremity, above knee, leather socket |
| HCPCS L5643 | Addition to lower extremity, hip disarticulation, flexible inner socket, external frame |
| HCPCS L5644 | Addition to lower extremity, above knee, wood socket |
| HCPCS L5645 | Addition to lower extremity, below knee, flexible inner socket, external frame |
| HCPCS L5646 | Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket |
| HCPCS L5647 | Addition to lower extremity, below knee suction socket |
| HCPCS L5648 | Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket |
| HCPCS L5649 | Addition to lower extremity, ischial containment/narrow m-l socket |
| HCPCS L5650 | Additions to lower extremity, total contact, above knee or knee disarticulation socket |
| HCPCS L5651 | Addition to lower extremity, above knee, flexible inner socket, external frame |
| HCPCS L5652 | Addition to lower extremity, suction suspension, above knee or knee disarticulation socket |
| HCPCS L5653 | Addition to lower extremity, knee disarticulation, expandable wall socket |
| HCPCS L5654 | Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal) |
| HCPCS L5655 | Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) |
| HCPCS L5656 | Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal) |
| HCPCS L5658 | Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal) |
| HCPCS L5661 | Addition to lower extremity, socket insert, multi-durometer symes |
| HCPCS L5665 | Addition to lower extremity, socket insert, multi-durometer, below knee |
| HCPCS L5666 | Addition to lower extremity, below knee, cuff suspension |
| HCPCS L5668 | Addition to lower extremity, below knee, molded distal cushion |
| HCPCS L5670 | Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar) |
| HCPCS L5671 | Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
| HCPCS L5672 | Addition to lower extremity, below knee, removable medial brim suspension |
| HCPCS L5673 | Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism |
| HCPCS L5674 | ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL, EACH |
| HCPCS L5675 | ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY MATERIAL, EACH |
| HCPCS L5676 | Additions to lower extremity, below knee, knee joints, single axis, pair |
| HCPCS L5677 | Additions to lower extremity, below knee, knee joints, polycentric, pair |
| HCPCS L5678 | Additions to lower extremity, below knee, joint covers, pair |
| HCPCS L5679 | Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism |
| HCPCS L5680 | Addition to lower extremity, below knee, thigh lacer, nonmolded |
| HCPCS L5681 | Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) |
| HCPCS L5682 | Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded |
| HCPCS L5683 | Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679) |
| HCPCS L5684 | Addition to lower extremity, below knee, fork strap |
| HCPCS L5685 | Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
| HCPCS L5686 | Addition to lower extremity, below knee, back check (extension control) |
| HCPCS L5688 | Addition to lower extremity, below knee, waist belt, webbing |
| HCPCS L5690 | Addition to lower extremity, below knee, waist belt, padded and lined |
| HCPCS L5692 | Addition to lower extremity, above knee, pelvic control belt, light |
| HCPCS L5694 | Addition to lower extremity, above knee, pelvic control belt, padded and lined |
| HCPCS L5695 | Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each |
| HCPCS L5696 | Addition to lower extremity, above knee or knee disarticulation, pelvic joint |
| HCPCS L5697 | Addition to lower extremity, above knee or knee disarticulation, pelvic band |
| HCPCS L5698 | Addition to lower extremity, above knee or knee disarticulation, silesian bandage |
| HCPCS L5699 | All lower extremity prostheses, shoulder harness |
| HCPCS L5700 | Replacement, socket, below knee, molded to patient model |
| HCPCS L5701 | Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model |
| HCPCS L5702 | Replacement, socket, hip disarticulation, including hip joint, molded to patient model |
| HCPCS L5703 | Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only |
| HCPCS L5704 | Custom shaped protective cover, below knee |
| HCPCS L5705 | Custom shaped protective cover, above knee |
| HCPCS L5706 | Custom shaped protective cover, knee disarticulation |
| HCPCS L5707 | Custom shaped protective cover, hip disarticulation |
| HCPCS L5710 | Addition, exoskeletal knee-shin system, single axis, manual lock |
| HCPCS L5711 | Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material |
| HCPCS L5712 | Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) |
| HCPCS L5714 | Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control |
| HCPCS L5716 | Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| HCPCS L5718 | Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control |
| HCPCS L5722 | Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control |
| HCPCS L5724 | Addition, exoskeletal knee-shin system, single axis, fluid swing phase control |
| HCPCS L5726 | Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control |
| HCPCS L5728 | Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| HCPCS L5780 | Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control |
| HCPCS L5781 | Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system |
| HCPCS L5782 | Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty |
| HCPCS L5785 | Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| HCPCS L5790 | Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
| HCPCS L5795 | Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) |
| HCPCS L5810 | Addition, endoskeletal knee-shin system, single axis, manual lock |
| HCPCS L5811 | Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material |
| HCPCS L5812 | Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee) |
| HCPCS L5814 | Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock |
| HCPCS L5816 | Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| HCPCS L5818 | Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control |
| HCPCS L5822 | Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control |
| HCPCS L5824 | Addition, endoskeletal knee-shin system, single axis, fluid swing phase control |
| HCPCS L5826 | Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame |
| HCPCS L5828 | Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| HCPCS L5830 | Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control |
| HCPCS L5840 | Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control |
| HCPCS L5845 | Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable |
| HCPCS L5846 | ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY |
| HCPCS L5847 | ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE |
| HCPCS L5848 | Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability |
| HCPCS L5850 | Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist |
| HCPCS L5855 | Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist |
| HCPCS L5856 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type |
| HCPCS L5857 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type |
| HCPCS L5858 | Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type |
| HCPCS L5859 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s) |
| HCPCS L5910 | Addition, endoskeletal system, below knee, alignable system |
| HCPCS L5920 | Addition, endoskeletal system, above knee or hip disarticulation, alignable system |
| HCPCS L5925 | Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock |
| HCPCS L5930 | Addition, endoskeletal system, high activity knee control frame |
| HCPCS L5940 | Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| HCPCS L5950 | Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
| HCPCS L5960 | Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal) |
| HCPCS L5961 | Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control |
| HCPCS L5962 | Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
| HCPCS L5964 | Addition, endoskeletal system, above knee, flexible protective outer surface covering system |
| HCPCS L5966 | Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system |
| HCPCS L5968 | Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature |
| HCPCS L5970 | All lower extremity prostheses, foot, external keel, sach foot |
| HCPCS L5971 | All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only |
| HCPCS L5972 | All lower extremity prostheses, foot, flexible keel |
| HCPCS L5973 | Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source |
| HCPCS L5974 | All lower extremity prostheses, foot, single axis ankle/foot |
| HCPCS L5975 | All lower extremity prosthesis, combination single axis ankle and flexible keel foot |
| HCPCS L5976 | All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) |
| HCPCS L5978 | All lower extremity prostheses, foot, multiaxial ankle/foot |
| HCPCS L5979 | All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system |
| HCPCS L5980 | All lower extremity prostheses, flex foot system |
| HCPCS L5981 | All lower extremity prostheses, flex-walk system or equal |
| HCPCS L5982 | All exoskeletal lower extremity prostheses, axial rotation unit |
| HCPCS L5984 | All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability |
| HCPCS L5985 | All endoskeletal lower extremity prostheses, dynamic prosthetic pylon |
| HCPCS L5986 | All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) |
| HCPCS L5987 | All lower extremity prosthesis, shank foot system with vertical loading pylon |
| HCPCS L5988 | Addition to lower limb prosthesis, vertical shock reducing pylon feature |
| HCPCS L5989 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH INTEGRATED ELECTRONIC FORCE SENSORS |
| HCPCS L5990 | Addition to lower extremity prosthesis, user adjustable heel height |
| HCPCS L5993 | ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, FOOT ONLY, (FOR PATIENT WEIGHT GREATER THAN 300 LBS) |
| HCPCS L5994 | ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, KNEE ONLY, (FOR PATIENT WEIGHT GREATER THAN 300 LBS) |
| HCPCS L5995 | ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, OTHER THAN FOOT OR KNEE, (FOR PATIENT WEIGHT GREATER THAN 300 LBS) |
| HCPCS L5999 | Lower extremity prosthesis, not otherwise specified |
| HCPCS L6000 | Partial hand, thumb remaining |
| HCPCS L6010 | Partial hand, little and/or ring finger remaining |
| HCPCS L6020 | Partial hand, no finger remaining |
| HCPCS L6025 | Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device |
| HCPCS L6050 | Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad |
| HCPCS L6055 | Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad |
| HCPCS L6100 | Below elbow, molded socket, flexible elbow hinge, triceps pad |
| HCPCS L6110 | Below elbow, molded socket, (muenster or northwestern suspension types) |
| HCPCS L6120 | Below elbow, molded double wall split socket, step-up hinges, half cuff |
| HCPCS L6130 | Below elbow, molded double wall split socket, stump activated locking hinge, half cuff |
| HCPCS L6200 | Elbow disarticulation, molded socket, outside locking hinge, forearm |
| HCPCS L6205 | Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm |
| HCPCS L6250 | Above elbow, molded double wall socket, internal locking elbow, forearm |
| HCPCS L6300 | Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm |
| HCPCS L6310 | Shoulder disarticulation, passive restoration (complete prosthesis) |
| HCPCS L6320 | Shoulder disarticulation, passive restoration (shoulder cap only) |
| HCPCS L6350 | Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm |
| HCPCS L6360 | Interscapular thoracic, passive restoration (complete prosthesis) |
| HCPCS L6370 | Interscapular thoracic, passive restoration (shoulder cap only) |
| HCPCS L6380 | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow |
| HCPCS L6382 | Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow |
| HCPCS L6384 | Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic |
| HCPCS L6386 | Immediate post surgical or early fitting, each additional cast change and realignment |
| HCPCS L6388 | Immediate post surgical or early fitting, application of rigid dressing only |
| HCPCS L6400 | Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| HCPCS L6450 | Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| HCPCS L6500 | Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| HCPCS L6550 | Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| HCPCS L6570 | Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping |
| HCPCS L6580 | Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model |
| HCPCS L6582 | Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed |
| HCPCS L6584 | Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model |
| HCPCS L6586 | Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed |
| HCPCS L6588 | Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model |
| HCPCS L6590 | Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed |
| HCPCS L6600 | Upper extremity additions, polycentric hinge, pair |
| HCPCS L6605 | Upper extremity additions, single pivot hinge, pair |
| HCPCS L6610 | Upper extremity additions, flexible metal hinge, pair |
| HCPCS L6611 | Addition to upper extremity prosthesis, external powered, additional switch, any type |
| HCPCS L6615 | Upper extremity addition, disconnect locking wrist unit |
| HCPCS L6616 | Upper extremity addition, additional disconnect insert for locking wrist unit, each |
| HCPCS L6620 | Upper extremity addition, flexion/extension wrist unit, with or without friction |
| HCPCS L6621 | Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device |
| HCPCS L6623 | Upper extremity addition, spring assisted rotational wrist unit with latch release |
| HCPCS L6624 | Upper extremity addition, flexion/extension and rotation wrist unit |
| HCPCS L6625 | Upper extremity addition, rotation wrist unit with cable lock |
| HCPCS L6628 | Upper extremity addition, quick disconnect hook adapter, otto bock or equal |
| HCPCS L6629 | Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal |
| HCPCS L6630 | Upper extremity addition, stainless steel, any wrist |
| HCPCS L6632 | Upper extremity addition, latex suspension sleeve, each |
| HCPCS L6635 | Upper extremity addition, lift assist for elbow |
| HCPCS L6637 | Upper extremity addition, nudge control elbow lock |
| HCPCS L6638 | Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow |
| HCPCS L6639 | UPPER EXTREMITY ADDITION, HEAVY DUTY FEATURE, ANY ELBOW |
| HCPCS L6640 | Upper extremity additions, shoulder abduction joint, pair |
| HCPCS L6641 | Upper extremity addition, excursion amplifier, pulley type |
| HCPCS L6642 | Upper extremity addition, excursion amplifier, lever type |
| HCPCS L6645 | Upper extremity addition, shoulder flexion-abduction joint, each |
| HCPCS L6646 | Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system |
| HCPCS L6647 | Upper extremity addition, shoulder lock mechanism, body powered actuator |
| HCPCS L6648 | Upper extremity addition, shoulder lock mechanism, external powered actuator |
| HCPCS L6650 | Upper extremity addition, shoulder universal joint, each |
| HCPCS L6655 | Upper extremity addition, standard control cable, extra |
| HCPCS L6660 | Upper extremity addition, heavy duty control cable |
| HCPCS L6665 | Upper extremity addition, teflon, or equal, cable lining |
| HCPCS L6670 | Upper extremity addition, hook to hand, cable adapter |
| HCPCS L6672 | Upper extremity addition, harness, chest or shoulder, saddle type |
| HCPCS L6675 | Upper extremity addition, harness, (e.g., figure of eight type), single cable design |
| HCPCS L6676 | Upper extremity addition, harness, (e.g., figure of eight type), dual cable design |
| HCPCS L6677 | Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow |
| HCPCS L6680 | Upper extremity addition, test socket, wrist disarticulation or below elbow |
| HCPCS L6682 | Upper extremity addition, test socket, elbow disarticulation or above elbow |
| HCPCS L6684 | Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic |
| HCPCS L6686 | Upper extremity addition, suction socket |
| HCPCS L6687 | Upper extremity addition, frame type socket, below elbow or wrist disarticulation |
| HCPCS L6688 | Upper extremity addition, frame type socket, above elbow or elbow disarticulation |
| HCPCS L6689 | Upper extremity addition, frame type socket, shoulder disarticulation |
| HCPCS L6690 | Upper extremity addition, frame type socket, interscapular-thoracic |
| HCPCS L6691 | Upper extremity addition, removable insert, each |
| HCPCS L6692 | Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each |
| HCPCS L6693 | Upper extremity addition, locking elbow, forearm counterbalance |
| HCPCS L6694 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism |
| HCPCS L6695 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism |
| HCPCS L6696 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) |
| HCPCS L6697 | Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695) |
| HCPCS L6698 | Addition to upper extremity prosthesis, lock mechanism, excludes socket insert |
| HCPCS L6700 | Upper extremity addition, external powered feature, myoelectronic control module, additional emg inputs, pattern-recognition decoding intent movement |
| HCPCS L6703 | Terminal device, passive hand/mitt, any material, any size |
| HCPCS L6704 | Terminal device, sport/recreational/work attachment, any material, any size |
| HCPCS L6705 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5 |
| HCPCS L6706 | Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined |
| HCPCS L6707 | Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined |
| HCPCS L6708 | Terminal device, hand, mechanical, voluntary opening, any material, any size |
| HCPCS L6709 | Terminal device, hand, mechanical, voluntary closing, any material, any size |
| HCPCS L6710 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5X |
| HCPCS L6711 | Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric |
| HCPCS L6712 | Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric |
| HCPCS L6713 | Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric |
| HCPCS L6714 | Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric |
| HCPCS L6715 | Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement |
| HCPCS L6720 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #6 |
| HCPCS L6721 | Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined |
| HCPCS L6722 | Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined |
| HCPCS L6725 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7 |
| HCPCS L6730 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7LO |
| HCPCS L6735 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8 |
| HCPCS L6740 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8X |
| HCPCS L6745 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #88X |
| HCPCS L6750 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10P |
| HCPCS L6755 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10X |
| HCPCS L6765 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #12P |
| HCPCS L6770 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #99X |
| HCPCS L6775 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #555 |
| HCPCS L6780 | TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #SS555 |
| HCPCS L6790 | TERMINAL DEVICE, HOOK-ACCU HOOK, OR EQUAL |
| HCPCS L6795 | TERMINAL DEVICE, HOOK-2 LOAD, OR EQUAL |
| HCPCS L6800 | TERMINAL DEVICE, HOOK-APRL VC, OR EQUAL |
| HCPCS L6805 | Addition to terminal device, modifier wrist unit |
| HCPCS L6806 | TERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL |
| HCPCS L6807 | TERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL |
| HCPCS L6808 | TERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL |
| HCPCS L6809 | TERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE |
| HCPCS L6810 | Addition to terminal device, precision pinch device |
| HCPCS L6825 | TERMINAL DEVICE, HAND, DORRANCE, VO |
| HCPCS L6830 | TERMINAL DEVICE, HAND, APRL, VC |
| HCPCS L6835 | TERMINAL DEVICE, HAND, SIERRA, VO |
| HCPCS L6840 | TERMINAL DEVICE, HAND, BECKER IMPERIAL |
| HCPCS L6845 | TERMINAL DEVICE, HAND, BECKER LOCK GRIP |
| HCPCS L6850 | TERMINAL DEVICE, HAND, BECKER PLYLITE |
| HCPCS L6855 | TERMINAL DEVICE, HAND, ROBIN-AIDS, VO |
| HCPCS L6860 | TERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT |
| HCPCS L6865 | TERMINAL DEVICE, HAND, PASSIVE HAND |
| HCPCS L6867 | TERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL) |
| HCPCS L6868 | TERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL) |
| HCPCS L6870 | TERMINAL DEVICE, HAND, CHILD MITT |
| HCPCS L6872 | TERMINAL DEVICE, HAND, NYU CHILD HAND |
| HCPCS L6873 | TERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL |
| HCPCS L6875 | TERMINAL DEVICE, HAND, BOCK, VC |
| HCPCS L6880 | Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s) |
| HCPCS L6881 | Automatic grasp feature, addition to upper limb electric prosthetic terminal device |
| HCPCS L6882 | Microprocessor control feature, addition to upper limb prosthetic terminal device |
| HCPCS L6883 | Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power |
| HCPCS L6884 | Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power |
| HCPCS L6885 | Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power |
| HCPCS L6890 | Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment |
| HCPCS L6895 | Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated |
| HCPCS L6900 | Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining |
| HCPCS L6905 | Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining |
| HCPCS L6910 | Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining |
| HCPCS L6915 | Hand restoration (shading, and measurements included), replacement glove for above |
| HCPCS L6920 | Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device |
| HCPCS L6925 | Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| HCPCS L6930 | Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| HCPCS L6935 | Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| HCPCS L6940 | Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| HCPCS L6945 | Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| HCPCS L6950 | Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| HCPCS L6955 | Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| HCPCS L6960 | Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| HCPCS L6965 | Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| HCPCS L6970 | Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| HCPCS L6975 | Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| HCPCS L7007 | Electric hand, switch or myoelectric controlled, adult |
| HCPCS L7008 | Electric hand, switch or myoelectric, controlled, pediatric |
| HCPCS L7009 | Electric hook, switch or myoelectric controlled, adult |
| HCPCS L7010 | ELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED |
| HCPCS L7015 | ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED |
| HCPCS L7020 | ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED |
| HCPCS L7025 | ELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED |
| HCPCS L7030 | ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED |
| HCPCS L7035 | ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED |
| HCPCS L7040 | Prehensile actuator, switch controlled |
| HCPCS L7045 | Electric hook, switch or myoelectric controlled, pediatric |
| HCPCS L7170 | Electronic elbow, hosmer or equal, switch controlled |
| HCPCS L7180 | Electronic elbow, microprocessor sequential control of elbow and terminal device |
| HCPCS L7181 | Electronic elbow, microprocessor simultaneous control of elbow and terminal device |
| HCPCS L7185 | Electronic elbow, adolescent, variety village or equal, switch controlled |
| HCPCS L7186 | Electronic elbow, child, variety village or equal, switch controlled |
| HCPCS L7190 | Electronic elbow, adolescent, variety village or equal, myoelectronically controlled |
| HCPCS L7191 | Electronic elbow, child, variety village or equal, myoelectronically controlled |
| HCPCS L7260 | Electronic wrist rotator, otto bock or equal |
| HCPCS L7261 | Electronic wrist rotator, for utah arm |
| HCPCS L7266 | Servo control, steeper or equal |
| HCPCS L7272 | Analogue control, unb or equal |
| HCPCS L7274 | Proportional control, 6-12 volt, liberty, utah or equal |
| HCPCS L7360 | Six volt battery, each |
| HCPCS L7362 | Battery charger, six volt, each |
| HCPCS L7364 | Twelve volt battery, each |
| HCPCS L7366 | Battery charger, twelve volt, each |
| HCPCS L7367 | Lithium ion battery, rechargeable, replacement |
| HCPCS L7368 | Lithium ion battery charger, replacement only |
| HCPCS L7400 | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) |
| HCPCS L7401 | Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) |
| HCPCS L7402 | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) |
| HCPCS L7403 | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material |
| HCPCS L7404 | Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material |
| HCPCS L7405 | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material |
| HCPCS L7499 | Upper extremity prosthesis, not otherwise specified |
| HCPCS L7500 | Repair of prosthetic device, hourly rate (excludes v5335 repair of oral or laryngeal prosthesis or artificial larynx) |
| HCPCS L7510 | Repair of prosthetic device, repair or replace minor parts |
| HCPCS L7520 | Repair prosthetic device, labor component, per 15 minutes |
| HCPCS L7600 | Prosthetic donning sleeve, any material, each |
| HCPCS L7611 | TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC |
| HCPCS L7612 | TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC |
| HCPCS L7613 | TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PEDIATRIC |
| HCPCS L7614 | TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PEDIATRIC |
| HCPCS L7621 | TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED |
| HCPCS L7622 | TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED |
| HCPCS L7900 | Male vacuum erection system |
| HCPCS L7902 | Tension ring, for vacuum erection device, any type, replacement only, each |
| HCPCS L8000 | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
| HCPCS L8001 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type |
| HCPCS L8002 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type |
| HCPCS L8010 | Breast prosthesis, mastectomy sleeve |
| HCPCS L8015 | External breast prosthesis garment, with mastectomy form, post mastectomy |
| HCPCS L8020 | Breast prosthesis, mastectomy form |
| HCPCS L8030 | Breast prosthesis, silicone or equal, without integral adhesive |
| HCPCS L8031 | Breast prosthesis, silicone or equal, with integral adhesive |
| HCPCS L8032 | Nipple prosthesis, prefabricated, reusable, any type, each |
| HCPCS L8035 | Custom breast prosthesis, post mastectomy, molded to patient model |
| HCPCS L8039 | Breast prosthesis, not otherwise specified |
| HCPCS L8040 | Nasal prosthesis, provided by a non-physician |
| HCPCS L8041 | Midfacial prosthesis, provided by a non-physician |
| HCPCS L8042 | Orbital prosthesis, provided by a non-physician |
| HCPCS L8043 | Upper facial prosthesis, provided by a non-physician |
| HCPCS L8044 | Hemi-facial prosthesis, provided by a non-physician |
| HCPCS L8045 | Auricular prosthesis, provided by a non-physician |
| HCPCS L8046 | Partial facial prosthesis, provided by a non-physician |
| HCPCS L8047 | Nasal septal prosthesis, provided by a non-physician |
| HCPCS L8048 | Unspecified maxillofacial prosthesis, by report, provided by a non-physician |
| HCPCS L8049 | Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician |
| HCPCS L8100 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH |
| HCPCS L8110 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH |
| HCPCS L8120 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH |
| HCPCS L8130 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH |
| HCPCS L8140 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH |
| HCPCS L8150 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH |
| HCPCS L8160 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH |
| HCPCS L8170 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH |
| HCPCS L8180 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH |
| HCPCS L8190 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH |
| HCPCS L8195 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH |
| HCPCS L8200 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH |
| HCPCS L8210 | GRADIENT COMPRESSION STOCKING, CUSTOM MADE |
| HCPCS L8220 | GRADIENT COMPRESSION STOCKING, LYMPHEDEMA |
| HCPCS L8230 | GRADIENT COMPRESSION STOCKING, GARTER BELT |
| HCPCS L8239 | GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED |
| HCPCS L8300 | Truss, single with standard pad |
| HCPCS L8310 | Truss, double with standard pads |
| HCPCS L8320 | Truss, addition to standard pad, water pad |
| HCPCS L8330 | Truss, addition to standard pad, scrotal pad |
| HCPCS L8400 | Prosthetic sheath, below knee, each |
| HCPCS L8410 | Prosthetic sheath, above knee, each |
| HCPCS L8415 | Prosthetic sheath, upper limb, each |
| HCPCS L8417 | Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each |
| HCPCS L8420 | Prosthetic sock, multiple ply, below knee, each |
| HCPCS L8430 | Prosthetic sock, multiple ply, above knee, each |
| HCPCS L8435 | Prosthetic sock, multiple ply, upper limb, each |
| HCPCS L8440 | Prosthetic shrinker, below knee, each |
| HCPCS L8460 | Prosthetic shrinker, above knee, each |
| HCPCS L8465 | Prosthetic shrinker, upper limb, each |
| HCPCS L8470 | Prosthetic sock, single ply, fitting, below knee, each |
| HCPCS L8480 | Prosthetic sock, single ply, fitting, above knee, each |
| HCPCS L8485 | Prosthetic sock, single ply, fitting, upper limb, each |
| HCPCS L8490 | ADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM |
| HCPCS L8499 | Unlisted procedure for miscellaneous prosthetic services |
| HCPCS L8500 | Artificial larynx, any type |
| HCPCS L8501 | Tracheostomy speaking valve |
| HCPCS L8505 | Artificial larynx replacement battery / accessory, any type |
| HCPCS L8507 | Tracheo-esophageal voice prosthesis, patient inserted, any type, each |
| HCPCS L8509 | Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type |
| HCPCS L8510 | Voice amplifier |
| HCPCS L8511 | Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each |
| HCPCS L8512 | Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 |
| HCPCS L8513 | Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each |
| HCPCS L8514 | Tracheoesophageal puncture dilator, replacement only, each |
| HCPCS L8515 | Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each |
| HCPCS L8600 | Implantable breast prosthesis, silicone or equal |
| HCPCS L8603 | Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies |
| HCPCS L8604 | Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies |
| HCPCS L8606 | Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies |
| HCPCS L8609 | Artificial cornea |
| HCPCS L8610 | Ocular implant |
| HCPCS L8612 | Aqueous shunt |
| HCPCS L8613 | Ossicula implant |
| HCPCS L8614 | Cochlear device, includes all internal and external components |
| HCPCS L8615 | Headset/headpiece for use with cochlear implant device, replacement |
| HCPCS L8616 | Microphone for use with cochlear implant device, replacement |
| HCPCS L8617 | Transmitting coil for use with cochlear implant device, replacement |
| HCPCS L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
| HCPCS L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement |
| HCPCS L8620 | LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH |
| HCPCS L8621 | Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each |
| HCPCS L8622 | Alkaline battery for use with cochlear implant device, any size, replacement, each |
| HCPCS L8623 | Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each |
| HCPCS L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
| HCPCS L8630 | Metacarpophalangeal joint implant |
| HCPCS L8631 | Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system) |
| HCPCS L8641 | Metatarsal joint implant |
| HCPCS L8642 | Hallux implant |
| HCPCS L8658 | Interphalangeal joint spacer, silicone or equal, each |
| HCPCS L8659 | Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size |
| HCPCS L8670 | Vascular graft material, synthetic, implant |
| HCPCS L8680 | Implantable neurostimulator electrode, each |
| HCPCS L8681 | Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only |
| HCPCS L8682 | Implantable neurostimulator radiofrequency receiver |
| HCPCS L8683 | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver |
| HCPCS L8684 | Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement |
| HCPCS L8685 | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension |
| HCPCS L8686 | Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension |
| HCPCS L8687 | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension |
| HCPCS L8688 | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension |
| HCPCS L8689 | External recharging system for battery (internal) for use with implantable neurostimulator, replacement only |
| HCPCS L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment |
| HCPCS L8693 | Auditory osseointegrated device abutment, any length, replacement only |
| HCPCS L8695 | External recharging system for battery (external) for use with implantable neurostimulator, replacement only |
| HCPCS L8699 | Prosthetic implant, not otherwise specified |
| HCPCS L9900 | Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code |
| HCPCS P9044 | Plasma, cryoprecipitate reduced, each unit |
| HCPCS Q0182 | DERMAL AND EPIDERMAL, TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER |
| HCPCS Q0183 | DERMAL TISSUE, OF HUMAN ORIGIN, WITH AND WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, BUT WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER |
| HCPCS Q0187 | FACTOR VIIA (COAGULATION FACTOR, RECOMBINANT) PER 1.2 MG |
| HCPCS Q0478 | Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type |
| HCPCS Q0479 | Power module for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0480 | Driver for use with pneumatic ventricular assist device, replacement only |
| HCPCS Q0481 | Microprocessor control unit for use with electric ventricular assist device, replacement only |
| HCPCS Q0482 | Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only |
| HCPCS Q0483 | Monitor/display module for use with electric ventricular assist device, replacement only |
| HCPCS Q0484 | Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0485 | Monitor control cable for use with electric ventricular assist device, replacement only |
| HCPCS Q0486 | Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0487 | Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0488 | Power pack base for use with electric ventricular assist device, replacement only |
| HCPCS Q0489 | Power pack base for use with electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0490 | Emergency power source for use with electric ventricular assist device, replacement only |
| HCPCS Q0491 | Emergency power source for use with electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0492 | Emergency power supply cable for use with electric ventricular assist device, replacement only |
| HCPCS Q0493 | Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0494 | Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0495 | Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0496 | Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0497 | Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0498 | Holster for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0499 | Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only |
| HCPCS Q0500 | Filters for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0501 | Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q0502 | Mobility cart for pneumatic ventricular assist device, replacement only |
| HCPCS Q0503 | Battery for pneumatic ventricular assist device, replacement only, each |
| HCPCS Q0504 | Power adapter for pneumatic ventricular assist device, replacement only, vehicle type |
| HCPCS Q0505 | Miscellaneous supply or accessory for use with ventricular assist device |
| HCPCS Q0506 | Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only |
| HCPCS Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml |
| HCPCS Q3000 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, RUBIDIUM RB-82, PER DOSE |
| HCPCS Q3001 | Radioelements for brachytherapy, any type, each |
| HCPCS Q3002 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, GALLIUM GA 67, PER MCI |
| HCPCS Q3003 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M BICISATE, PER UNIT DOSE |
| HCPCS Q3004 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, XENON XE 133, PER 10 MCI |
| HCPCS Q3005 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M MERTIATIDE, PER MCI |
| HCPCS Q3006 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M GLUCEPATATE, PER 5 MCI |
| HCPCS Q3007 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, SODIUM PHOSPHATE P32, PER MCI |
| HCPCS Q3008 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111-IN PENTETREOTIDE, PER 3 MCI |
| HCPCS Q3009 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M OXIDRONATE, PER MCI |
| HCPCS Q3010 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M - LABELED RED BLOOD CELLS, PER MCI |
| HCPCS Q3011 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CHROMIC PHOSPHATE P32 SUSPENSION, PER MCI |
| HCPCS Q3012 | SUPPLY OF ORAL RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN COBALT CO57, PER 0.5 MCI |
| HCPCS Q4001 | Casting supplies, body cast adult, with or without head, plaster |
| HCPCS Q4002 | Cast supplies, body cast adult, with or without head, fiberglass |
| HCPCS Q4003 | Cast supplies, shoulder cast, adult (11 years +), plaster |
| HCPCS Q4004 | Cast supplies, shoulder cast, adult (11 years +), fiberglass |
| HCPCS Q4005 | Cast supplies, long arm cast, adult (11 years +), plaster |
| HCPCS Q4006 | Cast supplies, long arm cast, adult (11 years +), fiberglass |
| HCPCS Q4007 | Cast supplies, long arm cast, pediatric (0-10 years), plaster |
| HCPCS Q4008 | Cast supplies, long arm cast, pediatric (0-10 years), fiberglass |
| HCPCS Q4009 | Cast supplies, short arm cast, adult (11 years +), plaster |
| HCPCS Q4010 | Cast supplies, short arm cast, adult (11 years +), fiberglass |
| HCPCS Q4011 | Cast supplies, short arm cast, pediatric (0-10 years), plaster |
| HCPCS Q4012 | Cast supplies, short arm cast, pediatric (0-10 years), fiberglass |
| HCPCS Q4013 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster |
| HCPCS Q4014 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass |
| HCPCS Q4015 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster |
| HCPCS Q4016 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass |
| HCPCS Q4017 | Cast supplies, long arm splint, adult (11 years +), plaster |
| HCPCS Q4018 | Cast supplies, long arm splint, adult (11 years +), fiberglass |
| HCPCS Q4019 | Cast supplies, long arm splint, pediatric (0-10 years), plaster |
| HCPCS Q4020 | Cast supplies, long arm splint, pediatric (0-10 years), fiberglass |
| HCPCS Q4021 | Cast supplies, short arm splint, adult (11 years +), plaster |
| HCPCS Q4022 | Cast supplies, short arm splint, adult (11 years +), fiberglass |
| HCPCS Q4023 | Cast supplies, short arm splint, pediatric (0-10 years), plaster |
| HCPCS Q4024 | Cast supplies, short arm splint, pediatric (0-10 years), fiberglass |
| HCPCS Q4025 | Cast supplies, hip spica (one or both legs), adult (11 years +), plaster |
| HCPCS Q4026 | Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass |
| HCPCS Q4027 | Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster |
| HCPCS Q4028 | Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass |
| HCPCS Q4029 | Cast supplies, long leg cast, adult (11 years +), plaster |
| HCPCS Q4030 | Cast supplies, long leg cast, adult (11 years +), fiberglass |
| HCPCS Q4031 | Cast supplies, long leg cast, pediatric (0-10 years), plaster |
| HCPCS Q4032 | Cast supplies, long leg cast, pediatric (0-10 years), fiberglass |
| HCPCS Q4033 | Cast supplies, long leg cylinder cast, adult (11 years +), plaster |
| HCPCS Q4034 | Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass |
| HCPCS Q4035 | Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster |
| HCPCS Q4036 | Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass |
| HCPCS Q4037 | Cast supplies, short leg cast, adult (11 years +), plaster |
| HCPCS Q4038 | Cast supplies, short leg cast, adult (11 years +), fiberglass |
| HCPCS Q4039 | Cast supplies, short leg cast, pediatric (0-10 years), plaster |
| HCPCS Q4040 | Cast supplies, short leg cast, pediatric (0-10 years), fiberglass |
| HCPCS Q4041 | Cast supplies, long leg splint, adult (11 years +), plaster |
| HCPCS Q4042 | Cast supplies, long leg splint, adult (11 years +), fiberglass |
| HCPCS Q4043 | Cast supplies, long leg splint, pediatric (0-10 years), plaster |
| HCPCS Q4044 | Cast supplies, long leg splint, pediatric (0-10 years), fiberglass |
| HCPCS Q4045 | Cast supplies, short leg splint, adult (11 years +), plaster |
| HCPCS Q4046 | Cast supplies, short leg splint, adult (11 years +), fiberglass |
| HCPCS Q4047 | Cast supplies, short leg splint, pediatric (0-10 years), plaster |
| HCPCS Q4048 | Cast supplies, short leg splint, pediatric (0-10 years), fiberglass |
| HCPCS Q4049 | Finger splint, static |
| HCPCS Q4050 | Cast supplies, for unlisted types and materials of casts |
| HCPCS Q4051 | Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) |
| HCPCS Q4080 | ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 20 MICROGRAMS |
| HCPCS Q4100 | Skin substitute, not otherwise specified |
| HCPCS Q4101 | Apligraf, per square centimeter |
| HCPCS Q4102 | Oasis wound matrix, per square centimeter |
| HCPCS Q4103 | Oasis burn matrix, per square centimeter |
| HCPCS Q4104 | Integra bilayer matrix wound dressing (bmwd), per square centimeter |
| HCPCS Q4105 | Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter |
| HCPCS Q4106 | Dermagraft, per square centimeter |
| HCPCS Q4107 | Graftjacket, per square centimeter |
| HCPCS Q4108 | Integra matrix, per square centimeter |
| HCPCS Q4109 | Skin substitute, tissuemend, per square centimeter |
| HCPCS Q4110 | Primatrix, per square centimeter |
| HCPCS Q4111 | Gammagraft, per square centimeter |
| HCPCS Q4112 | Cymetra, injectable, 1 cc |
| HCPCS Q4113 | Graftjacket xpress, injectable, 1 cc |
| HCPCS Q4114 | Integra flowable wound matrix, injectable, 1 cc |
| HCPCS Q4115 | Alloskin, per square centimeter |
| HCPCS Q4116 | Alloderm, per square centimeter |
| HCPCS Q4117 | Hyalomatrix, per square centimeter |
| HCPCS Q4118 | Matristem micromatrix, 1 mg |
| HCPCS Q4119 | Matristem wound matrix, per square centimeter |
| HCPCS Q4120 | Matristem burn matrix, per square centimeter |
| HCPCS Q4121 | Theraskin, per square centimeter |
| HCPCS Q4122 | Dermacell, dermacell awm or dermacell awm porous, per square centimeter |
| HCPCS Q4123 | Alloskin rt, per square centimeter |
| HCPCS Q4124 | Oasis ultra tri-layer wound matrix, per square centimeter |
| HCPCS Q4125 | Arthroflex, per square centimeter |
| HCPCS Q4126 | Memoderm, dermaspan, tranzgraft or integuply, per square centimeter |
| HCPCS Q4127 | Talymed, per square centimeter |
| HCPCS Q4128 | Flex hd, or allopatch hd, per square centimeter |
| HCPCS Q4129 | Unite biomatrix, per square centimeter |
| HCPCS Q4130 | Strattice tm, per square centimeter |
| HCPCS Q4131 | Epifix or epicord, per square centimeter |
| HCPCS Q4132 | Grafix core and grafixpl core, per square centimeter |
| HCPCS Q4133 | Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter |
| HCPCS Q4134 | Hmatrix, per square centimeter |
| HCPCS Q4135 | Mediskin, per square centimeter |
| HCPCS Q4136 | Ez-derm, per square centimeter |
| HCPCS Q9945 | LOW OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML |
| HCPCS Q9946 | LOW OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML |
| HCPCS Q9947 | LOW OSMOLAR CONTRAST MATERIAL, 200-249 MG/ML IODINE CONCENTRATION, PER ML |
| HCPCS Q9948 | LOW OSMOLAR CONTRAST MATERIAL, 250-299 MG/ML IODINE CONCENTRATION, PER ML |
| HCPCS Q9949 | LOW OSMOLAR CONTRAST MATERIAL, 300-349 MG/ML IODINE CONCENTRATION, PER ML |
| HCPCS Q9950 | Injection, sulfur hexafluoride lipid microspheres, per ml |
| HCPCS Q9951 | Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| HCPCS Q9954 | Oral magnetic resonance contrast agent, per 100 ml |
| HCPCS Q9958 | High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml |
| HCPCS Q9959 | High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml |
| HCPCS Q9960 | High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml |
| HCPCS Q9961 | High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml |
| HCPCS Q9962 | High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml |
| HCPCS Q9963 | High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml |
| HCPCS Q9964 | High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml |
| HCPCS Q9965 | Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml |
| HCPCS Q9966 | Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml |
| HCPCS Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
| HCPCS Q9968 | Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg |
| HCPCS Q9969 | Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
| HCPCS S0155 | Sterile dilutant for epoprostenol, 50 ml |
| HCPCS S0196 | Injectable poly-l-lactic acid, restorative implant, 1 ml, face (deep dermis, subcutaneous layers) |
| HCPCS S1001 | Deluxe item, patient aware (list in addition to code for basic item) |
| HCPCS S1002 | Customized item (list in addition to code for basic item) |
| HCPCS S1015 | Iv tubing extension set |
| HCPCS S1016 | Non-pvc (polyvinyl chloride) intravenous administration set, for use with drugs that are not stable in pvc e.g., paclitaxel |
| HCPCS S1025 | INHALED NITRIC OXIDE FOR THE TREATMENT OF HYPOXIC RESPIRATORY FAILURE IN THE NEONATE; PER DIEM |
| HCPCS S1030 | Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code) |
| HCPCS S1031 | Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code) |
| HCPCS S1040 | Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
| HCPCS S3600 | Stat laboratory request (situations other than s3601) |
| HCPCS S4989 | Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies |
| HCPCS S5010 | 5% dextrose and 0.45% normal saline, 1000 ml |
| HCPCS S5011 | 5% dextrose in lactated ringer's, 1000 ml |
| HCPCS S5013 | 5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1000 ml |
| HCPCS S5160 | Emergency response system; installation and testing |
| HCPCS S5161 | Emergency response system; service fee, per month (excludes installation and testing) |
| HCPCS S5162 | Emergency response system; purchase only |
| HCPCS S5165 | Home modifications; per service |
| HCPCS S5560 | Insulin delivery device, reusable pen; 1.5 ml size |
| HCPCS S5561 | Insulin delivery device, reusable pen; 3 ml size |
| HCPCS S5565 | Insulin cartridge for use in insulin delivery device other than pump; 150 units |
| HCPCS S5566 | Insulin cartridge for use in insulin delivery device other than pump; 300 units |
| HCPCS S5570 | Insulin delivery device, disposable pen (including insulin); 1.5 ml size |
| HCPCS S5571 | Insulin delivery device, disposable pen (including insulin); 3 ml size |
| HCPCS S8095 | WIG (FOR MEDICALLY-INDUCED OR CONGENITAL HAIR LOSS) |
| HCPCS S8096 | Portable peak flow meter |
| HCPCS S8097 | Asthma kit (including but not limited to portable peak expiratory flow meter, instructional video, brochure, and/or spacer) |
| HCPCS S8100 | Holding chamber or spacer for use with an inhaler or nebulizer; without mask |
| HCPCS S8101 | Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
| HCPCS S8110 | Peak expiratory flow rate (physician services) |
| HCPCS S8120 | Oxygen contents, gaseous, 1 unit equals 1 cubic foot |
| HCPCS S8121 | Oxygen contents, liquid, 1 unit equals 1 pound |
| HCPCS S8130 | Interferential current stimulator, 2 channel |
| HCPCS S8131 | Interferential current stimulator, 4 channel |
| HCPCS S8182 | HUMIDIFIER, HEATED, USED WITH VENTILATOR, NON-SERVO-CONTROLLED |
| HCPCS S8183 | HUMIDIFIER, HEATED, USED WITH VENTILATOR, DUAL SERVO-CONTROLLED WITH TEMPERATURE MONITORING |
| HCPCS S8185 | Flutter device |
| HCPCS S8186 | Swivel adapter |
| HCPCS S8189 | Tracheostomy supply, not otherwise classified |
| HCPCS S8190 | ELECTRONIC SPIROMETER (OR MICROSPIROMETER) |
| HCPCS S8210 | Mucus trap |
| HCPCS S8260 | ORAL ORTHOTIC FOR TREATMENT OF SLEEP APNEA, INCLUDES FITTING, FABRICATION, AND MATERIALS |
| HCPCS S8262 | Mandibular orthopedic repositioning device, each |
| HCPCS S8265 | Haberman feeder for cleft lip/palate |
| HCPCS S8270 | Enuresis alarm, using auditory buzzer and/or vibration device |
| HCPCS S8301 | Infection control supplies, not otherwise specified |
| HCPCS S8415 | Supplies for home delivery of infant |
| HCPCS S8420 | Gradient pressure aid (sleeve and glove combination), custom made |
| HCPCS S8421 | Gradient pressure aid (sleeve and glove combination), ready made |
| HCPCS S8422 | Gradient pressure aid (sleeve), custom made, medium weight |
| HCPCS S8423 | Gradient pressure aid (sleeve), custom made, heavy weight |
| HCPCS S8424 | Gradient pressure aid (sleeve), ready made |
| HCPCS S8425 | Gradient pressure aid (glove), custom made, medium weight |
| HCPCS S8426 | Gradient pressure aid (glove), custom made, heavy weight |
| HCPCS S8427 | Gradient pressure aid (glove), ready made |
| HCPCS S8428 | Gradient pressure aid (gauntlet), ready made |
| HCPCS S8429 | Gradient pressure exterior wrap |
| HCPCS S8430 | Padding for compression bandage, roll |
| HCPCS S8431 | Compression bandage, roll |
| HCPCS S8434 | INTERIM POST-OPERATIVE ORTHOTIC DEVICE FOR UPPER EXTREMITY, CUSTOM MADE |
| HCPCS S8450 | Splint, prefabricated, digit (specify digit by use of modifier) |
| HCPCS S8451 | Splint, prefabricated, wrist or ankle |
| HCPCS S8452 | Splint, prefabricated, elbow |
| HCPCS S8460 | Camisole, post-mastectomy |
| HCPCS S8490 | Insulin syringes (100 syringes, any size) |
| HCPCS S8999 | Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) |
| HCPCS S9001 | Home uterine monitor with or without associated nursing services |
| HCPCS S9007 | Ultrafiltration monitor |
| HCPCS S9055 | Procuren or other growth factor preparation to promote wound healing |
| HCPCS S9434 | Modified solid food supplements for inborn errors of metabolism |
| HCPCS S9435 | Medical foods for inborn errors of metabolism |
| HCPCS T1500 | DIAPER/INCONTINENT PANT, REUSABLE/WASHABLE, ANY SIZE, EACH |
| HCPCS T1505 | Electronic medication compliance management device, includes all components and accessories, not otherwise classified |
| HCPCS T1999 | Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
| HCPCS T2028 | Specialized supply, not otherwise specified, waiver |
| HCPCS T2029 | Specialized medical equipment, not otherwise specified, waiver |
| HCPCS T2039 | Vehicle modifications, waiver; per service |
| HCPCS T2101 | Human breast milk processing, storage and distribution only |
| HCPCS T4521 | Adult sized disposable incontinence product, brief/diaper, small, each |
| HCPCS T4522 | Adult sized disposable incontinence product, brief/diaper, medium, each |
| HCPCS T4523 | Adult sized disposable incontinence product, brief/diaper, large, each |
| HCPCS T4524 | Adult sized disposable incontinence product, brief/diaper, extra large, each |
| HCPCS T4525 | Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
| HCPCS T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
| HCPCS T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
| HCPCS T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
| HCPCS T4529 | Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
| HCPCS T4530 | Pediatric sized disposable incontinence product, brief/diaper, large size, each |
| HCPCS T4531 | Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
| HCPCS T4532 | Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
| HCPCS T4533 | Youth sized disposable incontinence product, brief/diaper, each |
| HCPCS T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each |
| HCPCS T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
| HCPCS T4536 | Incontinence product, protective underwear/pull-on, reusable, any size, each |
| HCPCS T4537 | Incontinence product, protective underpad, reusable, bed size, each |
| HCPCS T4538 | Diaper service, reusable diaper, each diaper |
| HCPCS T4539 | Incontinence product, diaper/brief, reusable, any size, each |
| HCPCS T4540 | Incontinence product, protective underpad, reusable, chair size, each |
| HCPCS T4541 | Incontinence product, disposable underpad, large, each |
| HCPCS T4542 | Incontinence product, disposable underpad, small size, each |
| HCPCS T4543 | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
| HCPCS T5001 | Positioning seat for persons with special orthopedic needs |
| HCPCS T5999 | Supply, not otherwise specified |
| HCPCS V5336 | Repair/modification of augmentative communicative system or device (excludes adaptive hearing aid) |
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