CRT Codes In Separate Benefit Category Legislation (By Code)

Transcription

1 # HCCS Description CAT * / ** 1 E0143 Walker, Folding 5-OTH 2 E0637 Combination Sit To Stand, Any Size Including ediatric, With Seatlift 5-OTH Feature, With Or Without Wheels 3 E0638 Standing Frame, One osition (E.G. Upright, Supine Or rone Stander), 5-OTH Any Size Including ediatric, With Or Without Wheels 4 E0641 Standing Frame, ulti-osition (E.G. Three-Way Stander), Any Size 5-OTH Including ediatric, With Or Without Wheels 5 E0642 Standing Frame, obile (Dynamic Stander), Any Size Including ediatric 5-OTH 6 E0950 Wheelchair Accessory, Tray 7 E0951 Heel Loop/Holder, Any Type, With Or Without Ankle Strap 8 E0952 Toe Loop/Holder, Any Type 9 E0955 Wheelchair Accessory, Headrest, Cushioned, Any Type 10 E0956 Wheelchair Accessory, Lateral Trunk Or Hip Support, Any Type 11 E0957 Wheelchair Accessory, edial Thigh Support, Any Type 12 E0960 Wheelchair Accessory, Shoulder Harness/Straps Or Chest Strap 13 E0967 anual Wheelchair Accessory, Hand Rim With rojections, Any Type 14 E0978 Wheelchair Accessory, ositioning Belt/Safety Belt/elvic Strap 15 E0986 anual Wheelchair Accessory, ush Activated ower Assist 16 E0990 Wheelchair Accessory, Elevating Leg Rest, Complete Assembly 17 E1002 Wheelchair Accessory, ower Seating, Tilt Only 18 E1003 Wheelchair Accessory, ower Seating, Recline Only, Without Shear Reduction 19 E1004 Wheelchair Accessory, ower Seating, Recline Only, With echanical Shear Reduction 20 E1005 Wheelchair Accessory, ower Seatng, Recline Only, With ower Shear Reduction 21 E1006 Wheelchair Accessory, ower Seating, Combination Tilt And Recline, Without Shear Reduction 22 E1007 Wheelchair Accessory, ower Seating, Combination Tilt And Recline, With echanical Shear Reduction 23 E1008 Wheelchair Accessory, ower Seating, Combination Tilt And Recline, With ower Shear Reduction 24 E1009 Wheelchair Accessory, Addition To ower Seating, echanically Linked Leg Elevation 25 E1010 Wheelchair Accessory, Addition To ower Seating, ower Leg Elevation 26 E1011 odification To ediatric Size Wheelchair, Width Adjustment ackage (Not To Be Dispensed With Initial Chair) 27 E1012 Wheelchair Accessory, Center ount ower Elevating Leg Rest/latform 28 E1014 Reclining Back, Addition To ediatric Size Wheelchair 29 E1015 Shock Absorber For anual Wheelchair 30 E1016 Shock Absorber For ower Wheelchair E1028 Wheelchair Accessory, anual Swingaway, Retractable Or Removable ounting For Joystick, Other Control Interface Or ositioning Accessory E1029 Wheelchair Accessory, Ventilator Tray, Fixed 33 E1030 Wheelchair Accessory, Ventilator Tray, Gimbaled 34 E1037 Transport Chair, ediatric Size 1-WC 35 E1161 anual Adult Size Wheelchair, Includes Tilt In Space 1-WC 36 E1220 Wheelchair; Specially Sized Or Constructed, (Indicate Brand Name, odel 1-WC Number, If Any) And Justification 37 E1228 Special Back Height For Wheelchair 38 E1229 Wheelchair, ediatric Size, Not Otherwise Specified 1-WC age 1 of 5

2 # HCCS Description CAT * / ** 39 E1231 Wheelchair, ediatric Size, Tilt-In-Space, Rigid, Adjustable, With Seating 1-WC 40 E1232 Wheelchair, ediatric Size, Tilt-In-Space, Folding, Adjustable, With Seating 1-WC 41 E1233 Wheelchair, ediatric Size, Tilt-In-Space, Rigid, Adjustable, Without Seating 1-WC 42 E1234 Wheelchair, ediatric Size, Tilt-In-Space, Folding, Adjustable, Without Seating 1-WC 43 E1235 Wheelchair, ediatric Size, Rigid, Adjustable, With Seating 1-WC 44 E1236 Wheelchair, ediatric Size, Folding, Adjustable, With Seating 1-WC 45 E1237 Wheelchair, ediatric Size, Rigid, Adjustable, Without Seating 1-WC 46 E1238 Wheelchair, ediatric Size, Folding, Adjustable, W/O Seating 1-WC 47 E1239 ower Wheelchair, ediatric Size, Not Otherwise Specified 2-WC 48 E2205 anual Wheelchair Accessory, Handrim W/O rojections, Including Ergonomic Or Contoured, Any Type 49 E2208 Wheelchair Accessory, Cylinder Tank Carrier 50 E2209 Arm Trough, With Or Without Hand Support 51 E2231 anual Wheelchair Accessory, Solid Seat Support Base (Replaces Sling Seat), Includes Any Type ounting 52 E2291 Back, lanar, For ediatric Size Wheelchair Including Fixed Attaching 53 E2292 Seat, lanar, For ediatric Size Wheelchair Including Fixed Attaching 54 E2293 Back, Contoured, For ediatric Size Wheelchair Including Fixed Attaching 55 E2294 Seat, Contoured, For ediatric Size Wheelchair Including Fixed Attaching 56 E2295 anual Wheelchair Accessory, For ediatric Size Wheelchair, Dynamic Seating Frame, Allows Coordinated ovement Of ultiple ositioning Features 57 E2300 ower Wheelchair Accessory, ower Seat Elevation 58 E2301 ower Wheelchair Accessory, ower Standing 59 E2310 ower Wheelchair Accessory, Electronic Connection Between Wheelchair Controller And One ower Seating otor, Including All Related Electronics, Indicator Feature, echanical Function Selection Switch 60 E2311 ower Wheelchair Accessory, Electronic Connection Between Wheelchair Controller And Two Or ore ower Seating otors, Including All Related Electronics, Indicator Feature, echanical Function Selection Switch E2312 ower Wheelchair Accessory, Hand Or Chin Control Interface, ini-roportional 61 Remote Joystick, roportional, Including Fixed ounting 62 E2313 ower Wheelchair Accessory, Harness For Upgrade To Expandable Controller, Including All Fasteners, Connections And ounting 63 E2321 ower Wheelchair Accessory, Hand Control Interface, Remote Joystick, Nonproportional, Including All Related Electronics And Fixed ounting E2322 ower Wheelchair Accessory, Hand Control Interface, ultiple echanical 64 Switches, Nonproportional, Including All Related Electronics, echanical Stop Switch 65 E2323 ower Wheelchair Accessory, Specialty Joystick Handle For Hand Control Interface, refabricated 66 E2324 ower Wheelchair Accessory, Chin Cup For Chin Control Interface 67 E2325 ower Wheelchair Accessory, Sip And uff Interface, Nonproportional, Including All Related Electronics, echanical Stop Switch age 2 of 5

3 # HCCS Description CAT * / ** 68 E2326 ower Wheelchair Accessory, Breath Tube Kit For Sip And uff Interface 69 E2327 ower Wheelchair Accessory, Head Control Interface, echanical, roportional, Including All Related Electronics E2328 ower Wheelchair Accessory, Head Control Or Extremity Control Interface, 70 Eletronic, roportional, Including All Related Electronics And Fixed ounting 71 E2329 ower Wheelchair Accessory, Head Control Interface, Contact Switch echanism, Nonproportional, Including All Related Electronics, echanical Stop Switch, echanical Direction Change Switch, Head Array 72 E2330 ower Wheelchair Accessory, Head Control Interface, roximity Switch echanism, Nonproportional, Including All Related Electronics, echanical Stop Switch, echanical Direction Change Switch, Head Array 73 E2331 ower Wheelchair Accessory, Attendant Control, roportional, Including All Related Electronics 74 E2351 ower Wheelchair Accessory, Electronic Interface To Operate Speech Generating Device Using ower Wheelchair Control Interface 75 E2368 ower Wheelchair Component, otor, Replacement Only 76 E2369 ower Wheelchair Component, Gear Box, Replacement Only 77 E2370 ower Wheelchair Component, otor And Gear Box Combination, Replacement Only 78 E2373 ower Wheelchair Accessory, Hand Or Chin Control Interface, Compact Remote Joystick, roportional, Including Fixed ounting E2374 ower Wheelchair Accessory, Hand Or Chin Control Interface, Standard Remote 79 Joystick (Not Including Controller), roportional, Including All Related Electronics And Fixed ounting, Replacement Only 80 E2376 ower Wheelchair Accessory, Expandable Controller, Including All Related Electronics And ounting 81 E2377 ower Wheelchair Accessory, Expandable Controller, Including All Related Electronics And ounting, Upgrade rovided At Initial Issue 82 E2605 ositioning Wheelchair Seat Cushion, < 22"W 83 E2606 ositioning Wheelchair Seat Cushion, > 22"W 84 E2607 Skin rotection And ositioning Wheelchair Seat Cushion, < 22"W 85 E2608 Skin rotection And ositioning Wheelchair Seat Cushion, > 22"W 86 E2609 Custom Fabricated Wheelchair Seat Cushion, Any Size 87 E2610 Wheelchair Seat Cushion, owered 88 E2613 ositioning Wheelchair Back Cushion, osterior, < 22"W 89 E2614 ositioning Wheelchair Back Cushion, osterior, > 22"W 90 E2615 ositioning Wheelchair Back Cushion, osterior-lateral, < 22"W 91 E2616 ositioning Wheelchair Back Cushion, osterior-lateral, > 22"W 92 E2617 Custom Fabricated Wheelchair Back Cushion, Any Size 93 E2620 ositioning Wheelchair Back Cushion, lanar Back With Lateral Supports, < 22"W 94 E2621 ositioning Wheelchair Back Cushion, lanar Back With Lateral Supports, > 22"W 95 E2624 Adjustable Skin rotection And ositioning Wheelchair Seat Cushion, < 22"W 96 E2625 Adjustable Skin rotection And ositioning Wheelchair Seat Cushion, > 22"W 97 E8000 Gait Trainer, ediatric Size, osterior Support, Includes All Accessories And 5-OTH 98 E8001 Gait Trainer, ediatric Size, Upright Support, Includes All Accessories And 5-OTH 99 E8002 Gait Trainer, ediatric Size, Anterior Support, Includes All Accessories And 5-OTH 100 EO995 Wheelchair Accessory, Calf Rest/ad 101 K0004 High Strength, Lightweight Wheelchair 1-WC age 3 of 5

4 # HCCS Description CAT * / ** 102 K0005 Ultralightweight Wheelchair 1-WC 103 K0009 Other anual Wheelchair Base 1-WC 104 K0040 Adjustable Angle Footplate 105 K0108 Wheelchair Component Or Accessory, Not Otherwise Specified K0669 Wheelchair Accessory, Wheelchair Seat Or Back Cushion, Does Not eet 106 Specific Code Criteria Or No Written Coding Verification From Dme dac 107 K0835 ower Wheelchair Group 2 Std (Up To 300#) Single ower Option 2-WC 108 K0836 ower Wheelchair Group 2 Std (Up To 300#) Single ower Option Captain Chair 2-WC K0837 ower Wheelchair Group 2 Heavy Duty (301# - 450#) Single ower Option 2-WC K0838 ower Wheelchair Group 2 Heavy Duty (301# - 450#) Single ower Option 2-WC Captain Chair 111 K0839 ower Wheelchair Group 2 Very Heavy Duty (451# - 600#) Single ower Option 2-WC K0840 ower Wheelchair Group 2 Extra Heavy Duty (> 601#) Single ower Option 2-WC K0841 ower Wheelchair Group 2 Std (Up To 300#) ulti ower Option 2-WC 114 K0842 ower Wheelchair Group 2 Std (Up To 300#) ulti ower Option Captain Chair 2-WC K0843 ower Wheelchair Group 2 Heavy Duty (301# - 450#) ulti ower Option 2-WC K0848 ower Wheelchair Group 3 Standard (Up To 300#) 2-WC 117 K0849 ower Wheelchair Group 3 Standard (Up To 300#) Captain Chair 2-WC 118 K0850 ower Wheelchair Group 3 Heavy Duty (301# - 450#) 2-WC 119 K0851 ower Wheelchair Group 3 Heavy Duty (301# - 450#) Captain Chair 2-WC 120 K0852 ower Wheelchair Group 3 Very Heavy Duty (451# - 600#) 2-WC 121 K0853 ower Wheelchair Group 3 Very Heavy Duty (451# - 600#) Captain Chair 2-WC 122 K0854 ower Wheelchair Group 3 Extra Heavy Duty (601# And Greater) 2-WC 123 K0855 ower Wheelchair Group 3 Extra Heavy Duty (601# And Greater) Captain Chair 2-WC 124 K0856 ower Wheelchair Group 3 Std (Up To 300#) Single ower Option 2-WC 125 K0857 ower Wheelchair Group 3 Std (Up To 300#) Single ower Option Captain Chair 2-WC 126 K0858 ower Wheelchair Group 3 Heavy Duty (301# - 450#) Single ower Option 2-WC K0859 ower Wheelchair Group 3 Heavy Duty (301# - 450#) Single ower Option 2-WC 127 Captain Chair 128 K0860 ower Wheelchair Group 3 Very Heavy Duty (451# - 600#) Single ower Option 2-WC 129 K0861 ower Wheelchair Group 3 Std (Up To 300#) ulti ower Option 2-WC K0862 ower Wheelchair Group 3 Heavy Duty (301# - 450#) ulti ower Option 2-WC K0863 ower Wheelchair Group 3 Very Heavy Duty (451# - 600#) ulti ower Option 2-WC 132 K0864 ower Wheelchair Group 3 Extra Heavy Duty (> 601#) ulti ower Option 2-WC 133 K0868 ower Wheelchair Group 4 Standard (Up To 300#) 2-WC 134 K0869 ower Wheelchair Group 4 Standard (Up To 300#) Captain Chair 2-WC 135 K0870 ower Wheelchair Group 4 Heavy Duty (301# - 451#) 2-WC 136 K0871 ower Wheelchair Group 4 Very Heavy (451# - 600#) Duty 2-WC 137 K0877 ower Wheelchair Group 4 Std (Up To 300#) Single ower Option 2-WC 138 K0878 ower Wheelchair Group 4 Std (Up To 300#) Single ower Option Captain Chair 2-WC age 4 of 5

5 # HCCS Description CAT * / ** K0879 ower Wheelchair Group 4 Heavy Duty (301# - 450#) Single ower Option 2-WC K0880 ower Wheelchair Group 4 Very Heavy Duty (451# - 600#) Single ower Option 2-WC 141 K0884 ower Wheelchair Group 4 Std (Up To 300#) ulti ower Option 2-WC 142 K0885 ower Wheelchair Group 4 Std (Up To 300#) ulti ower Option Captain 2-WC 143 K0886 ower Wheelchair Group 4 Heavy Duty (301# - 450#) ulti ower Option 2-WC 144 K0890 ower Wheelchair Group 5 ed (Up To 125#) Single ower Option 2-WC 145 K0891 ower Wheelchair Group 5 ed (Up To 125#) ulti ower Option 2-WC 146 K0898 ower Wheelchair, Not Otherwise Classified 2-WC * roduct Categories 1-WC 2-WC 5-OTH ** "" is for a "pure" code that contains 100% CRT products. "" is for a "mixed" code that contains both CRT and STANDARD products. Creation of new seperate CRT codes is required for these mixed codes to segregate CRT products. age 5 of 5