Type of Service (TOS) Indicator A: Used DME

HCPCS codes

CodeDescription
A4254  REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH  
A4618  Breathing circuits  
A4628  Oropharyngeal suction catheter, each  
A4630  Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient  
A4632  REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH  
A4633  Replacement bulb/lamp for ultraviolet light therapy system, each  
A4635  Underarm pad, crutch, replacement, each  
A4636  Replacement, handgrip, cane, crutch, or walker, each  
A4637  Replacement, tip, cane, crutch, walker, each.  
A4639  Replacement pad for infrared heating pad system, each  
A4640  Replacement pad for use with medically necessary alternating pressure pad owned by patient  
A7000  Canister, disposable, used with suction pump, each  
A7001  Canister, non-disposable, used with suction pump, each  
A7002  Tubing, used with suction pump, each  
A7005  Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable  
A7006  Administration set, with small volume filtered pneumatic nebulizer  
A7009  Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer  
A7012  Water collection device, used with large volume nebulizer  
A7014  Filter, nondisposable, used with aerosol compressor or ultrasonic generator  
A7015  Aerosol mask, used with dme nebulizer  
A7016  Dome and mouthpiece, used with small volume ultrasonic nebulizer  
A7017  Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen  
A7020  Interface for cough stimulating device, includes all components, replacement only  
A7025  High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each  
A7026  High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each  
A7027  Combination oral/nasal mask, used with continuous positive airway pressure device, each  
A7028  Oral cushion for combination oral/nasal mask, replacement only, each  
A7029  Nasal pillows for combination oral/nasal mask, replacement only, pair  
A7030  Full face mask used with positive airway pressure device, each  
A7031  Face mask interface, replacement for full face mask, each  
A7032  Cushion for use on nasal mask interface, replacement only, each  
A7033  Pillow for use on nasal cannula type interface, replacement only, pair  
A7034  Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap  
A7035  Headgear used with positive airway pressure device  
A7036  Chinstrap used with positive airway pressure device  
A7037  Tubing used with positive airway pressure device  
A7038  Filter, disposable, used with positive airway pressure device  
A7039  Filter, non disposable, used with positive airway pressure device  
A7044  Oral interface used with positive airway pressure device, each  
A7045  Exhalation port with or without swivel used with accessories for positive airway devices, replacement only  
A7047  Oral interface used with respiratory suction pump, each  
A8000  Helmet, protective, soft, prefabricated, includes all components and accessories  
A8001  Helmet, protective, hard, prefabricated, includes all components and accessories  
A8002  Helmet, protective, soft, custom fabricated, includes all components and accessories  
A8003  Helmet, protective, hard, custom fabricated, includes all components and accessories  
A8004  Soft interface for helmet, replacement only  
A9273  Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type  
A9281  Reaching/grabbing device, any type, any length, each  
A9284  Spirometer, non-electronic, includes all accessories  
B9000  Enteral nutrition infusion pump - without alarm  
B9002  Enteral nutrition infusion pump, any type  
B9004  Parenteral nutrition infusion pump, portable  
B9006  Parenteral nutrition infusion pump, stationary  
E0100  Cane, includes canes of all materials, adjustable or fixed, with tip  
E0105  Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips  
E0110  Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips  
E0111  Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips  
E0112  Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips  
E0113  Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip  
E0114  Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips  
E0116  Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each  
E0117  Crutch, underarm, articulating, spring assisted, each  
E0118  Crutch substitute, lower leg platform, with or without wheels, each  
E0130  Walker, rigid (pickup), adjustable or fixed height  
E0135  Walker, folding (pickup), adjustable or fixed height  
E0140  Walker, with trunk support, adjustable or fixed height, any type  
E0141  Walker, rigid, wheeled, adjustable or fixed height  
E0143  Walker, folding, wheeled, adjustable or fixed height  
E0144  Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat  
E0147  Walker, heavy duty, multiple braking system, variable wheel resistance  
E0148  Walker, heavy duty, without wheels, rigid or folding, any type, each  
E0149  Walker, heavy duty, wheeled, rigid or folding, any type  
E0153  Platform attachment, forearm crutch, each  
E0154  Platform attachment, walker, each  
E0155  Wheel attachment, rigid pick-up walker, per pair  
E0156  Seat attachment, walker  
E0157  Crutch attachment, walker, each  
E0158  Leg extensions for walker, per set of four (4)  
E0159  Brake attachment for wheeled walker, replacement, each  
E0160  Sitz type bath or equipment, portable, used with or without commode  
E0161  Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s  
E0162  Sitz bath chair  
E0163  Commode chair, mobile or stationary, with fixed arms  
E0164  COMMODE CHAIR, MOBILE, WITH FIXED ARMS  
E0167  Pail or pan for use with commode chair, replacement only  
E0168  Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each  
E0170  Commode chair with integrated seat lift mechanism, electric, any type  
E0171  Commode chair with integrated seat lift mechanism, non-electric, any type  
E0172  Seat lift mechanism placed over or on top of toilet, any type  
E0175  Foot rest, for use with commode chair, each  
E0176  AIR PRESSURE PAD OR CUSHION, NONPOSITIONING  
E0177  WATER PRESSURE PAD OR CUSHION, NONPOSITIONING  
E0178  GEL OR GEL-LIKE PRESSURE PAD OR CUSHION, NONPOSITIONING  
E0179  DRY PRESSURE PAD OR CUSHION, NONPOSITIONING  
E0184  Dry pressure mattress  
E0185  Gel or gel-like pressure pad for mattress, standard mattress length and width  
E0188  Synthetic sheepskin pad  
E0189  Lambswool sheepskin pad, any size  
E0191  Heel or elbow protector, each  
E0192  LOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR  
E0197  Air pressure pad for mattress, standard mattress length and width  
E0198  Water pressure pad for mattress, standard mattress length and width  
E0199  Dry pressure pad for mattress, standard mattress length and width  
E0200  Heat lamp, without stand (table model), includes bulb, or infrared element  
E0205  Heat lamp, with stand, includes bulb, or infrared element  
E0210  Electric heat pad, standard  
E0215  Electric heat pad, moist  
E0217  Water circulating heat pad with pump  
E0218  Fluid circulating cold pad with pump, any type  
E0220  Hot water bottle  
E0221  Infrared heating pad system  
E0225  Hydrocollator unit, includes pads  
E0230  Ice cap or collar  
E0238  Non-electric heat pad, moist  
E0239  Hydrocollator unit, portable  
E0241  Bath tub wall rail, each  
E0242  Bath tub rail, floor base  
E0243  Toilet rail, each  
E0244  Raised toilet seat  
E0245  Tub stool or bench  
E0246  Transfer tub rail attachment  
E0247  Transfer bench for tub or toilet with or without commode opening  
E0248  Transfer bench, heavy duty, for tub or toilet with or without commode opening  
E0249  Pad for water circulating heat unit, for replacement only  
E0271  Mattress, innerspring  
E0272  Mattress, foam rubber  
E0273  Bed board  
E0274  Over-bed table  
E0275  Bed pan, standard, metal or plastic  
E0276  Bed pan, fracture, metal or plastic  
E0280  Bed cradle, any type  
E0300  Pediatric crib, hospital grade, fully enclosed, with or without top enclosure  
E0310  Bed side rails, full length  
E0315  Bed accessory: board, table, or support device, any type  
E0316  Safety enclosure frame/canopy for use with hospital bed, any type  
E0325  Urinal; male, jug-type, any material  
E0326  Urinal; female, jug-type, any material  
E0370  Air pressure elevator for heel  
E0371  Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width  
E0372  Powered air overlay for mattress, standard mattress length and width  
E0373  Nonpowered advanced pressure reducing mattress  
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  
E0457  Chest shell (cuirass)  
E0481  Intrapulmonary percussive ventilation system and related accessories  
E0484  Oscillatory positive expiratory pressure device, non-electric, any type, each  
E0487  Spirometer, electronic, includes all accessories  
E0560  Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery  
E0561  Humidifier, non-heated, used with positive airway pressure device  
E0562  Humidifier, heated, used with positive airway pressure device  
E0571  Aerosol compressor, battery powered, for use with small volume nebulizer  
E0572  Aerosol compressor, adjustable pressure, light duty for intermittent use  
E0574  Ultrasonic/electronic aerosol generator with small volume nebulizer  
E0605  Vaporizer, room type  
E0607  Home blood glucose monitor  
E0610  Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)  
E0615  Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems  
E0620  Skin piercing device for collection of capillary blood, laser, each  
E0621  Sling or seat, patient lift, canvas or nylon  
E0625  Patient lift, bathroom or toilet, not otherwise classified  
E0627  Seat lift mechanism, electric, any type  
E0628  Separate seat lift mechanism for use with patient owned furniture-electric  
E0629  Seat lift mechanism, non-electric, any type  
E0637  Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels  
E0638  Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels  
E0641  Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels  
E0642  Standing frame/table system, mobile (dynamic stander), any size including pediatric  
E0650  Pneumatic compressor, non-segmental home model  
E0651  Pneumatic compressor, segmental home model without calibrated gradient pressure  
E0652  Pneumatic compressor, segmental home model with calibrated gradient pressure  
E0655  Non-segmental pneumatic appliance for use with pneumatic compressor, half arm  
E0656  Segmental pneumatic appliance for use with pneumatic compressor, trunk  
E0657  Segmental pneumatic appliance for use with pneumatic compressor, chest  
E0660  Non-segmental pneumatic appliance for use with pneumatic compressor, full leg  
E0665  Non-segmental pneumatic appliance for use with pneumatic compressor, full arm  
E0666  Non-segmental pneumatic appliance for use with pneumatic compressor, half leg  
E0667  Segmental pneumatic appliance for use with pneumatic compressor, full leg  
E0668  Segmental pneumatic appliance for use with pneumatic compressor, full arm  
E0669  Segmental pneumatic appliance for use with pneumatic compressor, half leg  
E0670  Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk  
E0671  Segmental gradient pressure pneumatic appliance, full leg  
E0672  Segmental gradient pressure pneumatic appliance, full arm  
E0673  Segmental gradient pressure pneumatic appliance, half leg  
E0676  Intermittent limb compression device (includes all accessories), not otherwise specified  
E0691  Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less  
E0692  Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel  
E0693  Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel  
E0694  Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection  
E0700  Safety equipment, device or accessory, any type  
E0701  HELMET WITH FACE GUARD AND SOFT INTERFACE MATERIAL, PREFABRICATED  
E0705  Transfer device, any type, each  
E0710  Restraints, any type (body, chest, wrist or ankle)  
E0720  Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation  
E0730  Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation  
E0731  Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric)  
E0740  Non-implanted pelvic floor electrical stimulator, complete system  
E0746  Electromyography (emg), biofeedback device  
E0747  Osteogenesis stimulator, electrical, non-invasive, other than spinal applications  
E0748  Osteogenesis stimulator, electrical, non-invasive, spinal applications  
E0755  Electronic salivary reflex stimulator (intra-oral/non-invasive)  
E0760  Osteogenesis stimulator, low intensity ultrasound, non-invasive  
E0762  Transcutaneous electrical joint stimulation device system, includes all accessories  
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  
E0765  Fda approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting  
E0770  Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified  
E0776  Iv pole  
E0779  Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater  
E0780  Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours  
E0782  Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)  
E0783  Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)  
E0840  Traction frame, attached to headboard, cervical traction  
E0849  Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible  
E0850  Traction stand, free standing, cervical traction  
E0855  Cervical traction equipment not requiring additional stand or frame  
E0856  Cervical traction device, with inflatable air bladder(s)  
E0860  Traction equipment, overdoor, cervical  
E0870  Traction frame, attached to footboard, extremity traction, (e.g., buck's)  
E0880  Traction stand, free standing, extremity traction, (e.g., buck's)  
E0890  Traction frame, attached to footboard, pelvic traction  
E0900  Traction stand, free standing, pelvic traction, (e.g., buck's)  
E0942  Cervical head harness/halter  
E0944  Pelvic belt/harness/boot  
E0945  Extremity belt/harness  
E0947  Fracture frame, attachments for complex pelvic traction  
E0948  Fracture frame, attachments for complex cervical traction  
E0950  Wheelchair accessory, tray, each  
E0951  Heel loop/holder, any type, with or without ankle strap, each  
E0952  Toe loop/holder, any type, each  
E0953  Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each  
E0954  Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot  
E0955  Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each  
E0956  Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each  
E0957  Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each  
E0959  Manual wheelchair accessory, adapter for amputee, each  
E0960  Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware  
E0961  Manual wheelchair accessory, wheel lock brake extension (handle), each  
E0962  1" CUSHION, FOR WHEELCHAIR  
E0963  2" CUSHION, FOR WHEELCHAIR  
E0964  3" CUSHION, FOR WHEELCHAIR  
E0965  4" CUSHION, FOR WHEELCHAIR  
E0966  Manual wheelchair accessory, headrest extension, each  
E0967  Manual wheelchair accessory, hand rim with projections, any type, replacement only, each  
E0969  Narrowing device, wheelchair  
E0970  No. 2 footplates, except for elevating leg rest  
E0971  Manual wheelchair accessory, anti-tipping device, each  
E0972  WHEELCHAIR ACCESSORY, TRANSFER BOARD OR DEVICE, EACH  
E0973  Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each  
E0974  Manual wheelchair accessory, anti-rollback device, each  
E0977  WEDGE CUSHION, WHEELCHAIR  
E0978  Wheelchair accessory, positioning belt/safety belt/pelvic strap, each  
E0980  Safety vest, wheelchair  
E0981  Wheelchair accessory, seat upholstery, replacement only, each  
E0982  Wheelchair accessory, back upholstery, replacement only, each  
E0984  Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control  
E0985  Wheelchair accessory, seat lift mechanism  
E0986  Manual wheelchair accessory, push-rim activated power assist system  
E0990  Wheelchair accessory, elevating leg rest, complete assembly, each  
E0992  Manual wheelchair accessory, solid seat insert  
E0994  Arm rest, each  
E0995  Wheelchair accessory, calf rest/pad, replacement only, each  
E0996  TIRE, SOLID, EACH  
E0997  CASTER WITH A FORK  
E0998  CASTER WITHOUT FORK  
E0999  PNEUMATIC TIRE WITH WHEEL  
E1000  TIRE, PNEUMATIC CASTER  
E1001  WHEEL, SINGLE  
E1002  Wheelchair accessory, power seating system, tilt only  
E1003  Wheelchair accessory, power seating system, recline only, without shear reduction  
E1004  Wheelchair accessory, power seating system, recline only, with mechanical shear reduction  
E1005  Wheelchair accessory, power seatng system, recline only, with power shear reduction  
E1006  Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction  
E1007  Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction  
E1008  Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction  
E1009  Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each  
E1010  Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair  
E1011  Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)  
E1012  Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each  
E1013  INTEGRATED SEATING SYSTEM, CONTOURED, FOR PEDIATRIC WHEELCHAIR  
E1014  Reclining back, addition to pediatric size wheelchair  
E1015  Shock absorber for manual wheelchair, each  
E1016  Shock absorber for power wheelchair, each  
E1017  Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each  
E1018  Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each  
E1019  WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, HEAVY DUTY FEATURE, PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS AND LESS THAN OR EQUAL TO 400 POUNDS  
E1020  Residual limb support system for wheelchair, any type  
E1021  WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, EXTRA HEAVY DUTY FEATURE, WEIGHT CAPACITY GREATER THAN 400 POUNDS  
E1025  LATERAL THORACIC SUPPORT, NON-CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)  
E1026  LATERAL THORACIC SUPPORT, CONTOURED, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)  
E1027  LATERAL/ANTERIOR SUPPORT, FOR PEDIATRIC WHEELCHAIR, EACH (INCLUDES HARDWARE)  
E1028  Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory  
E1029  Wheelchair accessory, ventilator tray, fixed  
E1030  Wheelchair accessory, ventilator tray, gimbaled  
E1161  Manual adult size wheelchair, includes tilt in space  
E1210  MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG RESTS  
E1211  MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH SWING AWAY,DETACHABLE ELEVATING LEG REST  
E1212  MOTORIZED WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS  
E1213  MOTORIZED WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE FOOT RESTS  
E1226  Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each  
E1227  Special height arms for wheelchair  
E1229  Wheelchair, pediatric size, not otherwise specified  
E1230  Power operated vehicle (three or four wheel nonhighway) specify brand name and model number  
E1231  Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system  
E1232  Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system  
E1233  Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system  
E1234  Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system  
E1235  Wheelchair, pediatric size, rigid, adjustable, with seating system  
E1236  Wheelchair, pediatric size, folding, adjustable, with seating system  
E1237  Wheelchair, pediatric size, rigid, adjustable, without seating system  
E1238  Wheelchair, pediatric size, folding, adjustable, without seating system  
E1239  Power wheelchair, pediatric size, not otherwise specified  
E1296  Special wheelchair seat height from floor  
E1297  Special wheelchair seat depth, by upholstery  
E1298  Special wheelchair seat depth and/or width, by construction  
E1300  Whirlpool, portable (overtub type)  
E1310  Whirlpool, non-portable (built-in type)  
E1354  Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each  
E1356  Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each  
E1357  Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each  
E1358  Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each  
E1372  Immersion external heater for nebulizer  
E1399  Durable medical equipment, miscellaneous  
E1700  Jaw motion rehabilitation system  
E1902  Communication board, non-electronic augmentative or alternative communication device  
E2100  Blood glucose monitor with integrated voice synthesizer  
E2101  Blood glucose monitor with integrated lancing/blood sample  
E2201  Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches  
E2202  Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches  
E2203  Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches  
E2204  Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches  
E2205  Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each  
E2206  Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each  
E2207  Wheelchair accessory, crutch and cane holder, each  
E2208  Wheelchair accessory, cylinder tank carrier, each  
E2209  Accessory, arm trough, with or without hand support, each  
E2210  Wheelchair accessory, bearings, any type, replacement only, each  
E2211  Manual wheelchair accessory, pneumatic propulsion tire, any size, each  
E2212  Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each  
E2213  Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each  
E2214  Manual wheelchair accessory, pneumatic caster tire, any size, each  
E2215  Manual wheelchair accessory, tube for pneumatic caster tire, any size, each  
E2216  Manual wheelchair accessory, foam filled propulsion tire, any size, each  
E2217  Manual wheelchair accessory, foam filled caster tire, any size, each  
E2218  Manual wheelchair accessory, foam propulsion tire, any size, each  
E2219  Manual wheelchair accessory, foam caster tire, any size, each  
E2220  Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each  
E2221  Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each  
E2222  Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each  
E2223  MANUAL WHEELCHAIR ACCESSORY, VALVE, ANY TYPE, REPLACEMENT ONLY, EACH  
E2224  Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each  
E2225  Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each  
E2226  Manual wheelchair accessory, caster fork, any size, replacement only, each  
E2227  Manual wheelchair accessory, gear reduction drive wheel, each  
E2228  Manual wheelchair accessory, wheel braking system and lock, complete, each  
E2230  Manual wheelchair accessory, manual standing system  
E2231  Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware  
E2291  Back, planar, for pediatric size wheelchair including fixed attaching hardware  
E2292  Seat, planar, for pediatric size wheelchair including fixed attaching hardware  
E2293  Back, contoured, for pediatric size wheelchair including fixed attaching hardware  
E2294  Seat, contoured, for pediatric size wheelchair including fixed attaching hardware  
E2295  Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features  
E2300  Wheelchair accessory, power seat elevation system, any type  
E2301  Wheelchair accessory, power standing system, any type  
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  
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  
E2312  Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware  
E2313  Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each  
E2320  POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, REMOTE JOYSTICK OR TOUCHPAD, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, AND FIXED MOUNTING HARDWARE  
E2321  Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware  
E2322  Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware  
E2323  Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated  
E2324  Power wheelchair accessory, chin cup for chin control interface  
E2325  Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware  
E2326  Power wheelchair accessory, breath tube kit for sip and puff interface  
E2327  Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware  
E2328  Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware  
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  
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  
E2331  Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware  
E2340  Power wheelchair accessory, nonstandard seat frame width, 20-23 inches  
E2341  Power wheelchair accessory, nonstandard seat frame width, 24-27 inches  
E2342  Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches  
E2343  Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches  
E2351  Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface  
E2358  Power wheelchair accessory, group 34 non-sealed lead acid battery, each  
E2359  Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)  
E2360  Power wheelchair accessory, 22nf non-sealed lead acid battery, each  
E2361  Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)  
E2362  Power wheelchair accessory, group 24 non-sealed lead acid battery, each  
E2363  Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)  
E2364  Power wheelchair accessory, u-1 non-sealed lead acid battery, each  
E2365  Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)  
E2366  Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each  
E2367  Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each  
E2368  Power wheelchair component, drive wheel motor, replacement only  
E2369  Power wheelchair component, drive wheel gear box, replacement only  
E2370  Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only  
E2371  Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each  
E2372  Power wheelchair accessory, group 27 non-sealed lead acid battery, each  
E2373  Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware  
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  
E2375  Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only  
E2376  Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only  
E2377  Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue  
E2378  Power wheelchair component, actuator, replacement only  
E2381  Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each  
E2382  Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each  
E2383  Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each  
E2384  Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each  
E2385  Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each  
E2386  Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each  
E2387  Power wheelchair accessory, foam filled caster tire, any size, replacement only, each  
E2388  Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each  
E2389  Power wheelchair accessory, foam caster tire, any size, replacement only, each  
E2390  Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each  
E2391  Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each  
E2392  Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each  
E2393  POWER WHEELCHAIR ACCESSORY, VALVE FOR PNEUMATIC TIRE TUBE, ANY TYPE, REPLACEMENT ONLY, EACH  
E2394  Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each  
E2395  Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each  
E2396  Power wheelchair accessory, caster fork, any size, replacement only, each  
E2399  POWER WHEELCHAIR ACCESSORY, NOT OTHERWISE CLASSIFIED INTERFACE, INCLUDING ALL RELATED ELECTRONICS AND ANY TYPE MOUNTING HARDWARE  
E2500  Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time  
E2502  Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time  
E2504  Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time  
E2506  Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time  
E2508  Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device  
E2510  Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access  
E2511  Speech generating software program, for personal computer or personal digital assistant  
E2512  Accessory for speech generating device, mounting system  
E2599  Accessory for speech generating device, not otherwise classified  
E2601  General use wheelchair seat cushion, width less than 22 inches, any depth  
E2602  General use wheelchair seat cushion, width 22 inches or greater, any depth  
E2603  Skin protection wheelchair seat cushion, width less than 22 inches, any depth  
E2604  Skin protection wheelchair seat cushion, width 22 inches or greater, any depth  
E2605  Positioning wheelchair seat cushion, width less than 22 inches, any depth  
E2606  Positioning wheelchair seat cushion, width 22 inches or greater, any depth  
E2607  Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth  
E2608  Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth  
E2609  Custom fabricated wheelchair seat cushion, any size  
E2610  Wheelchair seat cushion, powered  
E2611  General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware  
E2612  General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware  
E2613  Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware  
E2614  Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware  
E2615  Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware  
E2616  Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware  
E2617  Custom fabricated wheelchair back cushion, any size, including any type mounting hardware  
E2618  WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), FOR USE WITH MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, INCLUDES ANY TYPE MOUNTING HARDWARE  
E2619  Replacement cover for wheelchair seat cushion or back cushion, each  
E2620  Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware  
E2621  Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware  
E2622  Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth  
E2623  Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth  
E2624  Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth  
E2625  Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth  
E2626  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable  
E2627  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type  
E2628  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining  
E2629  Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)  
E2630  Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support  
E2631  Wheelchair accessory, addition to mobile arm support, elevating proximal arm  
E2632  Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control  
E2633  Wheelchair accessory, addition to mobile arm support, supinator  
K0005  Ultralightweight wheelchair  
K0009  Other manual wheelchair/base  
K0010  Standard - weight frame motorized/power wheelchair  
K0011  Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking  
K0012  Lightweight portable motorized/power wheelchair  
K0014  Other motorized/power wheelchair base  
K0015  Detachable, non-adjustable height armrest, replacement only, each  
K0017  Detachable, adjustable height armrest, base, replacement only, each  
K0018  Detachable, adjustable height armrest, upper portion, replacement only, each  
K0019  Arm pad, replacement only, each  
K0020  Fixed, adjustable height armrest, pair  
K0023  SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, ATTACHED WITH STRAPS  
K0024  SOLID BACK INSERT, PLANAR BACK, SINGLE DENSITY FOAM, WITH ADJUSTABLE HOOK-ON HARDWARE  
K0037  High mount flip-up footrest, each  
K0038  Leg strap, each  
K0039  Leg strap, h style, each  
K0040  Adjustable angle footplate, each  
K0041  Large size footplate, each  
K0042  Standard size footplate, replacement only, each  
K0043  Footrest, lower extension tube, replacement only, each  
K0044  Footrest, upper hanger bracket, replacement only, each  
K0045  Footrest, complete assembly, replacement only, each  
K0046  Elevating legrest, lower extension tube, replacement only, each  
K0047  Elevating legrest, upper hanger bracket, replacement only, each  
K0050  Ratchet assembly, replacement only  
K0051  Cam release assembly, footrest or legrest, replacement only, each  
K0052  Swingaway, detachable footrests, replacement only, each  
K0053  Elevating footrests, articulating (telescoping), each  
K0056  Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair  
K0059  PLASTIC COATED HANDRIM, EACH  
K0060  STEEL HANDRIM, EACH  
K0061  ALUMINUM HANDRIM, EACH  
K0064  ZERO PRESSURE TUBE (FLAT FREE INSERTS), ANY SIZE, EACH  
K0065  Spoke protectors, each  
K0066  SOLID TIRE, ANY SIZE, EACH  
K0067  PNEUMATIC TIRE, ANY SIZE, EACH  
K0068  PNEUMATIC TIRE TUBE, EACH  
K0069  Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each  
K0070  Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each  
K0071  Front caster assembly, complete, with pneumatic tire, replacement only, each  
K0072  Front caster assembly, complete, with semi-pneumatic tire, replacement only, each  
K0073  Caster pin lock, each  
K0074  PNEUMATIC CASTER TIRE, ANY SIZE, EACH  
K0075  SEMI-PNEUMATIC CASTER TIRE, ANY SIZE, EACH  
K0076  SOLID CASTER TIRE, ANY SIZE, EACH  
K0077  Front caster assembly, complete, with solid tire, replacement only, each  
K0078  PNEUMATIC CASTER TIRE TUBE, EACH  
K0081  WHEEL LOCK ASSEMBLY, COMPLETE, EACH  
K0090  REAR WHEEL TIRE FOR POWER WHEELCHAIR, ANY SIZE, EACH  
K0091  REAR WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR POWER WHEELCHAIR, ANY SIZE,EACH  
K0092  REAR WHEEL ASSEMBLY FOR POWER WHEELCHAIR, COMPLETE, EACH  
K0093  REAR WHEEL, ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER WHEELCHAIR, ANY SIZE, EACH  
K0094  WHEEL TIRE FOR POWER BASE, ANY SIZE, EACH  
K0095  WHEEL TIRE TUBE OTHER THAN ZERO PRESSURE FOR EACH BASE, ANY SIZE, EACH  
K0096  WHEEL ASSEMBLY FOR POWER BASE, COMPLETE, EACH  
K0097  WHEEL ZERO PRESSURE TIRE TUBE (FLAT FREE INSERT) FOR POWER BASE, ANY SIZE, EACH  
K0098  Drive belt for power wheelchair, replacement only  
K0099  FRONT CASTER FOR POWER WHEELCHAIR, EACH  
K0102  CRUTCH AND CANE HOLDER, EACH  
K0104  CYLINDER TANK CARRIER, EACH  
K0105  Iv hanger, each  
K0106  ARM TROUGH, EACH  
K0108  Wheelchair component or accessory, not otherwise specified  
K0114  BACK SUPPORT SYSTEM FOR USE WITH A WHEELCHAIR, WITH INNER FRAME, PREFABRICATED  
K0115  SEATING SYSTEM, BACK MODULE, POSTERIORLATERAL CONTROL, WITH OR WITHOUT LATERAL SUPPORTS, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE  
K0116  SEATING SYSTEM, COMBINED BACK AND SEAT MODULE, CUSTOM FABRICATED FOR ATTACHMENT TO WHEELCHAIR BASE  
K0452  WHEELCHAIR BEARINGS, ANY TYPE  
K0554  Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system  
K0555  NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR  
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  
K0601  Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each  
K0602  Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each  
K0603  Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each  
K0604  Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each  
K0605  Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each  
K0606  Automatic external defibrillator, with integrated electrocardiogram analysis, garment type  
K0607  Replacement battery for automated external defibrillator, garment type only, each  
K0608  Replacement garment for use with automated external defibrillator, each  
K0627  TRACTION EQUIPMENT, CERVICAL, FREE-STANDING, PNEUMATIC, APPLYING TRACTION FORCE TO OTHER THAN MANDIBLE  
K0650  GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH  
K0651  GENERAL USE WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  
K0652  SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH  
K0653  SKIN PROTECTION WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  
K0654  POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH  
K0655  POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  
K0656  SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH LESS THAN 22 INCHES, ANY DEPTH  
K0657  SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, WIDTH 22 INCHES OR GREATER, ANY DEPTH  
K0658  CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE  
K0659  WHEELCHAIR SEAT CUSHION, POWERED  
K0660  GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0661  GENERAL USE WHEELCHAIR BACK CUSHION, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0662  POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0663  POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0664  POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH LESS THAN 22 INCHES, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0665  POSITIONING WHEELCHAIR BACK CUSHION, POSTERIOR-LATERAL, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0666  CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE MOUNTING HARDWARE  
K0667  MOUNTING HARDWARE, ANY TYPE, FOR SEAT CUSHION OR SEAT SUPPORT BASE ATTACHED TO A MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, PER CUSHION/BASE  
K0668  REPLACEMENT COVER FOR WHEELCHAIR SEAT CUSHION OR BACK CUSHION, EACH  
K0669  Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from dme pdac  
K0730  Controlled dose inhalation drug delivery system  
K0733  Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)  
K0734  Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth  
K0735  Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth  
K0736  Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth  
K0737  Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth  
K0800  Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds  
K0801  Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds  
K0802  Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds  
K0806  Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds  
K0807  Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds  
K0808  Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds  
K0812  Power operated vehicle, not otherwise classified  
K0813  Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds  
K0814  Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds  
K0815  Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds  
K0816  Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds  
K0820  Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0821  Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds  
K0822  Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0823  Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds  
K0824  Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0825  Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds  
K0826  Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds  
K0827  Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds  
K0828  Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more  
K0829  Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more  
K0830  Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0831  Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds  
K0835  Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0836  Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds  
K0837  Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0838  Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds  
K0839  Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds  
K0840  Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more  
K0841  Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0842  Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds  
K0843  Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0848  Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0849  Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds  
K0850  Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0851  Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds  
K0852  Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds  
K0853  Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds  
K0854  Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more  
K0855  Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more  
K0856  Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0857  Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds  
K0858  Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds  
K0859  Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds  
K0860  Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds  
K0861  Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0862  Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0863  Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds  
K0864  Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more  
K0868  Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0869  Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds  
K0870  Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0871  Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds  
K0877  Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0878  Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds  
K0879  Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0880  Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds  
K0884  Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds  
K0885  Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds  
K0886  Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds  
K0890  Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds  
K0891  Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds  
K0898  Power wheelchair, not otherwise classified  
K0899  Power mobility device, not coded by dme pdac or does not meet criteria  
K0900  Customized durable medical equipment, other than wheelchair  
L3964  Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, adjustable, prefabricated, includes fitting and adjustment  
L3965  Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, adjustable rancho type, prefabricated, includes fitting and adjustment  
L3966  Shoulder elbow orthosis, mobile arm support attached to wheelchair, balanced, reclining, prefabricated, includes fitting and adjustment  
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  
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  
L3970  Seo, addition to mobile arm support, elevating proximal arm  
L3972  Seo, addition to mobile arm support, offset or lateral rocker arm with elastic balance control  
L3974  Seo, addition to mobile arm support, supinator  
S1031  Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code)  
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