Type of Service (TOS) Indicator P: Lump Sum Purchase of DME, Prosthetics, Orthotics

Special Considerations/Exceptions
For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is P or 1,

HCPCS codes

CodeDescription
A4216  Sterile water, saline and/or dextrose, diluent/flush, 10 ml  
A4217  Sterile water/saline, 500 ml  
A4218  Sterile saline or water, metered dose dispenser, 10 ml  
A4220  Refill kit for implantable infusion pump  
A4221  Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)  
A4222  Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)  
A4223  Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)  
A4224  Supplies for maintenance of insulin infusion catheter, per week  
A4225  Supplies for external insulin infusion pump, syringe type cartridge, sterile, each  
A4226  Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week  
A4230  Infusion set for external insulin pump, non needle cannula type  
A4231  Infusion set for external insulin pump, needle type  
A4232  Syringe with needle for external insulin pump, sterile, 3 cc  
A4233  Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each  
A4234  Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each  
A4235  Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each  
A4236  Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each  
A4252  Blood ketone test or reagent strip, each  
A4253  Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips  
A4254  REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH  
A4255  Platforms for home blood glucose monitor, 50 per box  
A4256  Normal, low and high calibrator solution / chips  
A4257  Replacement lens shield cartridge for use with laser skin piercing device, each  
A4258  Spring-powered device for lancet, each  
A4259  Lancets, per box of 100  
A4280  Adhesive skin support attachment for use with external breast prosthesis, each  
A4310  Insertion tray without drainage bag and without catheter (accessories only)  
A4311  Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)  
A4312  Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone  
A4313  Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation  
A4314  Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)  
A4315  Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone  
A4316  Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation  
A4320  Irrigation tray with bulb or piston syringe, any purpose  
A4321  Therapeutic agent for urinary catheter irrigation  
A4322  Irrigation syringe, bulb or piston, each  
A4324  MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH  
A4325  MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH  
A4326  Male external catheter with integral collection chamber, any type, each  
A4327  Female external urinary collection device; meatal cup, each  
A4328  Female external urinary collection device; pouch, each  
A4330  Perianal fecal collection pouch with adhesive, each  
A4331  Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each  
A4332  Lubricant, individual sterile packet, each  
A4333  Urinary catheter anchoring device, adhesive skin attachment, each  
A4334  Urinary catheter anchoring device, leg strap, each  
A4335  Incontinence supply; miscellaneous  
A4336  Incontinence supply, urethral insert, any type, each  
A4337  Incontinence supply, rectal insert, any type, each  
A4338  Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each  
A4340  Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each  
A4344  Indwelling catheter, foley type, two-way, all silicone, each  
A4346  Indwelling catheter; foley type, three way for continuous irrigation, each  
A4347  MALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX DEVICE; PER DOZEN  
A4348  MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR, EACH (E.G., 2 PER MONTH)  
A4349  Male external catheter, with or without adhesive, disposable, each  
A4351  Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each  
A4352  Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each  
A4353  Intermittent urinary catheter, with insertion supplies  
A4354  Insertion tray with drainage bag but without catheter  
A4355  Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each  
A4356  External urethral clamp or compression device (not to be used for catheter clamp), each  
A4357  Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each  
A4358  Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each  
A4359  URINARY SUSPENSORY WITHOUT LEG BAG, EACH  
A4361  Ostomy faceplate, each  
A4362  Skin barrier; solid, 4 x 4 or equivalent; each  
A4363  Ostomy clamp, any type, replacement only, each  
A4364  Adhesive, liquid or equal, any type, per oz  
A4365  ADHESIVE REMOVER WIPES, ANY TYPE, PER 50  
A4366  Ostomy vent, any type, each  
A4367  Ostomy belt, each  
A4368  Ostomy filter, any type, each  
A4369  Ostomy skin barrier, liquid (spray, brush, etc.), per oz  
A4371  Ostomy skin barrier, powder, per oz  
A4372  Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each  
A4373  Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each  
A4375  Ostomy pouch, drainable, with faceplate attached, plastic, each  
A4376  Ostomy pouch, drainable, with faceplate attached, rubber, each  
A4377  Ostomy pouch, drainable, for use on faceplate, plastic, each  
A4378  Ostomy pouch, drainable, for use on faceplate, rubber, each  
A4379  Ostomy pouch, urinary, with faceplate attached, plastic, each  
A4380  Ostomy pouch, urinary, with faceplate attached, rubber, each  
A4381  Ostomy pouch, urinary, for use on faceplate, plastic, each  
A4382  Ostomy pouch, urinary, for use on faceplate, heavy plastic, each  
A4383  Ostomy pouch, urinary, for use on faceplate, rubber, each  
A4384  Ostomy faceplate equivalent, silicone ring, each  
A4385  Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each  
A4387  Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each  
A4388  Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each  
A4389  Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each  
A4390  Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each  
A4391  Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each  
A4392  Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each  
A4393  Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each  
A4394  Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce  
A4395  Ostomy deodorant for use in ostomy pouch, solid, per tablet  
A4396  Ostomy belt with peristomal hernia support  
A4397  Irrigation supply; sleeve, each  
A4398  Ostomy irrigation supply; bag, each  
A4399  Ostomy irrigation supply; cone/catheter, with or without brush  
A4400  Ostomy irrigation set  
A4402  Lubricant, per ounce  
A4404  Ostomy ring, each  
A4405  Ostomy skin barrier, non-pectin based, paste, per ounce  
A4406  Ostomy skin barrier, pectin-based, paste, per ounce  
A4407  Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each  
A4408  Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each  
A4409  Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each  
A4410  Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each  
A4411  Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each  
A4412  Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each  
A4413  Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each  
A4414  Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each  
A4415  Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each  
A4416  Ostomy pouch, closed, with barrier attached, with filter (1 piece), each  
A4417  Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each  
A4418  Ostomy pouch, closed; without barrier attached, with filter (1 piece), each  
A4419  Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each  
A4420  Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each  
A4421  Ostomy supply; miscellaneous  
A4422  Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each  
A4423  Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each  
A4424  Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each  
A4425  Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each  
A4426  Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each  
A4427  Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each  
A4428  Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each  
A4429  Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each  
A4430  Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each  
A4431  Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each  
A4432  Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each  
A4433  Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each  
A4434  Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each  
A4435  Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each  
A4450  Tape, non-waterproof, per 18 square inches  
A4452  Tape, waterproof, per 18 square inches  
A4454  TAPE, ALL TYPES, ALL SIZES  
A4455  Adhesive remover or solvent (for tape, cement or other adhesive), per ounce  
A4456  Adhesive remover, wipes, any type, each  
A4470  Gravlee jet washer  
A4480  Vabra aspirator  
A4481  Tracheostoma filter, any type, any size, each  
A4483  Moisture exchanger, disposable, for use with invasive mechanical ventilation  
A4490  Surgical stockings above knee length, each  
A4495  Surgical stockings thigh length, each  
A4500  Surgical stockings below knee length, each  
A4510  Surgical stockings full length, each  
A4555  Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only  
A4556  Electrodes, (e.g., apnea monitor), per pair  
A4557  Lead wires, (e.g., apnea monitor), per pair  
A4558  Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz  
A4559  Coupling gel or paste, for use with ultrasound device, per oz  
A4561  Pessary, rubber, any type  
A4562  Pessary, non rubber, any type  
A4563  Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each  
A4565  Slings  
A4570  Splint  
A4595  Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)  
A4600  Sleeve for intermittent limb compression device, replacement only, each  
A4601  Lithium ion battery, rechargeable, for non-prosthetic use, replacement  
A4602  Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each  
A4604  Tubing with integrated heating element for use with positive airway pressure device  
A4605  Tracheal suction catheter, closed system, each  
A4608  Transtracheal oxygen catheter, each  
A4609  TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR LESS THAN 72 HOURS OF USE, EACH  
A4610  TRACHEAL SUCTION CATHETER, CLOSED SYSTEM, FOR 72 OR MORE HOURS OF USE, EACH  
A4611  Battery, heavy duty; replacement for patient owned ventilator  
A4612  Battery cables; replacement for patient-owned ventilator  
A4613  Battery charger; replacement for patient-owned ventilator  
A4615  Cannula, nasal  
A4616  Tubing (oxygen), per foot  
A4617  Mouth piece  
A4618  Breathing circuits  
A4619  Face tent  
A4620  Variable concentration mask  
A4623  Tracheostomy, inner cannula  
A4624  Tracheal suction catheter, any type other than closed system, each  
A4625  Tracheostomy care kit for new tracheostomy  
A4626  Tracheostomy cleaning brush, each  
A4628  Oropharyngeal suction catheter, each  
A4629  Tracheostomy care kit for established tracheostomy  
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.  
A4638  Replacement battery for patient-owned ear pulse generator, each  
A4639  Replacement pad for infrared heating pad system, each  
A4640  Replacement pad for use with medically necessary alternating pressure pad owned by patient  
A5051  Ostomy pouch, closed; with barrier attached (1 piece), each  
A5052  Ostomy pouch, closed; without barrier attached (1 piece), each  
A5053  Ostomy pouch, closed; for use on faceplate, each  
A5054  Ostomy pouch, closed; for use on barrier with flange (2 piece), each  
A5055  Stoma cap  
A5056  Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each  
A5057  Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each  
A5061  Ostomy pouch, drainable; with barrier attached, (1 piece), each  
A5062  Ostomy pouch, drainable; without barrier attached (1 piece), each  
A5063  Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each  
A5071  Ostomy pouch, urinary; with barrier attached (1 piece), each  
A5072  Ostomy pouch, urinary; without barrier attached (1 piece), each  
A5073  Ostomy pouch, urinary; for use on barrier with flange (2 piece), each  
A5081  Stoma plug or seal, any type  
A5082  Continent device; catheter for continent stoma  
A5083  Continent device, stoma absorptive cover for continent stoma  
A5093  Ostomy accessory; convex insert  
A5102  Bedside drainage bottle with or without tubing, rigid or expandable, each  
A5105  Urinary suspensory with leg bag, with or without tube, each  
A5112  Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each  
A5113  Leg strap; latex, replacement only, per set  
A5114  Leg strap; foam or fabric, replacement only, per set  
A5119  SKIN BARRIER, WIPES OR SWABS, PER BOX 50  
A5120  Skin barrier, wipes or swabs, each  
A5121  Skin barrier; solid, 6 x 6 or equivalent, each  
A5122  Skin barrier; solid, 8 x 8 or equivalent, each  
A5126  Adhesive or non-adhesive; disk or foam pad  
A5131  Appliance cleaner, incontinence and ostomy appliances, per 16 oz.  
A5200  Percutaneous catheter/tube anchoring device, adhesive skin attachment  
A6000  Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card  
A6413  Adhesive bandage, first-aid type, any size, each  
A6441  Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard  
A6442  Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard  
A6443  Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard  
A6444  Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard  
A6445  Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard  
A6446  Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard  
A6447  Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard  
A6448  Light compression bandage, elastic, knitted/woven, width less than three inches, per yard  
A6449  Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard  
A6450  Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard  
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  
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  
A6453  Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard  
A6454  Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard  
A6455  Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard  
A6456  Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard  
A6457  Tubular dressing with or without elastic, any width, per linear yard  
A6460  Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing  
A6461  Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing  
A6501  Compression burn garment, bodysuit (head to foot), custom fabricated  
A6502  Compression burn garment, chin strap, custom fabricated  
A6503  Compression burn garment, facial hood, custom fabricated  
A6504  Compression burn garment, glove to wrist, custom fabricated  
A6505  Compression burn garment, glove to elbow, custom fabricated  
A6506  Compression burn garment, glove to axilla, custom fabricated  
A6507  Compression burn garment, foot to knee length, custom fabricated  
A6508  Compression burn garment, foot to thigh length, custom fabricated  
A6509  Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated  
A6510  Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated  
A6511  Compression burn garment, lower trunk including leg openings (panty), custom fabricated  
A6512  Compression burn garment, not otherwise classified  
A6513  Compression burn mask, face and/or neck, plastic or equal, custom fabricated  
A6530  Gradient compression stocking, below knee, 18-30 mmhg, each  
A6531  Gradient compression stocking, below knee, 30-40 mmhg, each  
A6532  Gradient compression stocking, below knee, 40-50 mmhg, each  
A6533  Gradient compression stocking, thigh length, 18-30 mmhg, each  
A6534  Gradient compression stocking, thigh length, 30-40 mmhg, each  
A6535  Gradient compression stocking, thigh length, 40-50 mmhg, each  
A6536  Gradient compression stocking, full length/chap style, 18-30 mmhg, each  
A6537  Gradient compression stocking, full length/chap style, 30-40 mmhg, each  
A6538  Gradient compression stocking, full length/chap style, 40-50 mmhg, each  
A6539  Gradient compression stocking, waist length, 18-30 mmhg, each  
A6540  Gradient compression stocking, waist length, 30-40 mmhg, each  
A6541  Gradient compression stocking, waist length, 40-50 mmhg, each  
A6542  GRADIENT COMPRESSION STOCKING, CUSTOM MADE  
A6543  GRADIENT COMPRESSION STOCKING, LYMPHEDEMA  
A6544  Gradient compression stocking, garter belt  
A6545  Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each  
A6549  Gradient compression stocking/sleeve, not otherwise specified  
A6550  Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories  
A6551  CANISTER SET FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE, EACH  
A7000  Canister, disposable, used with suction pump, each  
A7001  Canister, non-disposable, used with suction pump, each  
A7002  Tubing, used with suction pump, each  
A7003  Administration set, with small volume nonfiltered pneumatic nebulizer, disposable  
A7004  Small volume nonfiltered pneumatic nebulizer, disposable  
A7005  Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable  
A7006  Administration set, with small volume filtered pneumatic nebulizer  
A7007  Large volume nebulizer, disposable, unfilled, used with aerosol compressor  
A7008  Large volume nebulizer, disposable, prefilled, used with aerosol compressor  
A7009  Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer  
A7010  Corrugated tubing, disposable, used with large volume nebulizer, 100 feet  
A7011  Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet  
A7012  Water collection device, used with large volume nebulizer  
A7013  Filter, disposable, used with aerosol compressor or ultrasonic generator  
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  
A7018  Water, distilled, used with large volume nebulizer, 1000 ml  
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  
A7040  One way chest drain valve  
A7041  Water seal drainage container and tubing for use with implanted chest tube  
A7042  Implanted pleural catheter, each  
A7043  Vacuum drainage bottle and tubing for use with implanted catheter  
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  
A7046  Water chamber for humidifier, used with positive airway pressure device, replacement, each  
A7047  Oral interface used with respiratory suction pump, each  
A7048  Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each  
A7501  Tracheostoma valve, including diaphragm, each  
A7502  Replacement diaphragm/faceplate for tracheostoma valve, each  
A7503  Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each  
A7504  Filter for use in a tracheostoma heat and moisture exchange system, each  
A7505  Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each  
A7506  Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each  
A7507  Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each  
A7508  Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each  
A7509  Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each  
A7520  Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each  
A7521  Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each  
A7522  Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each  
A7523  Tracheostomy shower protector, each  
A7524  Tracheostoma stent/stud/button, each  
A7525  Tracheostomy mask, each  
A7526  Tracheostomy tube collar/holder, each  
A7527  Tracheostomy/laryngectomy tube plug/stop, 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  
A9581  Injection, gadoxetate disodium, 1 ml  
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  
C1178  INJECTION, BUSULFAN, PER 6 MG  
C9121  Injection, argatroban, per 5 mg  
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  
E0232  Warming card for use with the non contact wound warming device and non contact wound warming wound cover  
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  
E0441  Stationary oxygen contents, gaseous, 1 month's supply = 1 unit  
E0442  Stationary oxygen contents, liquid, 1 month's supply = 1 unit  
E0443  Portable oxygen contents, gaseous, 1 month's supply = 1 unit  
E0444  Portable oxygen contents, liquid, 1 month's supply = 1 unit  
E0457  Chest shell (cuirass)  
E0481  Intrapulmonary percussive ventilation system and related accessories  
E0484  Oscillatory positive expiratory pressure device, non-electric, any type, each  
E0485  Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment  
E0486  Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment  
E0487  Spirometer, electronic, includes all accessories  
E0555  Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter  
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  
E0580  Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter  
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  
E0752  IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH  
E0754  PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE NEUROSTIMULATOR PULSE GENERATOR  
E0755  Electronic salivary reflex stimulator (intra-oral/non-invasive)  
E0756  IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR  
E0757  IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER  
E0758  RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER  
E0759  RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT  
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.)  
E0785  Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement  
E0830  Ambulatory traction device, all types, each  
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  
E1220  Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification  
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)  
E1352  Oxygen accessory, flow regulator capable of positive inspiratory pressure  
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  
E1701  Replacement cushions for jaw motion rehabilitation system, pkg. of 6  
E1702  Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200  
E1800  Dynamic adjustable elbow extension/flexion device, includes soft interface material  
E1801  Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories  
E1805  Dynamic adjustable wrist extension / flexion device, includes soft interface material  
E1806  Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories  
E1810  Dynamic adjustable knee extension / flexion device, includes soft interface material  
E1811  Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories  
E1812  Dynamic knee, extension/flexion device with active resistance control  
E1815  Dynamic adjustable ankle extension/flexion device, includes soft interface material  
E1816  Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories  
E1818  Static progressive stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories  
E1820  Replacement soft interface material, dynamic adjustable extension/flexion device  
E1821  Replacement soft interface material/cuffs for bi-directional static progressive stretch device  
E1825  Dynamic adjustable finger extension/flexion device, includes soft interface material  
E1830  Dynamic adjustable toe extension/flexion device, includes soft interface material  
E1831  Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories  
E1840  Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material  
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  
E2397  Power wheelchair accessory, lithium-based battery, 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  
J0120  Injection, tetracycline, up to 250 mg  
J0121  Injection, omadacycline, 1 mg  
J0122  Injection, eravacycline, 1 mg  
J0128  Injection, abarelix, 10 mg  
J0129  Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)  
J0130  Injection abciximab, 10 mg  
J0131  Injection, acetaminophen, 10 mg  
J0132  Injection, acetylcysteine, 100 mg  
J0133  Injection, acyclovir, 5 mg  
J0135  Injection, adalimumab, 20 mg  
J0150  Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)  
J0151  Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)  
J0152  Injection, adenosine for diagnostic use, 30 mg (not to be used to report any adenosine phosphate compounds; instead use a9270)  
J0153  Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)  
J0170  Injection, adrenalin, epinephrine, up to 1 ml ampule  
J0171  Injection, adrenalin, epinephrine, 0.1 mg  
J0178  Injection, aflibercept, 1 mg  
J0179  Injection, brolucizumab-dbll, 1 mg  
J0180  Injection, agalsidase beta, 1 mg  
J0185  Injection, aprepitant, 1 mg  
J0190  Injection, biperiden lactate, per 5 mg  
J0200  Injection, alatrofloxacin mesylate, 100 mg  
J0202  Injection, alemtuzumab, 1 mg  
J0205  Injection, alglucerase, per 10 units  
J0207  Injection, amifostine, 500 mg  
J0210  Injection, methyldopate hcl, up to 250 mg  
J0220  Injection, alglucosidase alfa, 10 mg, not otherwise specified  
J0221  Injection, alglucosidase alfa, (lumizyme), 10 mg  
J0256  Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg  
J0257  Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg  
J0278  Injection, amikacin sulfate, 100 mg  
J0280  Injection, aminophyllin, up to 250 mg  
J0282  Injection, amiodarone hydrochloride, 30 mg  
J0285  Injection, amphotericin b, 50 mg  
J0287  Injection, amphotericin b lipid complex, 10 mg  
J0288  Injection, amphotericin b cholesteryl sulfate complex, 10 mg  
J0289  Injection, amphotericin b liposome, 10 mg  
J0290  Injection, ampicillin sodium, 500 mg  
J0295  Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm  
J0300  Injection, amobarbital, up to 125 mg  
J0330  Injection, succinylcholine chloride, up to 20 mg  
J0348  Injection, anidulafungin, 1 mg  
J0350  Injection, anistreplase, per 30 units  
J0360  Injection, hydralazine hcl, up to 20 mg  
J0364  Injection, apomorphine hydrochloride, 1 mg  
J0365  Injection, aprotonin, 10,000 kiu  
J0380  Injection, metaraminol bitartrate, per 10 mg  
J0390  Injection, chloroquine hydrochloride, up to 250 mg  
J0395  Injection, arbutamine hcl, 1 mg  
J0400  Injection, aripiprazole, intramuscular, 0.25 mg  
J0401  Injection, aripiprazole, extended release, 1 mg  
J0456  Injection, azithromycin, 500 mg  
J0460  INJECTION, ATROPINE SULFATE, UP TO 0.3 MG  
J0461  Injection, atropine sulfate, 0.01 mg  
J0470  Injection, dimercaprol, per 100 mg  
J0475  Injection, baclofen, 10 mg  
J0476  Injection, baclofen, 50 mcg for intrathecal trial  
J0485  Injection, belatacept, 1 mg  
J0490  Injection, belimumab, 10 mg  
J0500  Injection, dicyclomine hcl, up to 20 mg  
J0515  Injection, benztropine mesylate, per 1 mg  
J0517  Injection, benralizumab, 1 mg  
J0520  Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg  
J0530  INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000 UNITS  
J0540  INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000 UNITS  
J0550  INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000 UNITS  
J0558  Injection, penicillin g benzathine and penicillin g procaine, 100,000 units  
J0559  Injection, penicillin g benzathine and penicillin g procaine, 2500 units  
J0560  Injection, penicillin g benzathine, up to 600,000 units  
J0561  Injection, penicillin g benzathine, 100,000 units  
J0565  Injection, bezlotoxumab, 10 mg  
J0567  Injection, cerliponase alfa, 1 mg  
J0570  Buprenorphine implant, 74.2 mg  
J0571  Buprenorphine, oral, 1 mg  
J0572  Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine  
J0573  Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine  
J0574  Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine  
J0575  Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine  
J0580  Injection, penicillin g benzathine, up to 2,400,000 units  
J0583  Injection, bivalirudin, 1 mg  
J0584  Injection, burosumab-twza 1 mg  
J0585  Injection, onabotulinumtoxina, 1 unit  
J0586  Injection, abobotulinumtoxina, 5 units  
J0587  Injection, rimabotulinumtoxinb, 100 units  
J0588  Injection, incobotulinumtoxin a, 1 unit  
J0592  Injection, buprenorphine hydrochloride, 0.1 mg  
J0594  injection, busulfan, 1 mg  
J0597  Injection, c-1 esterase inhibitor (human), berinert, 10 units  
J0598  Injection, c-1 esterase inhibitor (human), cinryze, 10 units  
J0599  Injection, c-1 esterase inhibitor (human), (haegarda), 10 units  
J0600  Injection, edetate calcium disodium, up to 1000 mg  
J0604  Cinacalcet, oral, 1 mg, (for esrd on dialysis)  
J0606  Injection, etelcalcetide, 0.1 mg  
J0610  Injection, calcium gluconate, per 10 ml  
J0620  Injection, calcium glycerophosphate and calcium lactate, per 10 ml  
J0630  Injection, calcitonin salmon, up to 400 units  
J0636  Injection, calcitriol, 0.1 mcg  
J0637  Injection, caspofungin acetate, 5 mg  
J0638  Injection, canakinumab, 1 mg  
J0640  Injection, leucovorin calcium, per 50 mg  
J0641  Injection, levoleucovorin, not otherwise specified, 0.5 mg  
J0642  Injection, levoleucovorin (khapzory), 0.5 mg  
J0670  Injection, mepivacaine hydrochloride, per 10 ml  
J0690  Injection, cefazolin sodium, 500 mg  
J0692  Injection, cefepime hydrochloride, 500 mg  
J0694  Injection, cefoxitin sodium, 1 gm  
J0695  Injection, ceftolozane 50 mg and tazobactam 25 mg  
J0696  Injection, ceftriaxone sodium, per 250 mg  
J0697  Injection, sterile cefuroxime sodium, per 750 mg  
J0698  Injection, cefotaxime sodium, per gm  
J0702  Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg  
J0704  Injection, betamethasone sodium phosphate, per 4 mg  
J0706  Injection, caffeine citrate, 5 mg  
J0710  Injection, cephapirin sodium, up to 1 gm  
J0712  Injection, ceftaroline fosamil, 10 mg  
J0713  Injection, ceftazidime, per 500 mg  
J0714  Injection, ceftazidime and avibactam, 0.5 g/0.125 g  
J0715  Injection, ceftizoxime sodium, per 500 mg  
J0716  Injection, centruroides immune f(ab)2, up to 120 milligrams  
J0717  Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)  
J0718  Injection, certolizumab pegol, 1 mg  
J0720  Injection, chloramphenicol sodium succinate, up to 1 gm  
J0725  Injection, chorionic gonadotropin, per 1,000 usp units  
J0735  Injection, clonidine hydrochloride, 1 mg  
J0740  Injection, cidofovir, 375 mg  
J0743  Injection, cilastatin sodium; imipenem, per 250 mg  
J0744  Injection, ciprofloxacin for intravenous infusion, 200 mg  
J0745  Injection, codeine phosphate, per 30 mg  
J0760  Injection, colchicine, per 1 mg  
J0770  Injection, colistimethate sodium, up to 150 mg  
J0775  Injection, collagenase, clostridium histolyticum, 0.01 mg  
J0780  Injection, prochlorperazine, up to 10 mg  
J0795  Injection, corticorelin ovine triflutate, 1 microgram  
J0800  Injection, corticotropin, up to 40 units  
J0833  Injection, cosyntropin, not otherwise specified, 0.25 mg  
J0834  Injection, cosyntropin, 0.25 mg  
J0835  INJECTION, COSYNTROPIN, PER 0.25 MG  
J0840  Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram  
J0841  Injection, crotalidae immune f(ab')2 (equine), 120 mg  
J0850  Injection, cytomegalovirus immune globulin intravenous (human), per vial  
J0875  Injection, dalbavancin, 5 mg  
J0878  Injection, daptomycin, 1 mg  
J0880  INJECTION, DARBEPOETIN ALFA, 5 MCG  
J0890  Injection, peginesatide, 0.1 mg (for esrd on dialysis)  
J0894  Injection, decitabine, 1 mg  
J0895  Injection, deferoxamine mesylate, 500 mg  
J0897  Injection, denosumab, 1 mg  
J0900  Injection, testosterone enanthate and estradiol valerate, up to 1 cc  
J0945  Injection, brompheniramine maleate, per 10 mg  
J0970  Injection, estradiol valerate, up to 40 mg  
J1000  Injection, depo-estradiol cypionate, up to 5 mg  
J1020  Injection, methylprednisolone acetate, 20 mg  
J1030  Injection, methylprednisolone acetate, 40 mg  
J1040  Injection, methylprednisolone acetate, 80 mg  
J1050  Injection, medroxyprogesterone acetate, 1 mg  
J1051  Injection, medroxyprogesterone acetate, 50 mg  
J1055  Injection, medroxyprogesterone acetate for contraceptive use, 150 mg  
J1056  Injection, medroxyprogesterone acetate / estradiol cypionate, 5mg / 25mg  
J1060  Injection, testosterone cypionate and estradiol cypionate, up to 1 ml  
J1070  Injection, testosterone cypionate, up to 100 mg  
J1071  Injection, testosterone cypionate, 1 mg  
J1080  Injection, testosterone cypionate, 1 cc, 200 mg  
J1094  Injection, dexamethasone acetate, 1 mg  
J1095  Injection, dexamethasone 9 percent, intraocular, 1 microgram  
J1100  Injection, dexamethasone sodium phosphate, 1 mg  
J1110  Injection, dihydroergotamine mesylate, per 1 mg  
J1120  Injection, acetazolamide sodium, up to 500 mg  
J1130  Injection, diclofenac sodium, 0.5 mg  
J1160  Injection, digoxin, up to 0.5 mg  
J1162  Injection, digoxin immune fab (ovine), per vial  
J1165  Injection, phenytoin sodium, per 50 mg  
J1170  Injection, hydromorphone, up to 4 mg  
J1180  Injection, dyphylline, up to 500 mg  
J1190  Injection, dexrazoxane hydrochloride, per 250 mg  
J1200  Injection, diphenhydramine hcl, up to 50 mg  
J1205  Injection, chlorothiazide sodium, per 500 mg  
J1212  Injection, dmso, dimethyl sulfoxide, 50%, 50 ml  
J1230  Injection, methadone hcl, up to 10 mg  
J1240  Injection, dimenhydrinate, up to 50 mg  
J1245  Injection, dipyridamole, per 10 mg  
J1250  Injection, dobutamine hydrochloride, per 250 mg  
J1260  Injection, dolasetron mesylate, 10 mg  
J1265  Injection, dopamine hcl, 40 mg  
J1267  Injection, doripenem, 10 mg  
J1270  Injection, doxercalciferol, 1 mcg  
J1290  Injection, ecallantide, 1 mg  
J1300  Injection, eculizumab, 10 mg  
J1301  Injection, edaravone, 1 mg  
J1303  Injection, ravulizumab-cwvz, 10 mg  
J1320  Injection, amitriptyline hcl, up to 20 mg  
J1322  Injection, elosulfase alfa, 1 mg  
J1324  Injection, enfuvirtide, 1 mg  
J1325  Injection, epoprostenol, 0.5 mg  
J1327  Injection, eptifibatide, 5 mg  
J1330  Injection, ergonovine maleate, up to 0.2 mg  
J1335  Injection, ertapenem sodium, 500 mg  
J1364  Injection, erythromycin lactobionate, per 500 mg  
J1380  Injection, estradiol valerate, up to 10 mg  
J1390  Injection, estradiol valerate, up to 20 mg  
J1410  Injection, estrogen conjugated, per 25 mg  
J1428  Injection, eteplirsen, 10 mg  
J1430  Injection, ethanolamine oleate, 100 mg  
J1435  Injection, estrone, per 1 mg  
J1436  Injection, etidronate disodium, per 300 mg  
J1438  Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)  
J1439  Injection, ferric carboxymaltose, 1 mg  
J1441  Injection, filgrastim (g-csf), 480 mcg  
J1442  Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram  
J1443  Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron  
J1444  Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron  
J1446  Injection, tbo-filgrastim, 5 micrograms  
J1447  Injection, tbo-filgrastim, 1 microgram  
J1450  Injection fluconazole, 200 mg  
J1451  Injection, fomepizole, 15 mg  
J1452  Injection, fomivirsen sodium, intraocular, 1.65 mg  
J1453  Injection, fosaprepitant, 1 mg  
J1454  Injection, fosnetupitant 235 mg and palonosetron 0.25 mg  
J1455  Injection, foscarnet sodium, per 1000 mg  
J1457  Injection, gallium nitrate, 1 mg  
J1458  Injection, galsulfase, 1 mg  
J1459  Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg  
J1460  Injection, gamma globulin, intramuscular, 1 cc  
J1470  Injection, gamma globulin, intramuscular, 2 cc  
J1480  Injection, gamma globulin, intramuscular, 3 cc  
J1490  Injection, gamma globulin, intramuscular, 4 cc  
J1500  Injection, gamma globulin, intramuscular, 5 cc  
J1510  Injection, gamma globulin, intramuscular, 6 cc  
J1520  Injection, gamma globulin, intramuscular, 7 cc  
J1530  Injection, gamma globulin, intramuscular, 8 cc  
J1540  Injection, gamma globulin, intramuscular, 9 cc  
J1550  Injection, gamma globulin, intramuscular, 10 cc  
J1555  Injection, immune globulin (cuvitru), 100 mg  
J1556  Injection, immune globulin (bivigam), 500 mg  
J1557  Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg  
J1559  Injection, immune globulin (hizentra), 100 mg  
J1560  Injection, gamma globulin, intramuscular, over 10 cc  
J1561  Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg  
J1562  Injection, immune globulin (vivaglobin), 100 mg  
J1563  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G  
J1564  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 10 MG  
J1565  INJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG  
J1566  Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg  
J1567  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG  
J1568  Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg  
J1569  Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg  
J1570  Injection, ganciclovir sodium, 500 mg  
J1571  Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml  
J1572  Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg  
J1573  Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml  
J1575  Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin  
J1580  Injection, garamycin, gentamicin, up to 80 mg  
J1590  Injection, gatifloxacin, 10 mg  
J1595  Injection, glatiramer acetate, 20 mg  
J1599  Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg  
J1600  Injection, gold sodium thiomalate, up to 50 mg  
J1602  Injection, golimumab, 1 mg, for intravenous use  
J1610  Injection, glucagon hydrochloride, per 1 mg  
J1620  Injection, gonadorelin hydrochloride, per 100 mcg  
J1626  Injection, granisetron hydrochloride, 100 mcg  
J1627  Injection, granisetron, extended-release, 0.1 mg  
J1628  Injection, guselkumab, 1 mg  
J1630  Injection, haloperidol, up to 5 mg  
J1631  Injection, haloperidol decanoate, per 50 mg  
J1640  Injection, hemin, 1 mg  
J1642  Injection, heparin sodium, (heparin lock flush), per 10 units  
J1644  Injection, heparin sodium, per 1000 units  
J1645  Injection, dalteparin sodium, per 2500 iu  
J1650  Injection, enoxaparin sodium, 10 mg  
J1652  Injection, fondaparinux sodium, 0.5 mg  
J1655  Injection, tinzaparin sodium, 1000 iu  
J1670  Injection, tetanus immune globulin, human, up to 250 units  
J1680  Injection, human fibrinogen concentrate, 100 mg  
J1700  Injection, hydrocortisone acetate, up to 25 mg  
J1710  Injection, hydrocortisone sodium phosphate, up to 50 mg  
J1720  Injection, hydrocortisone sodium succinate, up to 100 mg  
J1725  Injection, hydroxyprogesterone caproate, 1 mg  
J1726  Injection, hydroxyprogesterone caproate, (makena), 10 mg  
J1729  Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg  
J1730  Injection, diazoxide, up to 300 mg  
J1740  Injection, ibandronate sodium, 1 mg  
J1741  Injection, ibuprofen, 100 mg  
J1742  Injection, ibutilide fumarate, 1 mg  
J1743  Injection, idursulfase, 1 mg  
J1744  Injection, icatibant, 1 mg  
J1745  Injection, infliximab, excludes biosimilar, 10 mg  
J1746  Injection, ibalizumab-uiyk, 10 mg  
J1750  Injection, iron dextran, 50 mg  
J1751  INJECTION, IRON DEXTRAN 165, 50 MG  
J1752  INJECTION, IRON DEXTRAN 267, 50 MG  
J1756  Injection, iron sucrose, 1 mg  
J1785  Injection, imiglucerase, per unit  
J1786  Injection, imiglucerase, 10 units  
J1790  Injection, droperidol, up to 5 mg  
J1800  Injection, propranolol hcl, up to 1 mg  
J1810  Injection, droperidol and fentanyl citrate, up to 2 ml ampule  
J1815  Injection, insulin, per 5 units  
J1817  Insulin for administration through dme (i.e., insulin pump) per 50 units  
J1835  Injection, itraconazole, 50 mg  
J1840  Injection, kanamycin sulfate, up to 500 mg  
J1850  Injection, kanamycin sulfate, up to 75 mg  
J1885  Injection, ketorolac tromethamine, per 15 mg  
J1890  Injection, cephalothin sodium, up to 1 gram  
J1930  Injection, lanreotide, 1 mg  
J1931  Injection, laronidase, 0.1 mg  
J1940  Injection, furosemide, up to 20 mg  
J1942  Injection, aripiprazole lauroxil, 1 mg  
J1945  Injection, lepirudin, 50 mg  
J1950  Injection, leuprolide acetate (for depot suspension), per 3.75 mg  
J1953  Injection, levetiracetam, 10 mg  
J1955  Injection, levocarnitine, per 1 gm  
J1956  Injection, levofloxacin, 250 mg  
J1960  Injection, levorphanol tartrate, up to 2 mg  
J1980  Injection, hyoscyamine sulfate, up to 0.25 mg  
J1990  Injection, chlordiazepoxide hcl, up to 100 mg  
J2001  Injection, lidocaine hcl for intravenous infusion, 10 mg  
J2010  Injection, lincomycin hcl, up to 300 mg  
J2020  Injection, linezolid, 200 mg  
J2060  Injection, lorazepam, 2 mg  
J2062  Loxapine for inhalation, 1 mg  
J2150  Injection, mannitol, 25% in 50 ml  
J2170  Injection, mecasermin, 1 mg  
J2175  Injection, meperidine hydrochloride, per 100 mg  
J2180  Injection, meperidine and promethazine hcl, up to 50 mg  
J2182  Injection, mepolizumab, 1 mg  
J2185  Injection, meropenem, 100 mg  
J2186  Injection, meropenem and vaborbactam, 10mg/10mg (20mg)  
J2210  Injection, methylergonovine maleate, up to 0.2 mg  
J2212  Injection, methylnaltrexone, 0.1 mg  
J2248  Injection, micafungin sodium, 1 mg  
J2250  Injection, midazolam hydrochloride, per 1 mg  
J2260  Injection, milrinone lactate, 5 mg  
J2265  Injection, minocycline hydrochloride, 1 mg  
J2270  Injection, morphine sulfate, up to 10 mg  
J2271  Injection, morphine sulfate, 100mg  
J2274  Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg  
J2275  Injection, morphine sulfate (preservative-free sterile solution), per 10 mg  
J2278  Injection, ziconotide, 1 microgram  
J2280  Injection, moxifloxacin, 100 mg  
J2300  Injection, nalbuphine hydrochloride, per 10 mg  
J2310  Injection, naloxone hydrochloride, per 1 mg  
J2315  Injection, naltrexone, depot form, 1 mg  
J2320  Injection, nandrolone decanoate, up to 50 mg  
J2321  Injection, nandrolone decanoate, up to 100 mg  
J2322  Injection, nandrolone decanoate, up to 200 mg  
J2323  Injection, natalizumab, 1 mg  
J2324  INJECTION, NESIRITIDE, 0.25 MG  
J2325  Injection, nesiritide, 0.1 mg  
J2326  Injection, nusinersen, 0.1 mg  
J2350  Injection, ocrelizumab, 1 mg  
J2353  Injection, octreotide, depot form for intramuscular injection, 1 mg  
J2354  Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg  
J2355  Injection, oprelvekin, 5 mg  
J2357  Injection, omalizumab, 5 mg  
J2358  Injection, olanzapine, long-acting, 1 mg  
J2360  Injection, orphenadrine citrate, up to 60 mg  
J2370  Injection, phenylephrine hcl, up to 1 ml  
J2400  Injection, chloroprocaine hydrochloride, per 30 ml  
J2405  Injection, ondansetron hydrochloride, per 1 mg  
J2407  Injection, oritavancin, 10 mg  
J2410  Injection, oxymorphone hcl, up to 1 mg  
J2425  Injection, palifermin, 50 micrograms  
J2426  Injection, paliperidone palmitate extended release, 1 mg  
J2430  Injection, pamidronate disodium, per 30 mg  
J2440  Injection, papaverine hcl, up to 60 mg  
J2460  Injection, oxytetracycline hcl, up to 50 mg  
J2469  Injection, palonosetron hcl, 25 mcg  
J2501  Injection, paricalcitol, 1 mcg  
J2502  Injection, pasireotide long acting, 1 mg  
J2503  Injection, pegaptanib sodium, 0.3 mg  
J2504  Injection, pegademase bovine, 25 iu  
J2505  Injection, pegfilgrastim, 6 mg  
J2507  Injection, pegloticase, 1 mg  
J2510  Injection, penicillin g procaine, aqueous, up to 600,000 units  
J2513  Injection, pentastarch, 10% solution, 100 ml  
J2515  Injection, pentobarbital sodium, per 50 mg  
J2540  Injection, penicillin g potassium, up to 600,000 units  
J2543  Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)  
J2545  Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg  
J2547  Injection, peramivir, 1 mg  
J2550  Injection, promethazine hcl, up to 50 mg  
J2560  Injection, phenobarbital sodium, up to 120 mg  
J2562  Injection, plerixafor, 1 mg  
J2590  Injection, oxytocin, up to 10 units  
J2597  Injection, desmopressin acetate, per 1 mcg  
J2650  Injection, prednisolone acetate, up to 1 ml  
J2670  Injection, tolazoline hcl, up to 25 mg  
J2675  Injection, progesterone, per 50 mg  
J2680  Injection, fluphenazine decanoate, up to 25 mg  
J2690  Injection, procainamide hcl, up to 1 gm  
J2700  Injection, oxacillin sodium, up to 250 mg  
J2704  Injection, propofol, 10 mg  
J2710  Injection, neostigmine methylsulfate, up to 0.5 mg  
J2720  Injection, protamine sulfate, per 10 mg  
J2724  Injection, protein c concentrate, intravenous, human, 10 iu  
J2725  Injection, protirelin, per 250 mcg  
J2730  Injection, pralidoxime chloride, up to 1 gm  
J2760  Injection, phentolamine mesylate, up to 5 mg  
J2765  Injection, metoclopramide hcl, up to 10 mg  
J2770  Injection, quinupristin/dalfopristin, 500 mg (150/350)  
J2778  Injection, ranibizumab, 0.1 mg  
J2780  Injection, ranitidine hydrochloride, 25 mg  
J2783  Injection, rasburicase, 0.5 mg  
J2785  Injection, regadenoson, 0.1 mg  
J2786  Injection, reslizumab, 1 mg  
J2787  Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml  
J2788  Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)  
J2790  Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)  
J2791  Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu  
J2792  Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu  
J2793  Injection, rilonacept, 1 mg  
J2794  Injection, risperidone (risperdal consta), 0.5 mg  
J2795  Injection, ropivacaine hydrochloride, 1 mg  
J2796  Injection, romiplostim, 10 micrograms  
J2797  Injection, rolapitant, 0.5 mg  
J2798  Injection, risperidone, (perseris), 0.5 mg  
J2800  Injection, methocarbamol, up to 10 ml  
J2805  Injection, sincalide, 5 micrograms  
J2810  Injection, theophylline, per 40 mg  
J2820  Injection, sargramostim (gm-csf), 50 mcg  
J2840  Injection, sebelipase alfa, 1 mg  
J2850  Injection, secretin, synthetic, human, 1 microgram  
J2860  Injection, siltuximab, 10 mg  
J2910  Injection, aurothioglucose, up to 50 mg  
J2912  INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML  
J2916  Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg  
J2940  Injection, somatrem, 1 mg  
J2941  Injection, somatropin, 1 mg  
J2950  Injection, promazine hcl, up to 25 mg  
J2993  Injection, reteplase, 18.1 mg  
J2995  Injection, streptokinase, per 250,000 iu  
J2997  Injection, alteplase recombinant, 1 mg  
J3000  Injection, streptomycin, up to 1 gm  
J3010  Injection, fentanyl citrate, 0.1 mg  
J3030  Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)  
J3031  Injection, fremanezumab-vfrm, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)  
J3060  Injection, taliglucerase alfa, 10 units  
J3070  Injection, pentazocine, 30 mg  
J3090  Injection, tedizolid phosphate, 1 mg  
J3095  Injection, telavancin, 10 mg  
J3100  INJECTION, TENECTEPLASE, 50MG  
J3101  Injection, tenecteplase, 1 mg  
J3105  Injection, terbutaline sulfate, up to 1 mg  
J3110  Injection, teriparatide, 10 mcg  
J3120  Injection, testosterone enanthate, up to 100 mg  
J3121  Injection, testosterone enanthate, 1 mg  
J3130  Injection, testosterone enanthate, up to 200 mg  
J3140  Injection, testosterone suspension, up to 50 mg  
J3145  Injection, testosterone undecanoate, 1 mg  
J3150  Injection, testosterone propionate, up to 100 mg  
J3230  Injection, chlorpromazine hcl, up to 50 mg  
J3240  Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial  
J3243  Injection, tigecycline, 1 mg  
J3245  Injection, tildrakizumab, 1 mg  
J3246  Injection, tirofiban hcl, 0.25 mg  
J3250  Injection, trimethobenzamide hcl, up to 200 mg  
J3260  Injection, tobramycin sulfate, up to 80 mg  
J3262  Injection, tocilizumab, 1 mg  
J3265  Injection, torsemide, 10 mg/ml  
J3280  Injection, thiethylperazine maleate, up to 10 mg  
J3285  Injection, treprostinil, 1 mg  
J3300  Injection, triamcinolone acetonide, preservative free, 1 mg  
J3301  Injection, triamcinolone acetonide, not otherwise specified, 10 mg  
J3302  Injection, triamcinolone diacetate, per 5 mg  
J3303  Injection, triamcinolone hexacetonide, per 5 mg  
J3304  Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg  
J3305  Injection, trimetrexate glucuronate, per 25 mg  
J3310  Injection, perphenazine, up to 5 mg  
J3315  Injection, triptorelin pamoate, 3.75 mg  
J3316  Injection, triptorelin, extended-release, 3.75 mg  
J3320  Injection, spectinomycin dihydrochloride, up to 2 gm  
J3350  Injection, urea, up to 40 gm  
J3355  Injection, urofollitropin, 75 iu  
J3357  Ustekinumab, for subcutaneous injection, 1 mg  
J3358  Ustekinumab, for intravenous injection, 1 mg  
J3360  Injection, diazepam, up to 5 mg  
J3364  Injection, urokinase, 5000 iu vial  
J3365  Injection, iv, urokinase, 250,000 i.u. vial  
J3370  Injection, vancomycin hcl, 500 mg  
J3380  Injection, vedolizumab, 1 mg  
J3385  Injection, velaglucerase alfa, 100 units  
J3395  INJECTION, VERTEPORFIN, 15MG  
J3400  Injection, triflupromazine hcl, up to 20 mg  
J3410  Injection, hydroxyzine hcl, up to 25 mg  
J3411  Injection, thiamine hcl, 100 mg  
J3415  Injection, pyridoxine hcl, 100 mg  
J3420  Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg  
J3430  Injection, phytonadione (vitamin k), per 1 mg  
J3465  Injection, voriconazole, 10 mg  
J3470  Injection, hyaluronidase, up to 150 units  
J3471  Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)  
J3472  Injection, hyaluronidase, ovine, preservative free, per 1000 usp units  
J3473  Injection, hyaluronidase, recombinant, 1 usp unit  
J3475  Injection, magnesium sulfate, per 500 mg  
J3480  Injection, potassium chloride, per 2 meq  
J3485  Injection, zidovudine, 10 mg  
J3486  Injection, ziprasidone mesylate, 10 mg  
J3487  Injection, zoledronic acid (zometa), 1 mg  
J3488  Injection, zoledronic acid (reclast), 1 mg  
J3489  Injection, zoledronic acid, 1 mg  
J3490  Unclassified drugs  
J3520  Edetate disodium, per 150 mg  
J3530  Nasal vaccine inhalation  
J3535  Drug administered through a metered dose inhaler  
J3570  Laetrile, amygdalin, vitamin b17  
J3590  Unclassified biologics  
J3591  Unclassified drug or biological used for esrd on dialysis  
J7030  Infusion, normal saline solution , 1000 cc  
J7040  Infusion, normal saline solution, sterile (500 ml = 1 unit)  
J7042  5% dextrose/normal saline (500 ml = 1 unit)  
J7050  Infusion, normal saline solution, 250 cc  
J7051  STERILE SALINE OR WATER, UP TO 5 CC  
J7060  5% dextrose/water (500 ml = 1 unit)  
J7070  Infusion, d5w, 1000 cc  
J7100  Infusion, dextran 40, 500 ml  
J7110  Infusion, dextran 75, 500 ml  
J7120  Ringers lactate infusion, up to 1000 cc  
J7121  5% dextrose in lactated ringers infusion, up to 1000 cc  
J7130  Hypertonic saline solution, 50 or 100 meq, 20 cc vial  
J7131  Hypertonic saline solution, 1 ml  
J7170  Injection, emicizumab-kxwh, 0.5 mg  
J7175  Injection, factor x, (human), 1 i.u.  
J7177  Injection, human fibrinogen concentrate (fibryga), 1 mg  
J7178  Injection, human fibrinogen concentrate, not otherwise specified, 1 mg  
J7179  Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco  
J7180  Injection, factor xiii (antihemophilic factor, human), 1 i.u.  
J7184  Injection, von willebrand factor complex (human), wilate, per 100 iu vwf:rco  
J7185  Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.  
J7186  Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u.  
J7187  Injection, von willebrand factor complex (humate-p), per iu vwf:rco  
J7188  Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.  
J7189  Factor viia (antihemophilic factor, recombinant), per 1 microgram  
J7190  Factor viii (antihemophilic factor, human) per i.u.  
J7191  Factor viii (antihemophilic factor (porcine)), per i.u.  
J7192  Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified  
J7193  Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.  
J7194  Factor ix, complex, per i.u.  
J7195  Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified  
J7196  Injection, antithrombin recombinant, 50 i.u.  
J7197  Antithrombin iii (human), per i.u.  
J7198  Anti-inhibitor, per i.u.  
J7199  Hemophilia clotting factor, not otherwise classified  
J7312  Injection, dexamethasone, intravitreal implant, 0.1 mg  
J7315  Mitomycin, ophthalmic, 0.2 mg  
J7316  Injection, ocriplasmin, 0.125 mg  
J7325  Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg  
J7326  Hyaluronan or derivative, gel-one, for intra-articular injection, per dose  
J7327  Hyaluronan or derivative, monovisc, for intra-articular injection, per dose  
J7328  Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg  
J7329  Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg  
J7330  Autologous cultured chondrocytes, implant  
J7604  Acetylcysteine, inhalation solution, compounded product, administered through dme, unit dose form, per gram  
J7605  Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms  
J7606  Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms  
J7607  Levalbuterol, inhalation solution, compounded product, administered through dme, concentrated form, 0.5 mg  
J7608  Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram  
J7609  Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg  
J7610  Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg  
J7611  Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg  
J7612  Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg  
J7613  Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg  
J7614  Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg  
J7615  Levalbuterol, inhalation solution, compounded product, administered through dme, unit dose, 0.5 mg  
J7616  ALBUTEROL, UP TO 5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME  
J7617  LEVALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME  
J7618  ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)  
J7619  ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)  
J7620  Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme  
J7621  ALBUTEROL, ALL FORMULATIONS, INCLUDING SEPARATED ISOMERS, UP TO 5 MG (ALBUTEROL) OR 2.5 MG (LEVOALBUTEROL), AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME  
J7622  Beclomethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7624  Betamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7626  Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg  
J7627  Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg  
J7628  Bitolterol mesylate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7629  Bitolterol mesylate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7631  Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams  
J7632  Cromolyn sodium, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams  
J7633  Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 0.25 milligram  
J7634  Budesonide, inhalation solution, compounded product, administered through dme, concentrated form, per 0.25 milligram  
J7635  Atropine, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7636  Atropine, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7637  Dexamethasone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7638  Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7639  Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram  
J7640  Formoterol, inhalation solution, compounded product, administered through dme, unit dose form, 12 micrograms  
J7641  Flunisolide, inhalation solution, compounded product, administered through dme, unit dose, per milligram  
J7642  Glycopyrrolate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7643  Glycopyrrolate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7644  Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram  
J7645  Ipratropium bromide, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7647  Isoetharine hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7648  Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram  
J7649  Isoetharine hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram  
J7650  Isoetharine hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7657  Isoproterenol hcl, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7658  Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per milligram  
J7659  Isoproterenol hcl, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram  
J7660  Isoproterenol hcl, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7667  Metaproterenol sulfate, inhalation solution, compounded product, concentrated form, per 10 milligrams  
J7668  Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, per 10 milligrams  
J7669  Metaproterenol sulfate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams  
J7670  Metaproterenol sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per 10 milligrams  
J7674  Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg  
J7676  Pentamidine isethionate, inhalation solution, compounded product, administered through dme, unit dose form, per 300 mg  
J7677  Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram  
J7680  Terbutaline sulfate, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7681  Terbutaline sulfate, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7682  Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams  
J7683  Triamcinolone, inhalation solution, compounded product, administered through dme, concentrated form, per milligram  
J7684  Triamcinolone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram  
J7685  Tobramycin, inhalation solution, compounded product, administered through dme, unit dose form, per 300 milligrams  
J7686  Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg  
J7699  Noc drugs, inhalation solution administered through dme  
J7799  Noc drugs, other than inhalation drugs, administered through dme  
J8499  Prescription drug, oral, non chemotherapeutic, nos  
J8510  Busulfan; oral, 2 mg  
J8515  Cabergoline, oral, 0.25 mg  
J8520  Capecitabine, oral, 150 mg  
J8521  Capecitabine, oral, 500 mg  
J8530  Cyclophosphamide; oral, 25 mg  
J8560  Etoposide; oral, 50 mg  
J8600  Melphalan; oral, 2 mg  
J8610  Methotrexate; oral, 2.5 mg  
J8700  Temozolomide, oral, 5 mg  
J8705  Topotecan, oral, 0.25 mg  
J8999  Prescription drug, oral, chemotherapeutic, nos  
J9000  Injection, doxorubicin hydrochloride, 10 mg  
J9001  Injection, doxorubicin hydrochloride, all lipid formulations, 10 mg  
J9002  Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg  
J9010  Injection, alemtuzumab, 10 mg  
J9015  Injection, aldesleukin, per single use vial  
J9017  Injection, arsenic trioxide, 1 mg  
J9019  Injection, asparaginase (erwinaze), 1,000 iu  
J9020  Injection, asparaginase, not otherwise specified, 10,000 units  
J9022  Injection, atezolizumab, 10 mg  
J9023  Injection, avelumab, 10 mg  
J9025  Injection, azacitidine, 1 mg  
J9027  Injection, clofarabine, 1 mg  
J9030  Bcg live intravesical instillation, 1 mg  
J9031  Bcg (intravesical) per instillation  
J9032  Injection, belinostat, 10 mg  
J9033  Injection, bendamustine hcl (treanda), 1 mg  
J9034  Injection, bendamustine hcl (bendeka), 1 mg  
J9035  Injection, bevacizumab, 10 mg  
J9039  Injection, blinatumomab, 1 microgram  
J9040  Injection, bleomycin sulfate, 15 units  
J9041  Injection, bortezomib (velcade), 0.1 mg  
J9042  Injection, brentuximab vedotin, 1 mg  
J9043  Injection, cabazitaxel, 1 mg  
J9044  Injection, bortezomib, not otherwise specified, 0.1 mg  
J9045  Injection, carboplatin, 50 mg  
J9047  Injection, carfilzomib, 1 mg  
J9050  Injection, carmustine, 100 mg  
J9055  Injection, cetuximab, 10 mg  
J9057  Injection, copanlisib, 1 mg  
J9060  Injection, cisplatin, powder or solution, 10 mg  
J9062  Cisplatin, 50 mg  
J9065  Injection, cladribine, per 1 mg  
J9070  Cyclophosphamide, 100 mg  
J9080  Cyclophosphamide, 200 mg  
J9090  Cyclophosphamide, 500 mg  
J9091  Cyclophosphamide, 1.0 gram  
J9092  Cyclophosphamide, 2.0 gram  
J9093  Cyclophosphamide, lyophilized, 100 mg  
J9094  Cyclophosphamide, lyophilized, 200 mg  
J9095  Cyclophosphamide, lyophilized, 500 mg  
J9096  Cyclophosphamide, lyophilized, 1.0 gram  
J9097  Cyclophosphamide, lyophilized, 2.0 gram  
J9098  Injection, cytarabine liposome, 10 mg  
J9100  Injection, cytarabine, 100 mg  
J9110  Injection, cytarabine, 500 mg  
J9118  Injection, calaspargase pegol-mknl, 10 units  
J9120  Injection, dactinomycin, 0.5 mg  
J9130  Dacarbazine, 100 mg  
J9140  Dacarbazine, 200 mg  
J9145  Injection, daratumumab, 10 mg  
J9150  Injection, daunorubicin, 10 mg  
J9151  Injection, daunorubicin citrate, liposomal formulation, 10 mg  
J9153  Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine  
J9155  Injection, degarelix, 1 mg  
J9160  Injection, denileukin diftitox, 300 micrograms  
J9165  Injection, diethylstilbestrol diphosphate, 250 mg  
J9170  INJECTION, DOCETAXEL, 20 MG  
J9171  Injection, docetaxel, 1 mg  
J9173  Injection, durvalumab, 10 mg  
J9175  Injection, elliotts' b solution, 1 ml  
J9176  Injection, elotuzumab, 1 mg  
J9178  Injection, epirubicin hcl, 2 mg  
J9179  Injection, eribulin mesylate, 0.1 mg  
J9181  Injection, etoposide, 10 mg  
J9182  ETOPOSIDE, 100 MG  
J9185  Injection, fludarabine phosphate, 50 mg  
J9190  Injection, fluorouracil, 500 mg  
J9199  Injection, gemcitabine hydrochloride (infugem), 200 mg  
J9200  Injection, floxuridine, 500 mg  
J9201  Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg  
J9202  Goserelin acetate implant, per 3.6 mg  
J9203  Injection, gemtuzumab ozogamicin, 0.1 mg  
J9204  Injection, mogamulizumab-kpkc, 1 mg  
J9205  Injection, irinotecan liposome, 1 mg  
J9206  Injection, irinotecan, 20 mg  
J9207  Injection, ixabepilone, 1 mg  
J9208  Injection, ifosfamide, 1 gram  
J9209  Injection, mesna, 200 mg  
J9211  Injection, idarubicin hydrochloride, 5 mg  
J9212  Injection, interferon alfacon-1, recombinant, 1 microgram  
J9217  Leuprolide acetate (for depot suspension), 7.5 mg  
J9218  Leuprolide acetate, per 1 mg  
J9219  Leuprolide acetate implant, 65 mg  
J9225  Histrelin implant (vantas), 50 mg  
J9226  Histrelin implant (supprelin la), 50 mg  
J9228  Injection, ipilimumab, 1 mg  
J9229  Injection, inotuzumab ozogamicin, 0.1 mg  
J9230  Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg  
J9245  Injection, melphalan hydrochloride, 50 mg  
J9250  Methotrexate sodium, 5 mg  
J9260  Methotrexate sodium, 50 mg  
J9261  Injection, nelarabine, 50 mg  
J9262  Injection, omacetaxine mepesuccinate, 0.01 mg  
J9263  Injection, oxaliplatin, 0.5 mg  
J9264  Injection, paclitaxel protein-bound particles, 1 mg  
J9265  Injection, paclitaxel, 30 mg  
J9266  Injection, pegaspargase, per single dose vial  
J9267  Injection, paclitaxel, 1 mg  
J9268  Injection, pentostatin, 10 mg  
J9270  Injection, plicamycin, 2.5 mg  
J9271  Injection, pembrolizumab, 1 mg  
J9280  Injection, mitomycin, 5 mg  
J9285  Injection, olaratumab, 10 mg  
J9290  Mitomycin, 20 mg  
J9291  Mitomycin, 40 mg  
J9293  Injection, mitoxantrone hydrochloride, per 5 mg  
J9295  Injection, necitumumab, 1 mg  
J9299  Injection, nivolumab, 1 mg  
J9300  Injection, gemtuzumab ozogamicin, 5 mg  
J9301  Injection, obinutuzumab, 10 mg  
J9302  Injection, ofatumumab, 10 mg  
J9303  Injection, panitumumab, 10 mg  
J9305  Injection, pemetrexed, 10 mg  
J9306  Injection, pertuzumab, 1 mg  
J9307  Injection, pralatrexate, 1 mg  
J9308  Injection, ramucirumab, 5 mg  
J9309  Injection, polatuzumab vedotin-piiq, 1 mg  
J9310  Injection, rituximab, 100 mg  
J9311  Injection, rituximab 10 mg and hyaluronidase  
J9312  Injection, rituximab, 10 mg  
J9313  Injection, moxetumomab pasudotox-tdfk, 0.01 mg  
J9315  Injection, romidepsin, 1 mg  
J9320  Injection, streptozocin, 1 gram  
J9325  Injection, talimogene laherparepvec, per 1 million plaque forming units  
J9328  Injection, temozolomide, 1 mg  
J9330  Injection, temsirolimus, 1 mg  
J9340  Injection, thiotepa, 15 mg  
J9350  Injection, topotecan, 4 mg  
J9351  Injection, topotecan, 0.1 mg  
J9352  Injection, trabectedin, 0.1 mg  
J9354  Injection, ado-trastuzumab emtansine, 1 mg  
J9355  Injection, trastuzumab, excludes biosimilar, 10 mg  
J9357  Injection, valrubicin, intravesical, 200 mg  
J9360  Injection, vinblastine sulfate, 1 mg  
J9370  Vincristine sulfate, 1 mg  
J9371  Injection, vincristine sulfate liposome, 1 mg  
J9375  Vincristine sulfate, 2 mg  
J9380  Vincristine sulfate, 5 mg  
J9390  Injection, vinorelbine tartrate, 10 mg  
J9395  Injection, fulvestrant, 25 mg  
J9600  Injection, porfimer sodium, 75 mg  
J9999  Not otherwise classified, antineoplastic drugs  
K0005  Ultralightweight wheelchair  
K0008  Custom manual wheelchair/base  
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  
K0013  Custom motorized/power wheelchair base  
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  
K0552  Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each  
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  
K0609  Replacement electrodes for use with automated external defibrillator, garment type only, each  
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  
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  
K0627  TRACTION EQUIPMENT, CERVICAL, FREE-STANDING, PNEUMATIC, APPLYING TRACTION FORCE TO OTHER THAN MANDIBLE  
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  
K0631  SACROILIAC ORTHOSIS, FLEXIBLE, PROVIDES PELVIC-SACRAL SUPPORT, REDUCES MOTION ABOUT THE SACROILIAC JOINT, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
K0670  ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE  
K0672  Addition to lower extremity orthosis, removable soft interface, all components, replacement only, each  
K0730  Controlled dose inhalation drug delivery system  
K0731  LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, OTHER THAN EAR LEVEL, REPLACEMENT, EACH  
K0732  LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE SPEECH PROCESSOR, EAR LEVEL, REPLACEMENT, EACH  
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  
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  
K0741  Portable gaseous oxygen system, rental, includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing, for cluster headaches  
K0742  Portable oxygen contents, gaseous, 1 month's supply = 1 unit, for cluster headaches, for initial months supply or to replace used contents  
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  
L0100  CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT INTERFACE, MOLDED TO PATIENT MODEL  
L0110  CRANIAL ORTHOSIS (HELMET), WITH OR WITHOUT SOFT-INTERFACE, NON-MOLDED  
L0112  Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated  
L0113  Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment  
L0120  Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)  
L0130  Cervical, flexible, thermoplastic collar, molded to patient  
L0140  Cervical, semi-rigid, adjustable (plastic collar)  
L0150  Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)  
L0160  Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf  
L0170  Cervical, collar, molded to patient model  
L0172  Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf  
L0174  Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf  
L0180  Cervical, multiple post collar, occipital/mandibular supports, adjustable  
L0190  Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)  
L0200  Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension  
L0210  THORACIC, RIB BELT  
L0220  Thoracic, rib belt, custom fabricated  
L0430  Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (dewall posture protector only)  
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  
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  
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  
L0455  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, off-the-shelf  
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  
L0457  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, off-the-shelf  
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  
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  
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  
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  
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  
L0467  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, off-the-shelf  
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  
L0469  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, off-the-shelf  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
L0500  LUMBAR-SACRAL-ORTHOSIS (LSO), FLEXIBLE, (LUMBO-SACRAL SUPPORT)  
L0510  LSO, FLEXIBLE (LUMBO-SACRAL SUPPORT), CUSTOM FABRICATED  
L0515  LSO, ANTERIOR-POSTERIOR CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED  
L0520  LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL (KNIGHT, WILCOX TYPES), WITH APRON FRONT  
L0530  LSO, ANTERIOR-POSTERIOR CONTROL (MACAUSLAND TYPE), WITH APRON FRONT  
L0540  LSO, LUMBAR FLEXION (WILLIAMS FLEXION TYPE)  
L0550  LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL  
L0560  LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, MOLDED TO PATIENT MODEL, WITH INTERFACE MATERIAL  
L0561  LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, WITH RIGID OR SEMI-RIGID POSTERIOR PANEL, PREFABRICATED  
L0565  LSO, ANTERIOR-POSTERIOR-LATERAL CONTROL, CUSTOM FITTED  
L0600  SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT)  
L0610  SACROILIAC, FLEXIBLE (SACROILIAC SURGICAL SUPPORT), CUSTOM FABRICATED  
L0620  SACROILIAC, SEMI-RIGID (GOLDTHWAITE, OSGOOD TYPES), WITH APRON FRONT  
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  
L0622  Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
L0641  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, off-the-shelf  
L0642  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, off-the-shelf  
L0643  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, off-the-shelf  
L0648  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, off-the-shelf  
L0649  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, off-the-shelf  
L0650  Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf  
L0651  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, off-the-shelf  
L0700  Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)  
L0710  Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)  
L0810  Halo procedure, cervical halo incorporated into jacket vest  
L0820  Halo procedure, cervical halo incorporated into plaster body jacket  
L0830  Halo procedure, cervical halo incorporated into milwaukee type orthosis  
L0859  Addition to halo procedure, magnetic resonance image compatible systems, rings and pins, any material  
L0860  ADDITION TO HALO PROCEDURES, MAGNETIC REASONANCE IMAGE COMPATIBLE SYSTEM  
L0861  Addition to halo procedure, replacement liner/interface material  
L0960  TORSO SUPPORT, POST SURGICAL SUPPORT, PADS FOR POST SURGICAL SUPPORT  
L0970  Tlso, corset front  
L0972  Lso, corset front  
L0974  Tlso, full corset  
L0976  Lso, full corset  
L0978  Axillary crutch extension  
L0980  Peroneal straps, prefabricated, off-the-shelf, pair  
L0982  Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)  
L0984  Protective body sock, prefabricated, off-the-shelf, each  
L0999  Addition to spinal orthosis, not otherwise specified  
L1000  Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model  
L1001  Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment  
L1005  Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment  
L1010  Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling  
L1020  Addition to ctlso or scoliosis orthosis, kyphosis pad  
L1025  Addition to ctlso or scoliosis orthosis, kyphosis pad, floating  
L1030  Addition to ctlso or scoliosis orthosis, lumbar bolster pad  
L1040  Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad  
L1050  Addition to ctlso or scoliosis orthosis, sternal pad  
L1060  Addition to ctlso or scoliosis orthosis, thoracic pad  
L1070  Addition to ctlso or scoliosis orthosis, trapezius sling  
L1080  Addition to ctlso or scoliosis orthosis, outrigger  
L1085  Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions  
L1090  Addition to ctlso or scoliosis orthosis, lumbar sling  
L1100  Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather  
L1110  Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model  
L1120  Addition to ctlso, scoliosis orthosis, cover for upright, each  
L1200  Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only  
L1210  Addition to tlso, (low profile), lateral thoracic extension  
L1220  Addition to tlso, (low profile), anterior thoracic extension  
L1230  Addition to tlso, (low profile), milwaukee type superstructure  
L1240  Addition to tlso, (low profile), lumbar derotation pad  
L1250  Addition to tlso, (low profile), anterior asis pad  
L1260  Addition to tlso, (low profile), anterior thoracic derotation pad  
L1270  Addition to tlso, (low profile), abdominal pad  
L1280  Addition to tlso, (low profile), rib gusset (elastic), each  
L1290  Addition to tlso, (low profile), lateral trochanteric pad  
L1300  Other scoliosis procedure, body jacket molded to patient model  
L1310  Other scoliosis procedure, post-operative body jacket  
L1499  Spinal orthosis, not otherwise specified  
L1500  Thoracic-hip-knee-ankle orthosis (thkao), mobility frame (newington, parapodium types)  
L1510  Thkao, standing frame, with or without tray and accessories  
L1520  Thkao, swivel walker  
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  
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  
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  
L1630  Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated  
L1640  Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated  
L1650  Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment  
L1652  Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, includes fitting and adjustment, any type  
L1660  Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment  
L1680  Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated  
L1685  Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated  
L1686  Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment  
L1690  Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment  
L1700  Legg perthes orthosis, (toronto type), custom fabricated  
L1710  Legg perthes orthosis, (newington type), custom fabricated  
L1720  Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated  
L1730  Legg perthes orthosis, (scottish rite type), custom fabricated  
L1750  LEGG PERTHES ORTHOSIS, LEGG PERTHES SLING (SAM BROWN TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L1755  Legg perthes orthosis, (patten bottom type), custom fabricated  
L1800  KNEE ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
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  
L1812  Knee orthosis, elastic with joints, prefabricated, off-the-shelf  
L1815  KNEE ORTHOSIS, ELASTIC OR OTHER ELASTIC TYPE MATERIAL WITH CONDYLAR PAD(S), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L1820  Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment  
L1825  KNEE ORTHOSIS, ELASTIC KNEE CAP, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L1830  Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf  
L1831  Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment  
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  
L1833  Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf  
L1834  Knee orthosis, without knee joint, rigid, custom fabricated  
L1836  Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf  
L1840  Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated  
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  
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  
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  
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  
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  
L1848  Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf  
L1850  Knee orthosis, swedish type, prefabricated, off-the-shelf  
L1851  Knee orthosis (ko), 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, off-the-shelf  
L1852  Knee orthosis (ko), 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, off-the-shelf  
L1855  KNEE ORTHOSIS, MOLDED PLASTIC, THIGH AND CALF SECTIONS, WITH DOUBLE UPRIGHT KNEE JOINTS, CUSTOM-FABRICATED  
L1858  KNEE ORTHOSIS, MOLDED PLASTIC, POLYCENTRIC KNEE JOINTS, PNEUMATIC KNEE PADS (CTI), CUSTOM-FABRICATED  
L1860  Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)  
L1870  KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED  
L1880  KNEE ORTHOSIS, DOUBLE UPRIGHT, NON-MOLDED THIGH AND CALF CUFFS/LACERS WITH KNEE JOINTS, CUSTOM-FABRICATED  
L1900  Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated  
L1901  ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)  
L1902  Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf  
L1904  Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated  
L1906  Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf  
L1907  Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated  
L1910  Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment  
L1920  Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated  
L1930  Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment  
L1932  Afo, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment  
L1940  Ankle foot orthosis, plastic or other material, custom fabricated  
L1945  Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated  
L1950  Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated  
L1951  Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment  
L1960  Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated  
L1970  Ankle foot orthosis, plastic with ankle joint, custom fabricated  
L1971  Ankle foot orthosis, plastic or other material with ankle joint, prefabricated, includes fitting and adjustment  
L1980  Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated  
L1990  Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated  
L2000  Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated  
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  
L2006  Knee ankle foot device, any material, single or double upright, swing and/or stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated  
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  
L2020  Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated  
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  
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  
L2035  Knee ankle foot orthosis, full plastic, static (pediatric size), without free motion ankle, prefabricated, includes fitting and adjustment  
L2036  Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated  
L2037  Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated  
L2038  Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated  
L2039  KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED  
L2040  Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated  
L2050  Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated  
L2060  Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated  
L2070  Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated  
L2080  Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated  
L2090  Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated  
L2106  Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated  
L2108  Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated  
L2112  Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment  
L2114  Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment  
L2116  Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment  
L2126  Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated  
L2128  Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated  
L2132  Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment  
L2134  Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment  
L2136  Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment  
L2180  Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints  
L2182  Addition to lower extremity fracture orthosis, drop lock knee joint  
L2184  Addition to lower extremity fracture orthosis, limited motion knee joint  
L2186  Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type  
L2188  Addition to lower extremity fracture orthosis, quadrilateral brim  
L2190  Addition to lower extremity fracture orthosis, waist belt  
L2192  Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt  
L2200  Addition to lower extremity, limited ankle motion, each joint  
L2210  Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint  
L2220  Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint  
L2230  Addition to lower extremity, split flat caliper stirrups and plate attachment  
L2232  Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only  
L2240  Addition to lower extremity, round caliper and plate attachment  
L2250  Addition to lower extremity, foot plate, molded to patient model, stirrup attachment  
L2260  Addition to lower extremity, reinforced solid stirrup (scott-craig type)  
L2265  Addition to lower extremity, long tongue stirrup  
L2270  Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad  
L2275  Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined  
L2280  Addition to lower extremity, molded inner boot  
L2300  Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable  
L2310  Addition to lower extremity, abduction bar-straight  
L2320  Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only  
L2330  Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only  
L2335  Addition to lower extremity, anterior swing band  
L2340  Addition to lower extremity, pre-tibial shell, molded to patient model  
L2350  Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)  
L2360  Addition to lower extremity, extended steel shank  
L2370  Addition to lower extremity, patten bottom  
L2375  Addition to lower extremity, torsion control, ankle joint and half solid stirrup  
L2380  Addition to lower extremity, torsion control, straight knee joint, each joint  
L2385  Addition to lower extremity, straight knee joint, heavy duty, each joint  
L2387  Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint  
L2390  Addition to lower extremity, offset knee joint, each joint  
L2395  Addition to lower extremity, offset knee joint, heavy duty, each joint  
L2397  Addition to lower extremity orthosis, suspension sleeve  
L2405  Addition to knee joint, drop lock, each  
L2415  Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint  
L2425  Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint  
L2430  Addition to knee joint, ratchet lock for active and progressive knee extension, each joint  
L2435  ADDITION TO KNEE JOINT, POLYCENTRIC JOINT, EACH JOINT  
L2492  Addition to knee joint, lift loop for drop lock ring  
L2500  Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring  
L2510  Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model  
L2520  Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted  
L2525  Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model  
L2526  Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted  
L2530  Addition to lower extremity, thigh-weight bearing, lacer, non-molded  
L2540  Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model  
L2550  Addition to lower extremity, thigh/weight bearing, high roll cuff  
L2570  Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each  
L2580  Addition to lower extremity, pelvic control, pelvic sling  
L2600  Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each  
L2610  Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each  
L2620  Addition to lower extremity, pelvic control, hip joint, heavy duty, each  
L2622  Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each  
L2624  Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each  
L2627  Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables  
L2628  Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables  
L2630  Addition to lower extremity, pelvic control, band and belt, unilateral  
L2640  Addition to lower extremity, pelvic control, band and belt, bilateral  
L2650  Addition to lower extremity, pelvic and thoracic control, gluteal pad, each  
L2660  Addition to lower extremity, thoracic control, thoracic band  
L2670  Addition to lower extremity, thoracic control, paraspinal uprights  
L2680  Addition to lower extremity, thoracic control, lateral support uprights  
L2750  Addition to lower extremity orthosis, plating chrome or nickel, per bar  
L2755  Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only  
L2760  Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)  
L2768  Orthotic side bar disconnect device, per bar  
L2770  ADDITION TO LOWER EXTREMITY ORTHOSIS, ANY MATERIAL - PER BAR OR JOINT  
L2780  Addition to lower extremity orthosis, non-corrosive finish, per bar  
L2785  Addition to lower extremity orthosis, drop lock retainer, each  
L2795  Addition to lower extremity orthosis, knee control, full kneecap  
L2800  Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only  
L2810  Addition to lower extremity orthosis, knee control, condylar pad  
L2820  Addition to lower extremity orthosis, soft interface for molded plastic, below knee section  
L2830  Addition to lower extremity orthosis, soft interface for molded plastic, above knee section  
L2840  Addition to lower extremity orthosis, tibial length sock, fracture or equal, each  
L2850  Addition to lower extremity orthosis, femoral length sock, fracture or equal, each  
L2860  ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM, EACH  
L2861  Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each  
L2999  Lower extremity orthoses, not otherwise specified  
L3000  Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each  
L3001  Foot, insert, removable, molded to patient model, spenco, each  
L3002  Foot, insert, removable, molded to patient model, plastazote or equal, each  
L3003  Foot, insert, removable, molded to patient model, silicone gel, each  
L3010  Foot, insert, removable, molded to patient model, longitudinal arch support, each  
L3020  Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each  
L3030  Foot, insert, removable, formed to patient foot, each  
L3031  Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each  
L3040  Foot, arch support, removable, premolded, longitudinal, each  
L3050  Foot, arch support, removable, premolded, metatarsal, each  
L3060  Foot, arch support, removable, premolded, longitudinal/ metatarsal, each  
L3070  Foot, arch support, non-removable attached to shoe, longitudinal, each  
L3080  Foot, arch support, non-removable attached to shoe, metatarsal, each  
L3090  Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each  
L3100  Hallus-valgus night dynamic splint, prefabricated, off-the-shelf  
L3140  Foot, abduction rotation bar, including shoes  
L3150  Foot, abduction rotation bar, without shoes  
L3160  Foot, adjustable shoe-styled positioning device  
L3170  Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each  
L3201  Orthopedic shoe, oxford with supinator or pronator, infant  
L3202  Orthopedic shoe, oxford with supinator or pronator, child  
L3203  Orthopedic shoe, oxford with supinator or pronator, junior  
L3204  Orthopedic shoe, hightop with supinator or pronator, infant  
L3206  Orthopedic shoe, hightop with supinator or pronator, child  
L3207  Orthopedic shoe, hightop with supinator or pronator, junior  
L3208  Surgical boot, each, infant  
L3209  Surgical boot, each, child  
L3211  Surgical boot, each, junior  
L3212  Benesch boot, pair, infant  
L3213  Benesch boot, pair, child  
L3214  Benesch boot, pair, junior  
L3215  Orthopedic footwear, ladies shoe, oxford, each  
L3216  Orthopedic footwear, ladies shoe, depth inlay, each  
L3217  Orthopedic footwear, ladies shoe, hightop, depth inlay, each  
L3219  Orthopedic footwear, mens shoe, oxford, each  
L3221  Orthopedic footwear, mens shoe, depth inlay, each  
L3222  Orthopedic footwear, mens shoe, hightop, depth inlay, each  
L3224  Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)  
L3225  Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)  
L3230  Orthopedic footwear, custom shoe, depth inlay, each  
L3250  Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each  
L3251  Foot, shoe molded to patient model, silicone shoe, each  
L3252  Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each  
L3253  Foot, molded shoe plastazote (or similar) custom fitted, each  
L3254  Non-standard size or width  
L3255  Non-standard size or length  
L3257  Orthopedic footwear, additional charge for split size  
L3260  Surgical boot/shoe, each  
L3265  Plastazote sandal, each  
L3300  Lift, elevation, heel, tapered to metatarsals, per inch  
L3310  Lift, elevation, heel and sole, neoprene, per inch  
L3320  Lift, elevation, heel and sole, cork, per inch  
L3330  Lift, elevation, metal extension (skate)  
L3332  Lift, elevation, inside shoe, tapered, up to one-half inch  
L3334  Lift, elevation, heel, per inch  
L3340  Heel wedge, sach  
L3350  Heel wedge  
L3360  Sole wedge, outside sole  
L3370  Sole wedge, between sole  
L3380  Clubfoot wedge  
L3390  Outflare wedge  
L3400  Metatarsal bar wedge, rocker  
L3410  Metatarsal bar wedge, between sole  
L3420  Full sole and heel wedge, between sole  
L3430  Heel, counter, plastic reinforced  
L3440  Heel, counter, leather reinforced  
L3450  Heel, sach cushion type  
L3455  Heel, new leather, standard  
L3460  Heel, new rubber, standard  
L3465  Heel, thomas with wedge  
L3470  Heel, thomas extended to ball  
L3480  Heel, pad and depression for spur  
L3485  Heel, pad, removable for spur  
L3500  Orthopedic shoe addition, insole, leather  
L3510  Orthopedic shoe addition, insole, rubber  
L3520  Orthopedic shoe addition, insole, felt covered with leather  
L3530  Orthopedic shoe addition, sole, half  
L3540  Orthopedic shoe addition, sole, full  
L3550  Orthopedic shoe addition, toe tap standard  
L3560  Orthopedic shoe addition, toe tap, horseshoe  
L3570  Orthopedic shoe addition, special extension to instep (leather with eyelets)  
L3580  Orthopedic shoe addition, convert instep to velcro closure  
L3590  Orthopedic shoe addition, convert firm shoe counter to soft counter  
L3595  Orthopedic shoe addition, march bar  
L3600  Transfer of an orthosis from one shoe to another, caliper plate, existing  
L3610  Transfer of an orthosis from one shoe to another, caliper plate, new  
L3620  Transfer of an orthosis from one shoe to another, solid stirrup, existing  
L3630  Transfer of an orthosis from one shoe to another, solid stirrup, new  
L3640  Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes  
L3649  Orthopedic shoe, modification, addition or transfer, not otherwise specified  
L3650  Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf  
L3651  SHOULDER ORTHOSIS, SINGLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)  
L3652  SHOULDER ORTHOSIS, DOUBLE SHOULDER, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)  
L3660  Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf  
L3670  Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf  
L3671  Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
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  
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  
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  
L3675  Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf  
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  
L3678  Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf  
L3700  ELBOW ORTHOSIS, ELASTIC WITH STAYS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3701  ELBOW ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)  
L3702  Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3710  Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf  
L3720  Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated  
L3730  Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated  
L3740  Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated  
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  
L3761  Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf  
L3762  Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf  
L3763  Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
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  
L3765  Elbow wrist hand finger orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
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  
L3800  WRIST HAND FINGER ORTHOSIS, SHORT OPPONENS, NO ATTACHMENTS, CUSTOM-FABRICATED  
L3805  WRIST HAND FINGER ORTHOSIS, LONG OPPONENS, NO ATTACHMENT, CUSTOM-FABRICATED  
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  
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  
L3808  Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment  
L3809  Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type  
L3810  WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB ABDUCTION ('C') BAR  
L3815  WHFO, ADDITION TO SHORT AND LONG OPPONENS, SECOND M.P. ABDUCTION ASSIST  
L3820  WHFO, ADDITION TO SHORT AND LONG OPPONENS, I.P. EXTENSION ASSIST, WITH M.P. EXTENSION STOP  
L3825  WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION STOP  
L3830  WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. EXTENSION ASSIST  
L3835  WHFO, ADDITION TO SHORT AND LONG OPPONENS, M.P. SPRING EXTENSION ASSIST  
L3840  WHFO, ADDITION TO SHORT AND LONG OPPONENS, SPRING SWIVEL THUMB  
L3845  WHFO, ADDITION TO SHORT AND LONG OPPONENS, THUMB I.P. EXTENSION ASSIST, WITH M.P. STOP  
L3850  WHO, ADDITION TO SHORT AND LONG OPPONENS, ACTION WRIST, WITH DORSIFLEXION ASSIST  
L3855  WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL  
L3860  WHFO, ADDITION TO SHORT AND LONG OPPONENS, ADJUSTABLE M.P. FLEXION CONTROL AND I.P.  
L3890  ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM, EACH  
L3891  Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each  
L3900  Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated  
L3901  Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated  
L3902  WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, COMPRESSED GAS, CUSTOM-FABRICATED  
L3904  Wrist hand finger orthosis, external powered, electric, custom fabricated  
L3905  Wrist hand orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3906  Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3907  WRIST HAND FINGER ORTHOSIS, WRIST GAUNTLET WITH THUMB SPICA, CUSTOM-FABRICATED  
L3908  Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf  
L3909  WRIST ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)  
L3910  WRIST HAND FINGER ORTHOSIS, SWANSON DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3911  WRIST HAND FINGER ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. NEOPRENE, LYCRA)  
L3912  Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf  
L3913  Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3914  WRIST HAND ORTHOSIS, WRIST EXTENSION COCK-UP, PREFABRICATED, INCLUDES FITTING/ADJUSTMENT  
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  
L3916  Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf  
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  
L3918  Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf  
L3919  Hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3920  HAND FINGER ORTHOSIS, KNUCKLE BENDER WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3921  Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3922  HAND FINGER ORTHOSIS, KNUCKLE BENDER, TWO SEGMENT TO FLEX JOINTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
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  
L3924  Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf  
L3925  Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf  
L3926  WRIST HAND FINGER ORTHOSIS, THOMAS SUSPENSION, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
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  
L3928  HAND FINGER ORTHOSIS, FINGER EXTENSION, WITH CLOCK SPRING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
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  
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  
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  
L3932  FINGER ORTHOSIS, SAFETY PIN, SPRING WIRE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3933  Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment  
L3934  FINGER ORTHOSIS, SAFETY PIN, MODIFIED, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3935  Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment  
L3936  WRIST HAND FINGER ORTHOSIS, PALMER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3938  WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3940  WRIST HAND FINGER ORTHOSIS, DORSAL WRIST, WITH OUTRIGGER ATTACHMENT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3942  HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3944  HAND FINGER ORTHOSIS, REVERSE KNUCKLE BENDER, WITH OUTRIGGER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3946  HAND FINGER ORTHOSIS, COMPOSITE ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3948  FINGER ORTHOSIS, FINGER KNUCKLE BENDER, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3950  WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH KNUCKLE BENDER AND TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3952  WRIST HAND FINGER ORTHOSIS, COMBINATION OPPENHEIMER, WITH REVERSE KNUCKLE AND TWO ATTACHMENTS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3954  HAND FINGER ORTHOSIS, SPREADING HAND, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  
L3956  Addition of joint to upper extremity orthosis, any material; per joint  
L3960  Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment  
L3961  Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3962  Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment  
L3963  SHOULDER ELBOW WRIST HAND ORTHOSIS, MOLDED SHOULDER, ARM, FOREARM AND WRIST, WITH ARTICULATING ELBOW JOINT, CUSTOM-FABRICATED  
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  
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  
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  
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  
L3972  Seo, addition to mobile arm support, offset or lateral rocker arm with elastic balance control  
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  
L3974  Seo, addition to mobile arm support, supinator  
L3975  Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
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  
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  
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  
L3980  Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment  
L3981  Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments  
L3982  Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment  
L3984  Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment  
L3985  UPPER EXTREMITY FRACTURE ORTHOSIS, FOREARM, HAND WITH WRIST HINGE, CUSTOM-FABRICATED  
L3986  UPPER EXTREMITY FRACTURE ORTHOSIS, COMBINATION OF HUMERAL, RADIUS/ULNAR, WRIST, (EXAMPLE--COLLES' FRACTURE), CUSTOM FABRICATED  
L3995  Addition to upper extremity orthosis, sock, fracture or equal, each  
L3999  Upper limb orthosis, not otherwise specified  
L4000  Replace girdle for spinal orthosis (ctlso or so)  
L4002  Replacement strap, any orthosis, includes all components, any length, any type  
L4010  Replace trilateral socket brim  
L4020  Replace quadrilateral socket brim, molded to patient model  
L4030  Replace quadrilateral socket brim, custom fitted  
L4040  Replace molded thigh lacer, for custom fabricated orthosis only  
L4045  Replace non-molded thigh lacer, for custom fabricated orthosis only  
L4050  Replace molded calf lacer, for custom fabricated orthosis only  
L4055  Replace non-molded calf lacer, for custom fabricated orthosis only  
L4060  Replace high roll cuff  
L4070  Replace proximal and distal upright for kafo  
L4080  Replace metal bands kafo, proximal thigh  
L4090  Replace metal bands kafo-afo, calf or distal thigh  
L4100  Replace leather cuff kafo, proximal thigh  
L4110  Replace leather cuff kafo-afo, calf or distal thigh  
L4130  Replace pretibial shell  
L4205  Repair of orthotic device, labor component, per 15 minutes  
L4210  Repair of orthotic device, repair or replace minor parts  
L4350  Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf  
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  
L4361  Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf  
L4370  Pneumatic full leg splint, prefabricated, off-the-shelf  
L4380  Pneumatic knee splint, prefabricated, includes fitting and adjustment  
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  
L4387  Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf  
L4392  Replacement, soft interface material, static afo  
L4394  Replace soft interface material, foot drop splint  
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  
L4397  Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf  
L4398  Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf  
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  
L5000  Partial foot, shoe insert with longitudinal arch, toe filler  
L5010  Partial foot, molded socket, ankle height, with toe filler  
L5020  Partial foot, molded socket, tibial tubercle height, with toe filler  
L5050  Ankle, symes, molded socket, sach foot  
L5060  Ankle, symes, metal frame, molded leather socket, articulated ankle/foot  
L5100  Below knee, molded socket, shin, sach foot  
L5105  Below knee, plastic socket, joints and thigh lacer, sach foot  
L5150  Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot  
L5160  Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot  
L5200  Above knee, molded socket, single axis constant friction knee, shin, sach foot  
L5210  Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each  
L5220  Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each  
L5230  Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot  
L5250  Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot  
L5270  Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot  
L5280  Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot  
L5301  Below knee, molded socket, shin, sach foot, endoskeletal system  
L5311  Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot, endoskeletal system  
L5312  Knee disarticulation (or through knee), molded socket, single axis knee, pylon, sach foot, endoskeletal system  
L5321  Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee  
L5331  Hip disarticulation, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot  
L5341  Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot  
L5400  Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee  
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  
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  
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  
L5450  Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee  
L5460  Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee  
L5500  Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed  
L5505  Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed  
L5510  Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model  
L5520  Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed  
L5530  Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model  
L5535  Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket  
L5540  Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model  
L5560  Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model  
L5570  Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed  
L5580  Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model  
L5585  Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket  
L5590  Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model  
L5595  Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model  
L5600  Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model  
L5610  Addition to lower extremity, endoskeletal system, above knee, hydracadence system  
L5611  Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control  
L5613  Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control  
L5614  Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control  
L5616  Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control  
L5617  Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each  
L5618  Addition to lower extremity, test socket, symes  
L5620  Addition to lower extremity, test socket, below knee  
L5622  Addition to lower extremity, test socket, knee disarticulation  
L5624  Addition to lower extremity, test socket, above knee  
L5626  Addition to lower extremity, test socket, hip disarticulation  
L5628  Addition to lower extremity, test socket, hemipelvectomy  
L5629  Addition to lower extremity, below knee, acrylic socket  
L5630  Addition to lower extremity, symes type, expandable wall socket  
L5631  Addition to lower extremity, above knee or knee disarticulation, acrylic socket  
L5632  Addition to lower extremity, symes type, 'ptb' brim design socket  
L5634  Addition to lower extremity, symes type, posterior opening (canadian) socket  
L5636  Addition to lower extremity, symes type, medial opening socket  
L5637  Addition to lower extremity, below knee, total contact  
L5638  Addition to lower extremity, below knee, leather socket  
L5639  Addition to lower extremity, below knee, wood socket  
L5640  Addition to lower extremity, knee disarticulation, leather socket  
L5642  Addition to lower extremity, above knee, leather socket  
L5643  Addition to lower extremity, hip disarticulation, flexible inner socket, external frame  
L5644  Addition to lower extremity, above knee, wood socket  
L5645  Addition to lower extremity, below knee, flexible inner socket, external frame  
L5646  Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket  
L5647  Addition to lower extremity, below knee suction socket  
L5648  Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket  
L5649  Addition to lower extremity, ischial containment/narrow m-l socket  
L5650  Additions to lower extremity, total contact, above knee or knee disarticulation socket  
L5651  Addition to lower extremity, above knee, flexible inner socket, external frame  
L5652  Addition to lower extremity, suction suspension, above knee or knee disarticulation socket  
L5653  Addition to lower extremity, knee disarticulation, expandable wall socket  
L5654  Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)  
L5655  Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)  
L5656  Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)  
L5658  Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)  
L5661  Addition to lower extremity, socket insert, multi-durometer symes  
L5665  Addition to lower extremity, socket insert, multi-durometer, below knee  
L5666  Addition to lower extremity, below knee, cuff suspension  
L5668  Addition to lower extremity, below knee, molded distal cushion  
L5670  Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)  
L5671  Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert  
L5672  Addition to lower extremity, below knee, removable medial brim suspension  
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  
L5674  ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, ANY MATERIAL, EACH  
L5675  ADDITION TO LOWER EXTREMITY, BELOW KNEE, SUSPENSION SLEEVE, HEAVY DUTY, ANY MATERIAL, EACH  
L5676  Additions to lower extremity, below knee, knee joints, single axis, pair  
L5677  Additions to lower extremity, below knee, knee joints, polycentric, pair  
L5678  Additions to lower extremity, below knee, joint covers, pair  
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  
L5680  Addition to lower extremity, below knee, thigh lacer, nonmolded  
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)  
L5682  Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded  
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)  
L5684  Addition to lower extremity, below knee, fork strap  
L5685  Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each  
L5686  Addition to lower extremity, below knee, back check (extension control)  
L5688  Addition to lower extremity, below knee, waist belt, webbing  
L5690  Addition to lower extremity, below knee, waist belt, padded and lined  
L5692  Addition to lower extremity, above knee, pelvic control belt, light  
L5694  Addition to lower extremity, above knee, pelvic control belt, padded and lined  
L5695  Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each  
L5696  Addition to lower extremity, above knee or knee disarticulation, pelvic joint  
L5697  Addition to lower extremity, above knee or knee disarticulation, pelvic band  
L5698  Addition to lower extremity, above knee or knee disarticulation, silesian bandage  
L5699  All lower extremity prostheses, shoulder harness  
L5700  Replacement, socket, below knee, molded to patient model  
L5701  Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model  
L5702  Replacement, socket, hip disarticulation, including hip joint, molded to patient model  
L5703  Ankle, symes, molded to patient model, socket without solid ankle cushion heel (sach) foot, replacement only  
L5704  Custom shaped protective cover, below knee  
L5705  Custom shaped protective cover, above knee  
L5706  Custom shaped protective cover, knee disarticulation  
L5707  Custom shaped protective cover, hip disarticulation  
L5710  Addition, exoskeletal knee-shin system, single axis, manual lock  
L5711  Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material  
L5712  Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)  
L5714  Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control  
L5716  Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock  
L5718  Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control  
L5722  Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control  
L5724  Addition, exoskeletal knee-shin system, single axis, fluid swing phase control  
L5726  Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control  
L5728  Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control  
L5780  Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control  
L5781  Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system  
L5782  Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy duty  
L5785  Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)  
L5790  Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)  
L5795  Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)  
L5810  Addition, endoskeletal knee-shin system, single axis, manual lock  
L5811  Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material  
L5812  Addition, endoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)  
L5814  Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock  
L5816  Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock  
L5818  Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control  
L5822  Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control  
L5824  Addition, endoskeletal knee-shin system, single axis, fluid swing phase control  
L5826  Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame  
L5828  Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control  
L5830  Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control  
L5840  Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control  
L5845  Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable  
L5846  ADDITION, ENDOSKELETAL, KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY  
L5847  ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE  
L5848  Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability  
L5850  Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist  
L5855  Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist  
L5856  Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type  
L5857  Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type  
L5858  Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type  
L5859  Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)  
L5910  Addition, endoskeletal system, below knee, alignable system  
L5920  Addition, endoskeletal system, above knee or hip disarticulation, alignable system  
L5925  Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock  
L5930  Addition, endoskeletal system, high activity knee control frame  
L5940  Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)  
L5950  Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)  
L5960  Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)  
L5961  Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control  
L5962  Addition, endoskeletal system, below knee, flexible protective outer surface covering system  
L5964  Addition, endoskeletal system, above knee, flexible protective outer surface covering system  
L5966  Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system  
L5968  Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature  
L5969  Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)  
L5970  All lower extremity prostheses, foot, external keel, sach foot  
L5971  All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only  
L5972  All lower extremity prostheses, foot, flexible keel  
L5973  Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source  
L5974  All lower extremity prostheses, foot, single axis ankle/foot  
L5975  All lower extremity prosthesis, combination single axis ankle and flexible keel foot  
L5976  All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)  
L5978  All lower extremity prostheses, foot, multiaxial ankle/foot  
L5979  All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system  
L5980  All lower extremity prostheses, flex foot system  
L5981  All lower extremity prostheses, flex-walk system or equal  
L5982  All exoskeletal lower extremity prostheses, axial rotation unit  
L5984  All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability  
L5985  All endoskeletal lower extremity prostheses, dynamic prosthetic pylon  
L5986  All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)  
L5987  All lower extremity prosthesis, shank foot system with vertical loading pylon  
L5988  Addition to lower limb prosthesis, vertical shock reducing pylon feature  
L5989  ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL SYSTEM, PYLON WITH INTEGRATED ELECTRONIC FORCE SENSORS  
L5990  Addition to lower extremity prosthesis, user adjustable heel height  
L5993  ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, FOOT ONLY, (FOR PATIENT WEIGHT GREATER THAN 300 LBS)  
L5994  ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, KNEE ONLY, (FOR PATIENT WEIGHT GREATER THAN 300 LBS)  
L5995  ADDITION TO LOWER EXTREMITY PROSTHESIS, HEAVY DUTY FEATURE, OTHER THAN FOOT OR KNEE, (FOR PATIENT WEIGHT GREATER THAN 300 LBS)  
L5999  Lower extremity prosthesis, not otherwise specified  
L6000  Partial hand, thumb remaining  
L6010  Partial hand, little and/or ring finger remaining  
L6020  Partial hand, no finger remaining  
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  
L6026  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, excludes terminal device(s)  
L6050  Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad  
L6055  Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad  
L6100  Below elbow, molded socket, flexible elbow hinge, triceps pad  
L6110  Below elbow, molded socket, (muenster or northwestern suspension types)  
L6120  Below elbow, molded double wall split socket, step-up hinges, half cuff  
L6130  Below elbow, molded double wall split socket, stump activated locking hinge, half cuff  
L6200  Elbow disarticulation, molded socket, outside locking hinge, forearm  
L6205  Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm  
L6250  Above elbow, molded double wall socket, internal locking elbow, forearm  
L6300  Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm  
L6310  Shoulder disarticulation, passive restoration (complete prosthesis)  
L6320  Shoulder disarticulation, passive restoration (shoulder cap only)  
L6350  Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm  
L6360  Interscapular thoracic, passive restoration (complete prosthesis)  
L6370  Interscapular thoracic, passive restoration (shoulder cap only)  
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  
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  
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  
L6386  Immediate post surgical or early fitting, each additional cast change and realignment  
L6388  Immediate post surgical or early fitting, application of rigid dressing only  
L6400  Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping  
L6450  Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping  
L6500  Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping  
L6550  Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping  
L6570  Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping  
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  
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  
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  
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  
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  
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  
L6600  Upper extremity additions, polycentric hinge, pair  
L6605  Upper extremity additions, single pivot hinge, pair  
L6610  Upper extremity additions, flexible metal hinge, pair  
L6611  Addition to upper extremity prosthesis, external powered, additional switch, any type  
L6615  Upper extremity addition, disconnect locking wrist unit  
L6616  Upper extremity addition, additional disconnect insert for locking wrist unit, each  
L6620  Upper extremity addition, flexion/extension wrist unit, with or without friction  
L6621  Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device  
L6623  Upper extremity addition, spring assisted rotational wrist unit with latch release  
L6624  Upper extremity addition, flexion/extension and rotation wrist unit  
L6625  Upper extremity addition, rotation wrist unit with cable lock  
L6628  Upper extremity addition, quick disconnect hook adapter, otto bock or equal  
L6629  Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal  
L6630  Upper extremity addition, stainless steel, any wrist  
L6632  Upper extremity addition, latex suspension sleeve, each  
L6635  Upper extremity addition, lift assist for elbow  
L6637  Upper extremity addition, nudge control elbow lock  
L6638  Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow  
L6639  UPPER EXTREMITY ADDITION, HEAVY DUTY FEATURE, ANY ELBOW  
L6640  Upper extremity additions, shoulder abduction joint, pair  
L6641  Upper extremity addition, excursion amplifier, pulley type  
L6642  Upper extremity addition, excursion amplifier, lever type  
L6645  Upper extremity addition, shoulder flexion-abduction joint, each  
L6646  Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system  
L6647  Upper extremity addition, shoulder lock mechanism, body powered actuator  
L6648  Upper extremity addition, shoulder lock mechanism, external powered actuator  
L6650  Upper extremity addition, shoulder universal joint, each  
L6655  Upper extremity addition, standard control cable, extra  
L6660  Upper extremity addition, heavy duty control cable  
L6665  Upper extremity addition, teflon, or equal, cable lining  
L6670  Upper extremity addition, hook to hand, cable adapter  
L6672  Upper extremity addition, harness, chest or shoulder, saddle type  
L6675  Upper extremity addition, harness, (e.g., figure of eight type), single cable design  
L6676  Upper extremity addition, harness, (e.g., figure of eight type), dual cable design  
L6677  Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow  
L6680  Upper extremity addition, test socket, wrist disarticulation or below elbow  
L6682  Upper extremity addition, test socket, elbow disarticulation or above elbow  
L6684  Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic  
L6686  Upper extremity addition, suction socket  
L6687  Upper extremity addition, frame type socket, below elbow or wrist disarticulation  
L6688  Upper extremity addition, frame type socket, above elbow or elbow disarticulation  
L6689  Upper extremity addition, frame type socket, shoulder disarticulation  
L6690  Upper extremity addition, frame type socket, interscapular-thoracic  
L6691  Upper extremity addition, removable insert, each  
L6692  Upper extremity addition, silicone gel insert or equal, each  
L6693  Upper extremity addition, locking elbow, forearm counterbalance  
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  
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  
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)  
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)  
L6698  Addition to upper extremity prosthesis, below elbow/above elbow, lock mechanism, excludes socket insert  
L6700  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #3  
L6703  Terminal device, passive hand/mitt, any material, any size  
L6704  Terminal device, sport/recreational/work attachment, any material, any size  
L6705  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5  
L6706  Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined  
L6707  Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined  
L6708  Terminal device, hand, mechanical, voluntary opening, any material, any size  
L6709  Terminal device, hand, mechanical, voluntary closing, any material, any size  
L6710  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #5X  
L6711  Terminal device, hook, mechanical, voluntary opening, any material, any size, lined or unlined, pediatric  
L6712  Terminal device, hook, mechanical, voluntary closing, any material, any size, lined or unlined, pediatric  
L6713  Terminal device, hand, mechanical, voluntary opening, any material, any size, pediatric  
L6714  Terminal device, hand, mechanical, voluntary closing, any material, any size, pediatric  
L6715  Terminal device, multiple articulating digit, includes motor(s), initial issue or replacement  
L6720  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #6  
L6721  Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any material, any size, lined or unlined  
L6722  Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined  
L6725  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7  
L6730  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #7LO  
L6735  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8  
L6740  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #8X  
L6745  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #88X  
L6750  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10P  
L6755  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #10X  
L6765  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #12P  
L6770  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #99X  
L6775  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #555  
L6780  TERMINAL DEVICE, HOOK, DORRANCE, OR EQUAL, MODEL #SS555  
L6790  TERMINAL DEVICE, HOOK-ACCU HOOK, OR EQUAL  
L6795  TERMINAL DEVICE, HOOK-2 LOAD, OR EQUAL  
L6800  TERMINAL DEVICE, HOOK-APRL VC, OR EQUAL  
L6805  Addition to terminal device, modifier wrist unit  
L6806  TERMINAL DEVICE, HOOK, TRS GRIP, GRIP III, VC, OR EQUAL  
L6807  TERMINAL DEVICE, HOOK, GRIP I, GRIP II, VC, OR EQUAL  
L6808  TERMINAL DEVICE, HOOK, TRS ADEPT, INFANT OR CHILD, VC, OR EQUAL  
L6809  TERMINAL DEVICE, HOOK, TRS SUPER SPORT, PASSIVE  
L6810  Addition to terminal device, precision pinch device  
L6825  TERMINAL DEVICE, HAND, DORRANCE, VO  
L6830  TERMINAL DEVICE, HAND, APRL, VC  
L6835  TERMINAL DEVICE, HAND, SIERRA, VO  
L6840  TERMINAL DEVICE, HAND, BECKER IMPERIAL  
L6845  TERMINAL DEVICE, HAND, BECKER LOCK GRIP  
L6850  TERMINAL DEVICE, HAND, BECKER PLYLITE  
L6855  TERMINAL DEVICE, HAND, ROBIN-AIDS, VO  
L6860  TERMINAL DEVICE, HAND, ROBIN-AIDS, VO SOFT  
L6865  TERMINAL DEVICE, HAND, PASSIVE HAND  
L6867  TERMINAL DEVICE, HAND, DETROIT INFANT HAND (MECHANICAL)  
L6868  TERMINAL DEVICE, HAND, PASSIVE INFANT HAND, (STEEPER, HOSMER OR EQUAL)  
L6870  TERMINAL DEVICE, HAND, CHILD MITT  
L6872  TERMINAL DEVICE, HAND, NYU CHILD HAND  
L6873  TERMINAL DEVICE, HAND, MECHANICAL INFANT HAND, STEEPER OR EQUAL  
L6875  TERMINAL DEVICE, HAND, BOCK, VC  
L6880  Electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s)  
L6881  Automatic grasp feature, addition to upper limb electric prosthetic terminal device  
L6882  Microprocessor control feature, addition to upper limb prosthetic terminal device  
L6883  Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power  
L6884  Replacement socket, above elbow/elbow disarticulation, molded to patient model, for use with or without external power  
L6885  Replacement socket, shoulder disarticulation/interscapular thoracic, molded to patient model, for use with or without external power  
L6890  Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment  
L6895  Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated  
L6900  Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining  
L6905  Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining  
L6910  Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining  
L6915  Hand restoration (shading, and measurements included), replacement glove for above  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
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  
L7007  Electric hand, switch or myoelectric controlled, adult  
L7008  Electric hand, switch or myoelectric, controlled, pediatric  
L7009  Electric hook, switch or myoelectric controlled, adult  
L7010  ELECTRONIC HAND, OTTO BOCK, STEEPER OR EQUAL, SWITCH CONTROLLED  
L7015  ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED  
L7020  ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, SWITCH CONTROLLED  
L7025  ELECTRONIC HAND, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED  
L7030  ELECTRONIC HAND, SYSTEM TEKNIK, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED  
L7035  ELECTRONIC GREIFER, OTTO BOCK OR EQUAL, MYOELECTRONICALLY CONTROLLED  
L7040  Prehensile actuator, switch controlled  
L7045  Electric hook, switch or myoelectric controlled, pediatric  
L7170  Electronic elbow, hosmer or equal, switch controlled  
L7180  Electronic elbow, microprocessor sequential control of elbow and terminal device  
L7181  Electronic elbow, microprocessor simultaneous control of elbow and terminal device  
L7185  Electronic elbow, adolescent, variety village or equal, switch controlled  
L7186  Electronic elbow, child, variety village or equal, switch controlled  
L7190  Electronic elbow, adolescent, variety village or equal, myoelectronically controlled  
L7191  Electronic elbow, child, variety village or equal, myoelectronically controlled  
L7259  Electronic wrist rotator, any type  
L7260  Electronic wrist rotator, otto bock or equal  
L7261  Electronic wrist rotator, for utah arm  
L7266  Servo control, steeper or equal  
L7272  Analogue control, unb or equal  
L7274  Proportional control, 6-12 volt, liberty, utah or equal  
L7360  Six volt battery, each  
L7362  Battery charger, six volt, each  
L7364  Twelve volt battery, each  
L7366  Battery charger, twelve volt, each  
L7367  Lithium ion battery, rechargeable, replacement  
L7368  Lithium ion battery charger, replacement only  
L7400  Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)  
L7401  Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)  
L7402  Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)  
L7403  Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material  
L7404  Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material  
L7405  Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material  
L7499  Upper extremity prosthesis, not otherwise specified  
L7500  Repair of prosthetic device, hourly rate (excludes v5335 repair of oral or laryngeal prosthesis or artificial larynx)  
L7510  Repair of prosthetic device, repair or replace minor parts  
L7520  Repair prosthetic device, labor component, per 15 minutes  
L7600  Prosthetic donning sleeve, any material, each  
L7611  TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC  
L7612  TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC  
L7613  TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PEDIATRIC  
L7614  TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PEDIATRIC  
L7621  TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED  
L7622  TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED  
L7700  Gasket or seal, for use with prosthetic socket insert, any type, each  
L7900  Male vacuum erection system  
L7902  Tension ring, for vacuum erection device, any type, replacement only, each  
L8000  Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type  
L8001  Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type  
L8002  Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type  
L8010  Breast prosthesis, mastectomy sleeve  
L8015  External breast prosthesis garment, with mastectomy form, post mastectomy  
L8020  Breast prosthesis, mastectomy form  
L8030  Breast prosthesis, silicone or equal, without integral adhesive  
L8031  Breast prosthesis, silicone or equal, with integral adhesive  
L8032  Nipple prosthesis, prefabricated, reusable, any type, each  
L8033  Nipple prosthesis, custom fabricated, reusable, any material, any type, each  
L8035  Custom breast prosthesis, post mastectomy, molded to patient model  
L8039  Breast prosthesis, not otherwise specified  
L8040  Nasal prosthesis, provided by a non-physician  
L8041  Midfacial prosthesis, provided by a non-physician  
L8042  Orbital prosthesis, provided by a non-physician  
L8043  Upper facial prosthesis, provided by a non-physician  
L8044  Hemi-facial prosthesis, provided by a non-physician  
L8045  Auricular prosthesis, provided by a non-physician  
L8046  Partial facial prosthesis, provided by a non-physician  
L8047  Nasal septal prosthesis, provided by a non-physician  
L8048  Unspecified maxillofacial prosthesis, by report, provided by a non-physician  
L8049  Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician  
L8100  GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH  
L8110  GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH  
L8120  GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH  
L8130  GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH  
L8140  GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40 MMHG, EACH  
L8150  GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50 MMHG, EACH  
L8160  GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH  
L8170  GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, EACH  
L8180  GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH  
L8190  GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, EACH  
L8195  GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH  
L8200  GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40-50 MMHG, EACH  
L8210  GRADIENT COMPRESSION STOCKING, CUSTOM MADE  
L8220  GRADIENT COMPRESSION STOCKING, LYMPHEDEMA  
L8230  GRADIENT COMPRESSION STOCKING, GARTER BELT  
L8239  GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED  
L8300  Truss, single with standard pad  
L8310  Truss, double with standard pads  
L8320  Truss, addition to standard pad, water pad  
L8330  Truss, addition to standard pad, scrotal pad  
L8400  Prosthetic sheath, below knee, each  
L8410  Prosthetic sheath, above knee, each  
L8415  Prosthetic sheath, upper limb, each  
L8417  Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each  
L8420  Prosthetic sock, multiple ply, below knee, each  
L8430  Prosthetic sock, multiple ply, above knee, each  
L8435  Prosthetic sock, multiple ply, upper limb, each  
L8440  Prosthetic shrinker, below knee, each  
L8460  Prosthetic shrinker, above knee, each  
L8465  Prosthetic shrinker, upper limb, each  
L8470  Prosthetic sock, single ply, fitting, below knee, each  
L8480  Prosthetic sock, single ply, fitting, above knee, each  
L8485  Prosthetic sock, single ply, fitting, upper limb, each  
L8490  ADDITION TO PROSTHETIC SHEATH/SOCK, AIR SEAL SUCTION RETENTION SYSTEM  
L8499  Unlisted procedure for miscellaneous prosthetic services  
L8500  Artificial larynx, any type  
L8501  Tracheostomy speaking valve  
L8505  Artificial larynx replacement battery / accessory, any type  
L8507  Tracheo-esophageal voice prosthesis, patient inserted, any type, each  
L8509  Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type  
L8510  Voice amplifier  
L8511  Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each  
L8512  Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10  
L8513  Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each  
L8514  Tracheoesophageal puncture dilator, replacement only, each  
L8515  Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each  
L8600  Implantable breast prosthesis, silicone or equal  
L8603  Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies  
L8604  Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies  
L8605  Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies  
L8606  Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies  
L8607  Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies  
L8608  Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system  
L8609  Artificial cornea  
L8610  Ocular implant  
L8612  Aqueous shunt  
L8613  Ossicula implant  
L8614  Cochlear device, includes all internal and external components  
L8615  Headset/headpiece for use with cochlear implant device, replacement  
L8616  Microphone for use with cochlear implant device, replacement  
L8617  Transmitting coil for use with cochlear implant device, replacement  
L8618  Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement  
L8619  Cochlear implant, external speech processor and controller, integrated system, replacement  
L8620  LITHIUM ION BATTERY FOR USE WITH COCHLEAR IMPLANT DEVICE, REPLACEMENT, EACH  
L8621  Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each  
L8622  Alkaline battery for use with cochlear implant device, any size, replacement, each  
L8623  Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each  
L8624  Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each  
L8625  External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each  
L8627  Cochlear implant, external speech processor, component, replacement  
L8628  Cochlear implant, external controller component, replacement  
L8629  Transmitting coil and cable, integrated, for use with cochlear implant device, replacement  
L8630  Metacarpophalangeal joint implant  
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)  
L8641  Metatarsal joint implant  
L8642  Hallux implant  
L8658  Interphalangeal joint spacer, silicone or equal, each  
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  
L8670  Vascular graft material, synthetic, implant  
L8679  Implantable neurostimulator, pulse generator, any type  
L8680  Implantable neurostimulator electrode, each  
L8681  Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only  
L8682  Implantable neurostimulator radiofrequency receiver  
L8683  Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver  
L8684  Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement  
L8685  Implantable neurostimulator pulse generator, single array, rechargeable, includes extension  
L8686  Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension  
L8687  Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension  
L8688  Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension  
L8689  External recharging system for battery (internal) for use with implantable neurostimulator, replacement only  
L8690  Auditory osseointegrated device, includes all internal and external components  
L8691  Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each  
L8692  Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment  
L8693  Auditory osseointegrated device abutment, any length, replacement only  
L8694  Auditory osseointegrated device, transducer/actuator, replacement only, each  
L8695  External recharging system for battery (external) for use with implantable neurostimulator, replacement only  
L8696  Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each  
L8698  Miscellaneous component, supply or accessory for use with total artificial heart system  
L8699  Prosthetic implant, not otherwise specified  
L8701  Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated  
L8702  Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated  
L9900  Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code  
Q0138  Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)  
Q0139  Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)  
Q0162  Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen  
Q0187  FACTOR VIIA (COAGULATION FACTOR, RECOMBINANT) PER 1.2 MG  
Q0478  Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type  
Q0479  Power module for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0480  Driver for use with pneumatic ventricular assist device, replacement only  
Q0481  Microprocessor control unit for use with electric ventricular assist device, replacement only  
Q0482  Microprocessor control unit for use with electric/pneumatic combination ventricular assist device, replacement only  
Q0483  Monitor/display module for use with electric ventricular assist device, replacement only  
Q0484  Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0485  Monitor control cable for use with electric ventricular assist device, replacement only  
Q0486  Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only  
Q0487  Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only  
Q0488  Power pack base for use with electric ventricular assist device, replacement only  
Q0489  Power pack base for use with electric/pneumatic ventricular assist device, replacement only  
Q0490  Emergency power source for use with electric ventricular assist device, replacement only  
Q0491  Emergency power source for use with electric/pneumatic ventricular assist device, replacement only  
Q0492  Emergency power supply cable for use with electric ventricular assist device, replacement only  
Q0493  Emergency power supply cable for use with electric/pneumatic ventricular assist device, replacement only  
Q0494  Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0495  Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0496  Battery, other than lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0497  Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0498  Holster for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0499  Belt/vest/bag for use to carry external peripheral components of any type ventricular assist device, replacement only  
Q0500  Filters for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0501  Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0502  Mobility cart for pneumatic ventricular assist device, replacement only  
Q0503  Battery for pneumatic ventricular assist device, replacement only, each  
Q0504  Power adapter for pneumatic ventricular assist device, replacement only, vehicle type  
Q0505  Miscellaneous supply or accessory for use with ventricular assist device  
Q0506  Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only  
Q0507  Miscellaneous supply or accessory for use with an external ventricular assist device  
Q0508  Miscellaneous supply or accessory for use with an implanted ventricular assist device  
Q0509  Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a  
Q0515  Injection, sermorelin acetate, 1 microgram  
Q2001  ORAL, CABERGOLINE, 0.5 MG  
Q2002  INJECTION, ELLIOTTS B SOLUTION, PER ML  
Q2003  INJECTION, APROTININ, 10,000 KIU  
Q2004  Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml  
Q2005  INJECTION, CORTICORELIN OVINE TRIFLUTATE, PER DOSE  
Q2006  INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL  
Q2007  INJECTION, ETHANOLAMINE OLEATE, 100 MG  
Q2008  INJECTION, FOMEPIZOLE, 15 MG  
Q2009  Injection, fosphenytoin, 50 mg phenytoin equivalent  
Q2011  INJECTION, HEMIN, PER 1 MG  
Q2012  INJECTION, PEGADEMASE BOVINE, 25 IU  
Q2013  INJECTION, PENTASTARCH, 10% SOLUTION, PER 100 ML  
Q2014  INJECTION, SERMORELIN ACETATE, 0.5 MG  
Q2017  Injection, teniposide, 50 mg  
Q2018  INJECTION, UROFOLLITROPIN, 75 IU  
Q2020  INJECTION, HISTRELIN ACETATE, 10 MCG  
Q2021  INJECTION, LEPIRUDIN, 50 MG  
Q2022  VON WILLEBRAND FACTOR COMPLEX, HUMAN, PER IU  
Q2023  INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U.  
Q2024  INJECTION, BEVACIZUMAB, 0.25 MG  
Q2040  Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion  
Q2049  Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg  
Q3025  Injection, interferon beta-1a, 11 mcg for intramuscular use  
Q3026  Injection, interferon beta-1a, 11 mcg for subcutaneous use  
Q3027  Injection, interferon beta-1a, 1 mcg for intramuscular use  
Q3028  Injection, interferon beta-1a, 1 mcg for subcutaneous use  
Q4074  Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms  
Q4075  INJECTION, ACYCLOVIR, 5 MG  
Q4076  INJECTION, DOPAMINE HCL, 40 MG  
Q4077  INJECTION, TREPROSTINIL, 1 MG  
Q4079  INJECTION, NATALIZUMAB, 1 MG  
Q4080  ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 20 MICROGRAMS  
Q4087  INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG  
Q4088  INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), INTRAVENOUS, NON-LYOPHILIZED, (E.G. LIQUID), 500 MG  
Q4089  INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVENOUS, 100 IU  
Q4090  INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUSCULAR, 0.5 ML  
Q4091  INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED, (E.G. LIQUID), 500 MG  
Q4092  INJECTION, IMMUNE GLOBULIN, (GAMUNEX), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG  
Q4093  ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)  
Q4094  ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)  
Q4095  INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG  
Q4096  INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN COFACTOR (NOT OTHERWISE SPECIFIED), PER I.U. VWF: RCO  
Q4097  INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG  
Q4098  INJECTION, IRON DEXTRAN, 50 MG  
Q4099  FORMOTEROL FUMARATE, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 20 MICROGRAMS  
Q5103  Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg  
Q5104  Injection, infliximab-abda, biosimilar, (renflexis), 10 mg  
Q5105  Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units  
Q5106  Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units  
Q5107  Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg  
Q5108  Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg  
Q5109  Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg  
Q5110  Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram  
Q5111  Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg  
Q5112  Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg  
Q5113  Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg  
Q5114  Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg  
Q5115  Injection, rituximab-abbs, biosimilar, (truxima), 10 mg  
Q5116  Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg  
Q5117  Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg  
Q5118  Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg  
Q9941  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 1G  
Q9942  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED, 10 MG  
Q9943  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 1G  
Q9944  INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED, 10 MG  
Q9985  Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg  
Q9986  Injection, hydroxyprogesterone caproate, (makena), 10 mg  
Q9989  Ustekinumab, for intravenous injection, 1 mg  
S0014  Tacrine hydrochloride, 10 mg  
S0016  INJECTION, AMIKACIN SULFATE, 500 MG  
S0017  Injection, aminocaproic acid, 5 grams  
S0020  Injection, bupivicaine hydrochloride, 30 ml  
S0021  Injection, cefoperazone sodium, 1 gram  
S0023  Injection, cimetidine hydrochloride, 300 mg  
S0028  Injection, famotidine, 20 mg  
S0030  Injection, metronidazole, 500 mg  
S0032  Injection, nafcillin sodium, 2 grams  
S0034  Injection, ofloxacin, 400 mg  
S0039  Injection, sulfamethoxazole and trimethoprim, 10 ml  
S0040  Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams  
S0071  INJECTION, ACYCLOVIR SODIUM, 50 MG  
S0072  INJECTION, AMIKACIN SULFATE, 100 MG  
S0073  Injection, aztreonam, 500 mg  
S0074  Injection, cefotetan disodium, 500 mg  
S0077  Injection, clindamycin phosphate, 300 mg  
S0078  Injection, fosphenytoin sodium, 750 mg  
S0080  Injection, pentamidine isethionate, 300 mg  
S0081  Injection, piperacillin sodium, 500 mg  
S0090  Sildenafil citrate, 25 mg  
S0122  Injection, menotropins, 75 iu  
S0126  Injection, follitropin alfa, 75 iu  
S0128  Injection, follitropin beta, 75 iu  
S0132  Injection, ganirelix acetate, 250 mcg  
S0170  Anastrozole, oral, 1 mg  
S0179  Megestrol acetate, oral, 20 mg  
S0189  Testosterone pellet, 75 mg  
S1001  Deluxe item, patient aware (list in addition to code for basic item)  
S1002  Customized item (list in addition to code for basic item)  
S1030  Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code)  
S1031  Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code)  
S1040  Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)  
S8260  ORAL ORTHOTIC FOR TREATMENT OF SLEEP APNEA, INCLUDES FITTING, FABRICATION, AND MATERIALS  
S8450  Splint, prefabricated, digit (specify digit by use of modifier)  
S8451  Splint, prefabricated, wrist or ankle  
S8452  Splint, prefabricated, elbow  
V2623  Prosthetic eye, plastic, custom  
V2624  Polishing/resurfacing of ocular prosthesis  
V2625  Enlargement of ocular prosthesis  
V2626  Reduction of ocular prosthesis  
V2627  Scleral cover shell  
V2628  Fabrication and fitting of ocular conformer  
V2629  Prosthetic eye, other type  
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