Item Code Item Type Item Group ID Item Group Description

Transcription

1 Item Code Item Type Item Group ID Item Group Description A4335 Misc incontinence supply 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS A4554 Underpads, disposable, each 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS A9270 Non-covered item or service 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4521 Adult sized disposable incontinence product, brief 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4522 Adult sized disposable incontinence product, brief 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4523 Adult sized disposable incontinence product, brief 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4524 Adult sized disposable incontinence product, brief 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4525 Adult sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4526 Adult sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4527 Adult sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4528 Adult sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4529 Pediatric sized disposable incontinence product, b 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4530 Pediatric size disposable incontinence product bri 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4531 Pediatric size disposable incontinence product, pr 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4532 Pediatric sized disposable incontinence product, p 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4533 Youth sized disposable incontinence product, brief 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4534 Youth sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4535 Disposable liner/shield/guard/pad/undergarment, fo 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS

2 T4543 Adult sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS T4544 Adult sized disposable incontinence product, prote 9 INCONTINENCE PRODUCTS INCLUDING DIAPERS AND UNDERPADS E0117 Crutch, underarm, articulating, spring assisted, e AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0140 Walker, with trunk support, adjustable or fixed he AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0144 Walker, enclosed, four (4) sided framed, rigid or AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0147 Walker, heavy duty, multiple braking system, varia AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0148 Heavy duty walker, without wheels, rigid or foldin AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0149 Walker, heavy duty, wheeled, rigid or folding, any AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0641 Standing frame/table system, multi-position (e.g. AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0642 Standing frame/table system, mobile (dyna AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0637 Combination sit to stand/table system, any size in AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0638 Standing frame/table system, one (1) position (e.g AMBULATION DEVICES INCLUDING CRUTCHES, WALKERS, AND GAIT 12 TRAINERS and STANDERS E0240 Bath/shower chair, with or without wheels, any siz 13 BATH AND TOILETING EQUIPMENT E0241 Bathtub wall rail, each 13 BATH AND TOILETING EQUIPMENT E0242 Bathtub rail, floor base, each 13 BATH AND TOILETING EQUIPMENT E0243 Toilet rail, each 13 BATH AND TOILETING EQUIPMENT E0244 Toilet seat, raised, each 13 BATH AND TOILETING EQUIPMENT E0245 Tub stool or bench, each 13 BATH AND TOILETING EQUIPMENT E0246 Transfer tub rail attachment, each 13 BATH AND TOILETING EQUIPMENT E0247 Transfer bench for tub or toilet with or without 13 BATH AND TOILETING EQUIPMENT

3 E0248 Transfer bench, heavy duty, for tub or toilet with 13 BATH AND TOILETING EQUIPMENT E0165 Commode chair, mobile or stationary, with detachab 13 BATH AND TOILETING EQUIPMENT E0168 Extra wide and/or heavy duty commode chair, statio 13 BATH AND TOILETING EQUIPMENT E0170 Commode chair with integrated seat lift mechanism, 13 BATH AND TOILETING EQUIPMENT E0171 Commode chair with integrated seat lift mechanism, 13 BATH AND TOILETING EQUIPMENT E0172 Seat lift mechanism placed over or on top of toile 13 BATH AND TOILETING EQUIPMENT E1300 Whirlpool, portable (over tub type) 13 BATH AND TOILETING EQUIPMENT E1310 Whirlpool, nonportable (built-in type) 13 BATH AND TOILETING EQUIPMENT E0942 Cervical head harness or halter, each E0944 Pelvic belt, harness or boat, each A8000 Helmet, protective, soft, prefabricated, includes A8001 Helmet, protective, hard, prefabricated, includes A8002 Helmet, protective, soft, custom fabricated, inclu A8003 Helmet, protective, hard, custom fabricated, inclu A8004 Soft interface for helmet, replacement only S1040 Cranial remolding orthosis, pediatric, rigid, with E1841 Static progressive stretch shoulder device, with o L9900 Orthotic and prosthetic supply, accessory, and/or S8420 Gradient pressure aid (sleeve and glove combinatio

4 S8421 S8422 S8423 Gradient pressure aid (sleeve and glove combinatio Gradient pressure aid (sleeve), custom made, mediu Gradient pressure aid (sleeve), custom made, heavy S8424 Gradient pressure aid (sleeve), ready made S8425 Gradient pressure aid (glove), custom made, medium S8426 Gradient pressure aid (glove), custom made, heavy S8427 Gradient pressure aid (glove), ready made S8428 Gradient pressure aid (gauntlet), ready made S8429 Gradient pressure exterior wrap L0112 Cranial cervical orthosis, congenital torticollis L0113 Cranial cervical orthosis, toricollis type, with o L0130 Cervical, flexible, thermoplastic collar, molded t L0140 Cervical, semi-rigid, adjustable (plastic collar) L0150 Cervical, semi-rigid, adjustable molded chin cup ( L0160 Cervical, semi-rigid, wire frame occipital/mandibu L0170 Cervical, collar, molded to patient model L0172 Cervical, collar, semi-rigid thermoplastic foam, t L0174 Cervical, collar, semi-rigid, thermoplastic foam,

5 L0180 Cervical, multiple post collar occipital/mandibula L0190 Cervical, multiple post collar, occipital/mandibul L0200 Cervical, multiple post collar, occipital/ mandibu L0220 Thoracic rib belt, custom fabricated L3000 Foot insert, removable, molded to patient model,? L3001 Foot insert, removable, molded to patient model, S L3002 Foot insert, removable, molded to patient model, P L3003 Foot insert, removable, molded to patient model, s L3010 Foot insert, removable, molded to patient model, l L3020 Foot insert, removable, molded to patient model, l L3030 Foot insert, removable, formed to patient foot, ea L3031 Foot, insert/plate, removable, addition to lower e L3040 Foot, arch support, removable, pre-molded, longitu L3050 Foot, arch support, removable, pre-molded, metatar L3060 Foot, arch support, removable, pre-molded, longitu L3070 Foot, arch support, non-removable, attached to sho L3080 Foot, arch support, non-removable attached to shoe

6 L3090 L3100 L3140 Foot, arch support, non-removable attached to shoe Hallus-valgus night dynamic splint, prefabricated, 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, L3215 Orthopedic footwear, ladies shoe, oxford, each L3216 Orthopedic footwear, ladies shoe, depth inlay, eac L3217 Orthopedic footwear, ladies shoe, hightop, depth i L3219 Orthopedic footwear, men?s shoe, oxford, each L3221 Orthopedic footwear, men?s shoe, depth inlay, each L3222 Orthopedic footwear, men?s shoe, hightop, depth in L3224 Orthopedic footwear woman?s shoe, oxford, used as L3225 Orthopedic footwear man?s shoe, oxford, used as an L3230 Orthopedic footwear, custom shoe, depth inlay, eac L3250 Orthopedic footwear, custom molded shoe, removable L3251 Foot, shoe molded to patient model, silicone shoe,

7 L3252 Foot, shoe molded to patient model, Plastazote (or L3253 Foot, molded shoe Plastozote (or similar), custom L3254 Nonstandard size or width L3255 Nonstandard size or length L3257 Orthopedic footwear, additional charge for split s L3260 Surgical boot/shoe, each L3265 Plastazote sandal, each L3300 Lift, elevation, heel, tapered to metatarsals, per 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-h 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

8 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 wit 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 ins L3580 Orthopedic shoe addition, convert instep to Velcro L3590 Orthopedic shoe addition, convert firm shoe counte L3595 Orthopedic shoe addition, March bar L3600 Transfer of an orthosis from one (1) shoe to anoth L3610 Transfer of an orthosis from one (1) shoe to anoth L3620 Transfer of an orthosis from one (1) shoe to anoth L3630 Transfer of an orthosis from one (1) shoe to anoth L3640 Transfer of an orthosis from one (1) shoe to anoth L3649 Orthopedic shoe, modification, additional or trans L6704 Term dev, sport/rec/work att

9 L6715 Terminal device, multiple articulating digit, incl L6880 Electric hand, switch or myolelectric controlled, L6881 Automatic grasp feature, addition to upper limb el L6882 Microprocessor control feature, addition to upper L6890 Addition to upper extremity prosthesis, glove for L6895 Addition to upper extremity prosthesis, glove for L6900 Hand restoration (casts, shading and measurements L6905 Hand restoration (casts, shading and measurements L6910 Hand restoration (casts, shading and measurements L6915 Hand restoration (shading and measurements include L8030 Breast prosthesis, silicone or equal, without inte L8031 Breast prosthesis, silicone or equal, with integra L8032 Nipple prosthesis, reusable, any type, each L8039 Breast prosthesis, NOS L8040 Nasal prosthesis, provided by a nonphysician L8041 Midfacial prosthesis, provided by a nonphysician L8042 Orbital prosthesis, provided by a nonphysician L8043 Upper facial prosthesis, provided by a nonphysici

10 L8044 Hemi-facial prosthesis, provided by a nonphysicia L8045 Auricular prosthesis, provided by a nonphysician L8046 Partial facial prosthesis, provided by a nonphysi L8047 Nasal septal prosthesis, provided by a nonphysici L8048 Unspecified maxillofacial prosthesis, by report, p L8049 Repair or modification of maxillofacial prosthesis L8499 Unlisted procedure for miscellaneous prosthetic se L8505 Artificial larynx replacement battery/accessory, a L8507 Tracheo-esophageal voice prosthesis, patient inser L8509 Tracheo-esophageal voice prosthesis, inserted by a L8510 Voice amplifier L8600 Implantable breast prosthesis L8610 Ocular implant A4640 Replacement pad for use with medically necessary a E0181 Powered pressure reducing mattress overlay/pad, al E0182 Pump for alternating pressure pad, for replacement E0184 Mattress, dry flotation E0185 Gel or gel-like pressure pad for mattress, standar

11 E0186 Mattress, air pressure E0187 Mattress, water pressure E0188 Sheepskin pad, synthetic E0189 Sheepskin pad, lambs wool, any size E0190 Positioning cushion/pillow/wedge, any shape or siz E0191 Heel or elbow protector, each E0193 Air fluidized bed, per day E0194 Bed, powered air flotation (low air loss therapy), E0196 Mattress, Gel pressure E0197 Air pressure pad for mattress, standard mattress l E0198 Water pressure pad for mattress, standard mattress E0199 Dry pressure pad for mattress, standard mattress l E0250 Hospital bed, fixed height, with any type side rai E0255 Hospital bed, variable height, Hi-Lo, with any typ E0256 Hospital bed, variable height, hi-lo, with any typ E0260 Hospital bed, semi-electric (head & foot adjustmen E0261 Hospital bed, semi-electric (head and foot adjustm

12 E0265 Hospital bed, total electric (head, foot & height E0266 Hospital bed, total electric (head, foot, and heig E0270 Hospital bed, institutional type includes: oscill E0271 Mattress, innerspring E0272 Mattress, foam rubber E0273 Bed board E0274 Over-bed table E0277 Powered pressure-reducing air mattress E0280 Bed, cradle, any type E0290 Hospital bed, fixed height, without side rails, wi E0291 Hospital bed, fixed height, without side rails, wi E0292 Hospital bed, variable height, hi-lo, without side E0293 Hospital bed, variable height, hi-lo, without side E0294 Hospital bed, semi-electric (head and foot adjustm E0295 Hospital bed, semi-electric (head and foot adjustm E0296 Hospital bed, total electric (head, foot, and heig E0297 Hospital bed, total electric (head, foot, and heig

13 E0300 Pediatric crib, hospital grade, fully enclosed, wi E0301 Hospital bed, heavy duty, extra wide, with weight E0302 Hospital bed, extra heavy duty, extra wide, with w E0303 Hospital bed, heavy duty, extra wide, with weight E0304 Hospital bed, extra heavy duty, extra wide, with w E0305 Bed side rails, half length, pair E0310 Bed side rails, full length, pair E0315 Bed accessory: board, table, or support device any E0316 Safety enclosure frame/canopy for use with hospita E0328 Hospital bed, pediatric, manual, 360 degree side e E0329 Hospital bed, pediatric, electric or semielectric E0370 Air pressure elevator for heel E0371 Non-powered advanced pressure reducing overlay for E0372 Powered air overlay for mattress, standard mattres E0373 Non-powered advanced pressure reducing mattress E0462 Rocking bed with or without side rails, per day E0700 Safety equipment, device or accessory, any type

14 E0710 Restraints, any type (body, chest, wrist or ankle) E0910 Trapeze bars (also known as ""patient helper"" E0911 Trapeze bar, heavy duty, for patient weight capaci E0912 Trapeze bar, heavy duty, for patient weight capaci E2601 General use wheelchair seat cushion, width less th E2602 General use wheelchair seat cushion, width 22 inch E2603 Skin protection wheelchair seat cushion, width les E2604 Skin protection wheelchair seat cushion, width 22 E2605 Positioning wheelchair seat cushion, width less th E2606 Positioning wheelchair seat cushion, width 22 inch E2607 Skin protection and positioning wheelchair seat cu E2608 Skin protection and positioning wheelchair seat cu E2609 Custom fabricated wheelchair seat cushion, any siz E2610 Wheelchair seat cushion, powered E2611 General use wheelchair back cushion, width less th E2612 General use wheelchair back cushion, width 22 inch E2613 Positioning wheelchair back cushion, posterior, wi

15 E2614 E2615 E2616 E2617 E2619 E2620 E2621 E2622 E2623 E2624 E2625 E2626 E2627 E2628 E2629 E2630 E2631 Positioning wheelchair back cushion, posterior, wi Positioning wheelchair back cushion, posterior-lat Positioning wheelchair back cushion, posterior-lat Custom fabricated wheelchair back cushion, any siz Replacement cover for wheelchair seat cushion or b Positioning wheelchair back cushion, planar back w Positioning wheelchair back cushion, planar back w Skin protection wheelchair seat cushion, adjustabl Skin protection wheelchair seat cushion, adjustabl Skin protection and positioning wheelchair seat cu Skin protection and positioning wheelchair seat cu Wheelchair accessory, shoulder elbow, mobile arm s Wheelchair accessory, shoulder elbow, mobile arm s Wheelchair accessory, shoulder elbow, mobile arm s Wheelchair accessory, shoulder elbow, mobile arm s Wheelchair accessory, shoulder elbow, mobile arm s Wheelchair accessory, addition to mobile arm suppo

16 E2632 E2633 E8000 E8001 E8002 K0800 K0801 K0802 K0806 K0807 K0808 K0812 K0813 K0814 K0815 K0816 K0820 Wheelchair accessory, addition to mobile arm suppo Wheelchair accessory, addition to mobile arm suppo Gait trainer, pediatric size, posterior support, i Gait trainer, pediatric size, upright support, inc Gait trainer, pediatric size, anterior support, in Power operated vehicle, group 1 standard, patient Power operated vehicle, group 1 heavy duty, patien Power operated vehicle, group 1 very heavy duty, p Power operated vehicle, group 2 standard, patient Power operated vehicle, group 2 heavy duty, patien Power operated vehicle, group 2 very heavy duty, p Power operated vehicle, not otherwise classified Power wheelchair, group 1 standard, portable, slin Power wheelchair, group 1 standard, portable, capt Power wheelchair, group 1 standard, sling/solid se Power wheelchair, group 1 standard, captains chair Power wheelchair, group 2 standard, portable, slin

17 K0821 K0822 K0823 K0824 K0825 K0826 K0827 K0828 K0829 K0830 K0831 K0835 K0836 K0837 K0838 K0839 K0840 Power wheelchair, group 2 standard, portable, capt Power wheelchair, group 2 standard, sling/solid se Power wheelchair, group 2 standard, captains chair Power wheelchair, group 2 heavy duty, sling/solid Power wheelchair, group 2 heavy duty, captains cha Power wheelchair, group 2 very heavy duty, sling/s Power wheelchair, group 2 very heavy duty, captain Power wheelchair, group 2 extra heavy duty, sling/ Power wheelchair, group 2 extra heavy duty, captai Power wheelchair, group 2 standard, seat elevator, Power wheelchair, group 2 standard, seat elevator, Power wheelchair, group 2 standard, single power o Power wheelchair, group 2 standard, single power o Power wheelchair, group 2 heavy duty, single power Power wheelchair, group 2 heavy duty, single power Power wheelchair, group 2 very heavy duty, single Power wheelchair, group 2 very heavy duty, single

18 K0841 K0842 K0843 K0848 K0849 K0850 K0851 K0852 K0853 K0854 K0855 K0856 K0857 K0858 K0859 K0860 K0861 Power wheelchair, group 2 standard, multiple power Power wheelchair, group 2 standard, multiple power Power wheelchair, group 2 heavy duty, multiple pow Power wheelchair, group 3 standard, sling/solid se Power wheelchair, group 3 standard, captains chair Power wheelchair, group 3 heavy duty, sling/solid Power wheelchair, group 3 heavy duty, captains cha Power wheelchair, group 3 very heavy duty, sling/s Power wheelchair, group 3 very heavy duty, captain Power wheelchair, group 3 extra heavy duty, sling/ Power wheelchair, group 3 extra heavy duty, captai Power wheelchair, group 3 standard, single power o Power wheelchair, group 3 standard, single power o Power wheelchair, group 3 heavy duty, single power Power wheelchair, group 3 heavy duty, single power Power wheelchair, group 3 very heavy duty, single Power wheelchair, group 3 standard, multiple power

19 K0862 Power wheelchair, group 3 heavy duty, multiple pow K0863 Power wheelchair, group 3 very heavy duty, multipl K0864 Power wheelchair, group 3 extra heavy duty, multip K0868 Power wheelchair, group 4 standard, sling/solid se K0869 Power wheelchair, group 4 standard, captains chair K0870 Power wheelchair, group 4 heavy duty, sling/solid K0871 Power wheelchair, group 4 very heavy duty, sling/s K0877 Power wheelchair, group 4 standard, single power o K0878 Power wheelchair, group 4 standard, single power o K0879 Power wheelchair, group 4 heavy duty, single power K0880 Power wheelchair, group 4 very heavy duty, single K0884 Power wheelchair, group 4 standard, multiple power K0885 Power wheelchair, group 4 standard, multiple power K0886 Power wheelchair, group 4 heavy duty, multiple pow K0890 Power wheelchair, group 5 pediatric, single power K0891 Power wheelchair, group 5 pediatric, multiple powe K0898 Power wheelchair, not otherwise classified

20 K0899 Power mobility device, not coded by DME PDAC or do E0950 Wheelchair accessory, tray, each E0951 Heel loop/holder, any type, with or without ankle E0952 Toe loop/holder, any type, each E0955 Wheelchair accessory, headrest, cushioned, any typ E0956 Wheelchair accessory, lateral trunk or hip support E0957 Wheelchair accessory, medial thigh support, any ty E0958 Manual wheelchair accessory, one-arm drive attachm E0959 Manual wheelchair accessory, adapter for amputee, E0960 Wheelchair accessory, shoulder harness/straps or c E0961 Manual wheelchair accessory, wheel lock brake exte E0966 Manual wheelchair accessory, headrest extension, e E0967 Manual wheelchair accessory, hand rim with project E0968 Commode seat, wheelchair E0969 Narrowing device, wheelchair E0970 No. 2 footplates, except for elevating legrest E0971 Manual wheelchair accessory, anti-tipping device,

21 E0973 Wheelchair accessory, adjustable height, detachabl E0974 Manual wheelchair accessory, anti-rollback device, E0978 Wheelchair accessory, positioning belt/safety belt E0980 Safety vest, wheelchair E0981 Wheelchair accessory, seat upholstery, replacement E0982 Wheelchair accessory, back upholstery replacement E0983 Manual wheelchair accessory, power addon to conve E0984 Manual wheelchair accessory, power addon to conve E0985 Wheelchair accessory, seat lift mechanism E0986 Manual wheelchair accessory, push activated power E0988 Manual wheelchair accessory, leveractivated, whee E0990 Wheelchair accessory, elevating leg rest, complete E0992 Manual wheelchair accessory, solid seat insert E0994 Armrest, each E0995 Wheelchair accessory, calf rest/pad, each E1002 Wheelchair accessory, power seating system, tilt o E1003 Wheelchair accessory, power seating system, reclin

22 E1004 Wheelchair accessory, power seating system, reclin E1005 Wheelchair accessory, power seating system, reclin E1006 Wheelchair accessory, power seating system, combin E1007 Wheelchair accessory, power seating system, combin E1008 Wheelchair accessory, power seating system, combin E1009 Wheelchair accessory, addition to power seating sy E1010 Wheelchair accessory, addition to power seating sy E1011 Modification to pediatric size wheelchair width ad E1012 Ctr mount pwr elev leg rest E1014 Reclining back, addition to pediatric size wheelch E1015 Shock absorber for manual wheelchair, each E1016 Shock absorber for power wheelchair, each E1017 Heavy duty shock absorber for heavy duty or extra E1018 Heavy duty shock absorber for heavy duty or extra E1020 Residual limb support system for wheelchair, any t E1028 Wheelchair accessory, manual swing away, retractab E1029 Wheelchair accessory, ventilator tray, fixed

23 E1030 Wheelchair accessory, ventilator tray, gimbaled E1031 Rollabout chair, any and all types with castors 5 E1037 Transport chair, pediatric size E1038 Transport chair, adult size, patient weight capaci E1039 Transport chair, adult size, heavy duty, patient w E1050 Fully-reclining wheelchair, fixed full-length arms E1060 Fully-reclining wheelchair, detachable arms, desk E1070 Fully-reclining wheelchair, detachable arms (desk E1083 Hemi-wheelchair; fixed full-length arms, swing-awa E1084 Hemi-wheelchair, detachable arms desk or full-leng E1085 Hemi-wheelchair, fixed full-length arms, swing-awa E1086 Hemi-wheelchair, detachable arms, desk or full-len E1087 High strength lightweight wheelchair, fixed full-l E1088 High strength lightweight wheelchair, detachable a E1089 High-strength lightweight wheelchair, fixedlength E1090 High-strength lightweight wheelchair, detachable a E1092 Wide heavy-duty wheel chair, detachable arms (desk

24 E1093 Wide heavy-duty wheelchair, detachable arms, desk E1100 Semi-reclining wheelchair, fixed full-length arms, E1110 Semi-reclining wheelchair, detachable arms (desk o E1130 Standard wheelchair, fixed full-length arms, fixed E1140 Wheelchair, detachable arms, desk or fulllength, E1150 Wheelchair, detachable arms, desk or fulllength s E1160 Wheelchair, fixed full-length arms, swingaway det E1161 Manual adult size wheelchair, includes tiltin-sp E1170 Amputee wheelchair, fixed full-length arms, swing- E1171 Amputee wheelchair, fixed full-length arms, withou E1172 Amputee wheelchair, detachable arms (desk or full- E1180 Amputee wheelchair, detachable arms (desk or full- E1190 Amputee wheelchair, detachable arms (desk or full- E1195 Heavy-duty wheelchair, fixed full-length arms, swi E1200 Amputee wheelchair, fixed full-length arms, swing- E1220 Wheelchair, specially sized or constructed (indica E1221 Wheelchair with fixed arm, footrests

25 E1222 Wheelchair with fixed arm, elevating legrests E1223 Wheelchair with detachable arms, footrests E1224 Wheelchair with detachable arms, elevating legrest E1225 Wheelchair accessory, manual semireclining back, E1226 Manual wheelchair accessory, manual fully reclinin E1227 Special height arms for wheelchair E1228 Special back height for wheelchair E1229 Wheelchair, pediatric size, not otherwise specifie E1230 Power operated vehicle, three (3) or four (4) whee E1231 Wheelchair, pediatric size, tilt-in-space, rigid, E1232 Wheelchair, pediatric size, tilt-in-space, folding E1233 Wheelchair, pediatric size, tilt-in-space, rigid, E1234 Wheelchair, pediatric size, tilt-in-space, folding E1235 Wheelchair, pediatric size, rigid, adjustable, wit E1236 Wheelchair, pediatric size, folding, adjustable, w E1237 Wheelchair, pediatric size, rigid, adjustable, wit E1238 Wheelchair, pediatric size, folding, adjustable, w

26 E1239 Power wheelchair, pediatric size, not otherwise sp E1240 Lightweight wheelchair, detachable arms, (desk or E1250 Lightweight wheelchair, fixed full-length arms, sw E1260 Lightweight wheelchair, detachable arms (desk or f E1270 Lightweight wheelchair, fixed full-length arms, sw E1280 Heavy-duty wheelchair, detachable arms (desk or fu E1285 Heavy-duty wheelchair, fixed full-length arms, swi E1290 Heavy-duty wheelchair, detachable arms (desk or fu E1295 Heavy-duty wheelchair, fixed full-length arms, ele E1296 Special wheelchair seat height from floor E1297 Special wheelchair seat depth, by upholstery E1298 Special wheelchair seat depth and/or width, by con E2201 Manual wheelchair accessory, nonstandard seat fram E2202 Manual wheelchair accessory, nonstandard seat fram E2203 Manual wheelchair accessory, nonstandard seat fram E2204 Manual wheelchair accessory, nonstandard seat fram E2205 Manual wheelchair accessory, hand rim without proj

27 E2206 E2207 E2208 E2209 E2210 E2211 E2212 E2213 E2214 E2215 E2216 E2217 E2218 E2219 E2220 E2221 E2222 Manual wheelchair accessory, wheel lock assembly, Wheelchair accessory, crutch and cane holder, each Wheelchair accessory, cylinder tank carrier, each Accessory, arm trough, with or without hand suppor Wheelchair accessory, bearings, any type, replacem Manual wheelchair accessory, pneumatic propulsion Manual wheelchair accessory, tube for pneumatic pr Manual wheelchair accessory, insert for pneumatic Manual wheelchair accessory, pneumatic caster tire Manual wheelchair accessory, tube for pneumatic ca Manual wheelchair accessory, foam filled propulsio Manual wheelchair accessory, foam filled caster ti Manual wheelchair accessory, foam propulsion tire, Manual wheelchair accessory, foam caster tire, any Manual wheelchair accessory, solid (rubber/plastic Manual wheelchair accessory, solid (rubber/plastic Manual wheelchair accessory, solid (rubber/plastic

28 E2224 E2225 E2226 E2227 E2228 E2230 E2231 E2291 E2292 E2293 E2294 E2295 E2300 E2301 E2310 E2311 E2312 Manual wheelchair accessory, propulsion wheel excl Manual wheelchair accessory, caster wheel excludes Manual wheelchair accessory, caster fork, any size Manual wheelchair accessory, gear reduction drive Manual wheelchair accessory, wheel braking system Manual wheelchair accessory, manual standing syste Manual wheelchair accessory, solid seat support ba Back, planar, for pediatric size wheelchair includ Seat, planar, for pediatric size wheelchair includ Back, contoured, for pediatric size wheelchair inc Seat, contoured, for pediatric size wheelchair inc Manual wheelchair accessory, for pediatric size wh Wheelchair accessory, power seat elevation, system Wheelchair accessory, power standing system, any t Power wheelchair accessory, electronic connection Power wheelchair accessory, electronic connection Power wheelchair accessory, hand or chin control i

29 E2313 E2321 E2322 E2323 E2324 E2325 E2326 E2327 E2328 E2329 E2330 E2331 E2340 E2341 E2342 E2343 E2351 Power wheelchair accessory, harness for upgrade to Power wheelchair accessory, hand control interface Power wheelchair accessory, hand control interface Power wheelchair accessory, specialty joystick han Power wheelchair accessory, chin cup for chin cont Power wheelchair accessory, sip and puff interface Power wheelchair accessory, breath tube kit for si Power wheelchair accessory, head control interface Power wheelchair accessory, head control or extrem Power wheelchair accessory, head control interface Power wheelchair accessory, head control interface Power wheelchair accessory, attendant control, pro Power wheelchair accessory, nonstandard seat frame Power wheelchair accessory, nonstandard seat frame Power wheelchair accessory, nonstandard seat frame Power wheelchair accessory, nonstandard seat frame Power wheelchair accessory, electronic interface t

30 E2358 E2359 E2360 E2361 E2362 E2363 E2364 E2365 E2366 E2367 E2368 E2369 E2370 E2371 E2372 E2373 E2374 Power wheelchair accessory, group 34 nonsealed lea Power wheelchair accessory, group 34 sealed lead a Power wheelchair accessory, 22 NF nonsealed lead Power wheelchair accessory, 22 NF sealed lead acid Power wheelchair accessory, group 24 nonsealed l Power wheelchair accessory, group 24 sealed lead a Power wheelchair accessory, U-1 nonsealed lead ac Power wheelchair accessory, U-1 sealed lead acid b Power wheelchair accessory, battery charger,, sing Power wheelchair accessory, battery charger, dual Power wheelchair component, drive wheel motor, rep Power wheelchair component, drive wheel gear box, Power wheelchair component, integrated drive wheel Power wheelchair accessory, group 27 sealed lead a Power wheelchair accessory, group 27 nonsealed le Power wheelchair accessory, hand or chin control i Power wheelchair accessory, hand or chin control i

31 E2375 E2376 E2377 E2378 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2394 Power wheelchair accessory, nonexpandable control Power wheelchair accessory, expandable controller, Power wheelchair accessory, expandable controller, Power wheelchair component, actuator, replacement Power wheelchair accessory, pneumatic drive wheel Power wheelchair accessory, tube for pneumatic dri Power wheelchair accessory, insert for pneumatic d Power wheelchair accessory, pneumatic caster tire, Power wheelchair accessory, tube for pneumatic cas Power wheelchair accessory, foam filled drive whee Power wheelchair accessory, foam filled caster tir Power wheelchair accessory, foam drive wheel tire, Power wheelchair accessory, foam caster tire, any Power wheelchair accessory, solid (rubber/plastic) Power wheelchair accessory, solid (rubber/plastic) Power wheelchair accessory, solid (rubber/plastic) Power wheelchair accessory, drive wheel excludes t

32 E2395 Power wheelchair accessory, caster wheel excludes E2396 Power wheelchair accessory, caster fork, any size, E2397 Power wheelchair accessory, lithium based battery, E2399 Power wheelchair accessory, not otherwise classifi K0001 Standard wheelchair K0002 Standard Hemi (low seat) wheelchair K0003 Lightweight wheelchair K0004 High strength, lightweight wheelchair K0005 Ultra lightweight wheelchair K0006 Heavy duty wheelchair K0007 Extra heavy duty 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 K0012 Lightweight portable motorized/power wheelchair K0014 Other motorized/power wheelchair base

33 K0015 Detachable, non-adjustable height armrest, each K0017 Detachable, adjustable height armrest, base, each K0018 Detachable, adjustable height armrest, upper porti K0019 Arm pad, each K0020 Fixed, adjustable height armrest, pair 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, each K0043 Footrest, lower extension tube, each K0044 Footrest, lower extension bracket, each K0045 Footrest, complete assembly K0046 Elevating leg rest, lower extension tube, each K0047 Elevating leg rest, upper hanger bracket, each K0050 Ratchet assembly

34 K0051 Cam release assembly, footrest or leg rest, each K0052 Swing away, detachable footrests, each K0053 Elevating footrests, articulating (telescoping), e K0056 Seat height < 17 or equal to or greater than 21 fo K0065 Spoke protectors, each K0069 Rear wheel assembly, complete, with solid tire, sp K0070 Rear wheel assembly, complete, with pneumatic tire K0071 Front caster assembly, complete, with pneumatic ti K0072 Front caster assembly, complete, with semipneumat K0073 Caster pin lock, each K0077 Front caster assembly, complete, with solid tire, K0098 Drive belt for power wheelchair K0105 IV hanger, each K0108 Wheelchair component or accessory, not otherwise s K0195 Elevating leg rest, pair (for use with capped rent K0462 Temporary replacement for patient owned equipment K0669 Wheelchair accessory wheelchair seat or back cushi

35 K0733 Power wheelchair accessory, 12 to 24 AMP hour seal S9433 Medical food nutritionally complete, administered T5001 Positioning seat for persons with special orthoped E1035 Multi-positional patient transfer system, with int 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E1036 Multi-positional patient transfer system, extra-wi 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0705 Transfer device, any type, each 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0639 Patient lift, moveable from room to room with disa 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0621 Sling or seat, patient lift, canvas or nylon 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0625 Patient lift, bathroom or toilet, not otherwise cl 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0627 Seat lift mechanism incorporated into a combinatio 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0628 Separate seat lift mechanism for use with patient 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0629 Separate seat lift mechanism for use with patient 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0630 Patient lift, hydraulic or mechanical, includes an 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0635 Patient lift, electric, with seat or sling 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0636 Multipositional patient support system, with integ 26 HYDRAULIC LIFTS AND TRANSFER EQUIPMENT E0610 Pacemaker monitor, self-contained (checks battery MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES E0615 Pacemaker monitor, self-contained, checks battery MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES E0619 Apnea monitor, with recording feature MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES

36 E0445 Oximeter device for measuring blood oxygen levels MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES A9276 Sensor; invasive, disp w/ interstitial glucose MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES A9277 Transmitter; external, use w/ glucose monitoring MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES A9278 Receiver; external, use w/glucose monitoring MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES A4660 Sphygmomanometer/blood pressure apparatus with cuf MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES A4663 Blood pressure cuff only MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES A4670 Automatic blood pressure monitor MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES S9001 Home uterine monitor with or without associated nu MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES S8270 Enuresis alarm, using auditory buzzer and/or vibra MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES K0606 Automatic external defibrillator, with integrated MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES K0607 Replacement battery for automated external defibri MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES K0608 Replacement garment for use with automated externa MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES K0609 Replacement electrodes for use with automated exte MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES E2100 Blood glucose monitor with integrated voice synthe MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES E2101 Blood glucose monitor with integrated lancing/bloo MONITORS (APNEA, PACEMAKER, AND PULSE OXIMETER) AND 28 DEFIBRILLATORS, SUPPLIES E2000 Gastric suction pump, home model, portable or stat PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE S5520 Home infusion therapy, all supplies (including cat PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE

37 S5521 Home infusion therapy, all supplies (including cat PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE A4459 Manual pump-operated enema system PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE A4282 Adapter for breast pump, replacement PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE A4283 Cap for breast pump bottle, replacement PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE A4284 Breast shield and splash protector for use with br PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE A4286 Locking ring for breast pump, replacement PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE A9272 Wound suction, disposable, includes dressing, all PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE B9000 Enteral nutrition infusion pump, without alarm, ea PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE B9002 Enteral nutrition infusion pump, with alarm, each PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE B9004 Parenteral nutrition infusion pump, portable PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE B9006 Parenteral nutrition infusion pump, stationary PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE E2402 Negative pressure wound therapy electrical pump, s PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE E0776 IV pole PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE E0779 Ambulatory infusion pump, mechanical, reusable, fo PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE E0780 Ambulatory infusion pump, mechanical, reusable, fo PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE E0781 Ambulatory infusion pump, single or multiple chann PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE E0784 External ambulatory infusion pump, insulin PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, 29 LYMPHEDEMA, AND IV POLE

38 E0791 K0455 E0650 E0651 E0652 E0655 E0656 E0657 E0660 E0665 E0666 E0667 E0668 E0669 E0670 E0671 E0672 Parenteral infusion pump, stationary, single PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, or mu 29 LYMPHEDEMA, AND IV POLE Infusion pump used for uninterrupted PUMPS INCLUDING BREAST, ENTERAL, PARENTERAL, INSULIN, SUCTION, parenteral ad 29 LYMPHEDEMA, AND IV POLE Pneumatic compressor, non-segmental home model 34 COMPRESSORS Pneumatic compressor, segmental home model without 34 COMPRESSORS Pneumatic compressor, segmental home model with ca 34 COMPRESSORS Non-segmental pneumatic appliance for use with pne 34 COMPRESSORS Segmental pneumatic appliance for use with pneumat 34 COMPRESSORS Segmental pneumatic appliance for use with pneumat 34 COMPRESSORS Non-segmental pneumatic appliance for use with pne 34 COMPRESSORS Non-segmental pneumatic appliance for use with pne 34 COMPRESSORS Non-segmental pneumatic appliance for use with pne 34 COMPRESSORS Segmental pneumatic appliance for use with pneumat 34 COMPRESSORS Segmental pneumatic appliance for use with pneumat 34 COMPRESSORS Segmental pneumatic appliance for use with pneumat 34 COMPRESSORS Segmental pneumatic appliance for use with pneumat 34 COMPRESSORS Segmental gradient pressure pneumatic appliance, f 34 COMPRESSORS Segmental gradient pressure pneumatic appliance, f 34 COMPRESSORS

39 E0673 E0675 E0676 E0720 E0730 E0731 E0744 E0745 E0746 E0747 E0748 E0760 Segmental gradient pressure pneumatic appliance, h 34 COMPRESSORS Pneumatic compression device, high pressure, rapid 34 COMPRESSORS Intermittent limb compression device (includes all 34 COMPRESSORS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Transcutaneous Electrical Nerve Stimulation NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS (TENS) 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Transcutaneous Electrical Nerve Stimulation NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS (TENS) 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Form fitting conductive garment for NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS delivery of TE 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Neuromuscular stimulator for scoliosis, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS each 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Neuromuscular stimulator electronic shock NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS unit, ea 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Electromyography (EMG), biofeedback NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS device 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Osteogenesis stimulator, electrical NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS noninvasive, o 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Osteogenic stimulator, noninvasive, spinal NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS applica 38 STIMULATORS, PULSE GENERATOR SYSTEMS TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, Osteogenesis stimulator, low intensity NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS ultrasound, 38 STIMULATORS, PULSE GENERATOR SYSTEMS

40 TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, E0762 Transcutaneous electrical joint stimulation device NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS E0770 Functional electrical stimulator, transcutaneous s TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS S8130 Interferential current stimulator, 2 channel TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS S8131 Interferential current stimulator, 4 channel TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS E2120 Pulse generator system for tympanic treatment of i TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8681 Patient programmer, external TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8682 Implantable neurostimulator radiofreq rec TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8683 Radiofrequency transmitter (external) TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8684 Radiofrequency transmitter (external), sacral root TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8685 Implt nrostm pls gen sng rec TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8686 lmplt nrostm pls gen sng non TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS

41 L8688 Implt nrostm pls gen dua non TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS L8689 External recharging system for battery (internal) TREATMENT/ELECTRICAL EQUIPMENT INCLUDING BIOFEEDBACK, TENS, NEUROMUSCULAR ELECTRAL STIMULATORS (NMES), OSTEOGENESIS 38 STIMULATORS, PULSE GENERATOR SYSTEMS E0830 Ambulatory traction device, all types, each 46 TRACTION EQUIPMENT E0840 Traction frame, attached to headboard, cervical tr 46 TRACTION EQUIPMENT E0849 Traction equipment, cervical, free-standing stand/ 46 TRACTION EQUIPMENT E0850 Traction stand, free standing, cervical traction 46 TRACTION EQUIPMENT E0855 Cervical traction equipment not requiring addition 46 TRACTION EQUIPMENT E0856 Cervical traction device, cervical collar with inf 46 TRACTION EQUIPMENT E0860 Traction equipment, over door, cervical 46 TRACTION EQUIPMENT E0870 Traction frame, attached to footboard, extremity t 46 TRACTION EQUIPMENT E0880 Traction stand, free standing, extremity traction 46 TRACTION EQUIPMENT E0890 Traction frame, attached to footboard, pelvic trac 46 TRACTION EQUIPMENT E0900 Traction stand, free standing, pelvic traction 46 TRACTION EQUIPMENT E0920 Fracture frame, attached to bed, includes weights 46 TRACTION EQUIPMENT E0930 Fracture frame, free standing, includes weights 46 TRACTION EQUIPMENT E0940 Trapeze bar, free standing, complete with grab bar 46 TRACTION EQUIPMENT E0941 Traction device, gravity assisted, any type 46 TRACTION EQUIPMENT

42 E0946 Fracture frame, dual, with cross bars, attached to 46 TRACTION EQUIPMENT E0947 Fracture frame, attachments for complex pelvic tra 46 TRACTION EQUIPMENT E0948 Fracture frame, attachments for complex cervical t 46 TRACTION EQUIPMENT E1405 Oxygen & water vapor enriching system with heated E1406 Oxygen & water vapor enriching system without heat E0463 Pressure support ventilator with volume control mo E0464 Pressure support ventilator with volume control mo E0465 Home Ventilator, Invasive E0466 Home Ventilator, Non-invasive E0470 Respiratory assist device, bi-level pressure capab E0471 Respiratory assist device, bi-level pressure capab E0472 Respiratory assist device, bi-level pressure capab E0480 Percussor, electric or pneumatic, home model E0481 Intrpulmnry percuss vent sys E0482 Cough stimulating device, alternating positive and E0483 High frequency chest wall oscillation airpulse ge E0561 Humidifier, non-heated, used with positive airway

43 E0562 Humidifier, heated, used with positive airway pres E0601 Continuous positive airway pressure (CPAP) device E0450 Volume control ventilator, without pressure suppor E0457 Chest Shell (cuirass) E0459 Chest wrap E0460 Negative pressure ventilator, portable or stationa E0461 Volume control ventilator, without pressure suppor A4483 Moisture exchanger, disposable, for use with invas A4604 Tubing with integrated heating element for use wit A4606 Oxygen probe for use with oximeter device, replace A9280 Alert or alarm device, not otherwise classified A7020 Interface for cough stimulating device, includes a A7025 High frequency chest wall oscillation system vest, A7027 Combination oral/nasal mask, used with continuous A7028 Oral cushion for combination oral/nasal mask, repl A7029 Nasal pillows for combination oral/nasal mask, rep A7030 Full face mask used with positive airway pressure

44 A7031 Face mask interface, replacement for full face mas A7032 Cushion for use on nasal mask interface, replaceme A7033 Pillow for use on nasal cannula type interface, re A7034 Nasal interface (mask or cannula type) used with p A7035 Headgear used with positive airway pressure device A7036 Chinstrap used with positive airway pressure devic A7038 Filter, disposable, used with positive airway pres A7039 Filter, non disposable, used with positive airway A7044 Oral interface used with positive airway pressure A7045 Exhalation port with or without swivel used with a A7046 Water chamber for humidifier, used with positive a E0606 Postural drainage board S8185 Flutter device S8186 Swivel adapter E1902 Communication board, non-electronic augmentative o 48 AUGMENTATIVE COMMUNICATION DEVICES AND ACCESSORIES E2500 Speech generating device, digitalized speech, usin 48 AUGMENTATIVE COMMUNICATION DEVICES AND ACCESSORIES E2502 Speech generating device, digitalized speech, usin 48 AUGMENTATIVE COMMUNICATION DEVICES AND ACCESSORIES