Oxford Health Plans > Medical and Administrative Policies > DME, Orthotics, Ostomy Supplies, Medical Supplies, and Repairs/Replacements > DME, Orthotics, Ostomy Supplies, Medical Supplies, and Repairs/Replacements List
Title of Policy

DME, Orthotics, Ostomy Supplies, Medical Supplies, and Repairs/Replacements List


Effective Date: July 1, 2013

The Current Procedural Terminology (CPT®) codes, HCPCS and CDT® codes listed in this policy are for reference purposes only. Listing of a service code in this policy does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the enrollee’s certificate of coverage, summary of benefits; specific plan document and any federal or state mandates that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claims payment. Other policies may apply.

CPT® is a registered trademark of the American Medical Association.
CDT® is a registered trademark of the American Dental Association.

Code Description Related Policy
A4206 Syringe with needle, sterile, 1 cc or less, each  
A4207 Syringe with needle, sterile 2 cc, each  
A4208 Syringe with needle, sterile 3 cc, each  
A4209 Syringe with needle, sterile 5 cc or greater, each  
A4210 Needle-free injection device, each  
A4211 Cartridge for pen injector  
A4212 Noncoring needle or stylet with or without catheter  
A4213 Syringe, sterile, 20 cc or greater, each  
A4215 Needle, sterile, any size, each  
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 drug infusion catheter, per week (list drug 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)  
A4230 Infusion set for external insulin pump, nonneedle 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  
A4244 Alcohol or peroxide, per pint  
A4245 Alcohol wipes, per box  
A4246 Betadine or pHisoHex solution, per pint  
A4247 Betadine or iodine swabs/wipes, per box  
A4248 Chlorhexidine containing antiseptic, 1 ml  
A4250 Urine test or reagent strips or tablets (100 tablets or strips)  
A4252 Blood ketone test or reagent strip, each  
A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips  
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  
A4265 Paraffin, per pound  
A4267 Contraceptive supply, condom, male, each  
A4268 Contraceptive supply, condom, female, each  
A4269 Contraceptive supply, spermicide (e.g., foam, gel), each  
A4270 Disposable endoscope sheath, each  
A4280 Skin support for external breast prosthesis  
A4281 Tubing for breast pump, replacement  
A4282 Adapter for breast pump, replacement  
A4283 Cap for breast pump bottle, replacement  
A4284 Breast shield and splash protector for use with breast pump, replacement  
A4285 Polycarbonate bottle for use with breast pump, replacement  
A4286 Locking ring for breast pump, replacement  
A4290 Sacral nerve stimulation test lead, each  
A4300 Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access  
A4301 Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)  
A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour  
A4306 Disposable drug delivery system, flow rate of less than 50 ml per hour  
A4310 Insertion tray without drainage bag and without catheter (accessories only)  
A4311 Insertion tray without drainage bag with indwelling catheter, Foley type, 2-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, etc.)  
A4312 Insertion tray without drainage bag with indwelling catheter, Foley type, 2-way, all silicone  
A4313 Insertion tray without drainage bag with indwelling catheter, Foley type, 3-way, for continuous irrigation  
A4314 Insertion tray with drainage bag with indwelling catheter, Foley type, 2-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, etc.)  
A4315 Insertion tray with drainage bag with indwelling catheter, Foley type, 2-way, all silicone  
A4316 Insertion tray with drainage bag with indwelling catheter, Foley type, 3-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  
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  
A4338 Indwelling catheter; Foley type, 2-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, 2-way, all silicone, each  
A4346 Indwelling catheter; Foley type, 3-way for continuous irrigation, each  
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 3-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 antireflux device, with or without tube, each  
A4358 Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each  
A4360 Disposable external urethral clamp or compression device, with pad and/or pouch, 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  
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 accordian), 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 fl oz  
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 oz  
A4404 Ostomy ring, each  
A4405 Ostomy skin barrier, nonpectin-based, paste, per oz  
A4406 Ostomy skin barrier, pectin-based, paste, per oz  
A4407 Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 in or smaller, each  
A4408 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 in, each  
A4409 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 in or smaller, each  
A4410 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 in, 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 in or smaller, each  
A4415 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, 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 nonlocking 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 nonlocking 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 nonlocking 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, nonwaterproof, per 18 sq in  
A4452 Tape, waterproof, per 18 sq in  
A4455 Adhesive remover or solvent (for tape, cement or other adhesive), per oz  
A4456 Adhesive remover, wipes, any type, each  
A4458 Enema bag with tubing, reusable  
A4461 Surgical dressing holder, nonreusable, each  
A4463 Surgical dressing holder, reusable, each  
A4465 Nonelastic binder for extremity  
A4466 Garment, belt, sleeve or other covering, elastic or similar stretchable material, 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  
A4520 Incontinence garment, any type, (e.g., brief, diaper), each  
A4550 Surgical trays  
A4554 Disposable underpads, all sizes  
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  
A4561 Pessary, rubber, any type  
A4562 Pessary, nonrubber, any type  
A4565 sling, arm  
A4566 Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment  
A4575 Topical hyperbaric oxygen chamber, disposable  
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 for non-prosthetic use, replacement  
A4604 Tubing with integrated heating element for use with positive airway pressure device  
A4605 Tracheal suction catheter, closed system, each  
A4606 Oxygen probe for use with oximeter device, replacement  
A4608 Transtracheal oxygen catheter, 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  
A4614 Peak expiratory flow rate meter, hand held  
A4615 Cannula, nasal  
A4616 Tubing (oxygen), per foot  
A4617 Mouthpiece  
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  
A4627 Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler  
A4628 Oropharyngeal suction catheter, each  
A4629 Tracheostomy care kit for established tracheostomy  
A4630 Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient  
A4633 Replacement bulb/lamp for ultraviolet light therapy system, each  
A4634 Replacement bulb for therapeutic light box, tabletop model  
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  
A4640 Replacement pad for use with medically necessary alternating pressure pad owned by patient  
A4649 Surgical supply; miscellaneous  
A4651 Calibrated microcapillary tube, each  
A4652 Microcapillary tube sealant  
A4653 Peritoneal dialysis catheter anchoring device, belt, each  
A4657 Syringe, with or without needle, each  
A4660 Sphygmomanometer/blood pressure apparatus with cuff and stethoscope  
A4663 Blood pressure cuff only  
A4670 Automatic blood pressure monitor  
A4671 Disposable cycler set used with cycler dialysis machine, each  
A4672 Drainage extension line, sterile, for dialysis, each  
A4673 Extension line with easy lock connectors, used with dialysis  
A4674 Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz  
A4680 Activated carbon filter for hemodialysis, each  
A4690 Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each  
A4728 Dialysate solution, nondextrose containing, 500 ml  
A4770 Blood collection tube, vacuum, for dialysis, per 50  
A4771 Serum clotting time tube, for dialysis, per 50  
A4772 Blood glucose test strips, for dialysis, per 50  
A4773 Occult blood test strips, for dialysis, per 50  
A4774 Ammonia test strips, for dialysis, per 50  
A4860 Disposable catheter tips for peritoneal dialysis, per 10  
A4911 Drain bag/bottle, for dialysis, each  
A4913 Miscellaneous dialysis supplies, not otherwise specified  
A4918 Venous pressure clamp, for hemodialysis, each  
A4927 Gloves, nonsterile, per 100  
A4928 Surgical mask, per 20  
A4929 Tourniquet for dialysis, each  
A4930 Gloves, sterile, per pair  
A4931 Oral thermometer, reusable, any type, each  
A4932 Rectal thermometer, reusable, any type, each  
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 Continent device; plug for continent stoma  
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  
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 nonadhesive; disk or foam pad  
A5131 Appliance cleaner, incontinence and ostomy appliances, per 16 oz  
A5200 Percutaneous catheter/tube anchoring device, adhesive skin attachment  
A6010 Collagen based wound filler, dry form, sterile, per g of collagen  
A6011 Collagen based wound filler, gel/paste, per g of collagen  
A6021 Collagen dressing, sterile, size 16 sq in or less, each  
A6022 Collagen dressing, sterile, size more than 16 sq in but less than or equal to 48 sq in, each  
A6023 Collagen dressing, sterile, size more than 48 sq in, each  
A6024 Collagen dressing wound filler, sterile, per 6 in  
A6025 Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each  
A6154 Wound pouch, each  
A6196 Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq in or less, each dressing  
A6197 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, each dressing  
A6198 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq in, each dressing  
A6199 Alginate or other fiber gelling dressing, wound filler, sterile, per 6 in  
A6203 Composite dressing, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing  
A6204 Composite dressing, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, with any size adhesive border, each dressing  
A6205 Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing  
A6206 Contact layer, sterile, 16 sq in or less, each dressing  
A6207 Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing  
A6208 Contact layer, sterile, more than 48 sq in, each dressing  
A6209 Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6210 Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing  
A6211 Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6212 Foam dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing  
A6213 Foam dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing  
A6214 Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing  
A6215 Foam dressing, wound filler, sterile, per g  
A6216 Gauze, nonimpregnated, nonsterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6217 Gauze, nonimpregnated, nonsterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing  
A6218 Gauze, nonimpregnated, nonsterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6219 Gauze, nonimpregnated, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing  
A6220 Gauze, nonimpregnated, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing  
A6221 Gauze, nonimpregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing  
A6222 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6223 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq in, but less than or equal to 48 sq in, without adhesive border, each dressing  
A6224 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6228 Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6229 Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing  
A6230 Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6231 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq in or less, each dressing  
A6232 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq in, but less than or equal to 48 sq in, each dressing  
A6233 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq in, each dressing  
A6234 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6235 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing  
A6236 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6237 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing  
A6238 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing  
A6239 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing  
A6240 Hydrocolloid dressing, wound filler, paste, sterile, per oz  
A6241 Hydrocolloid dressing, wound filler, dry form, sterile, per g  
A6242 Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6243 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing  
A6244 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6245 Hydrogel dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing  
A6246 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing  
A6247 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing  
A6248 Hydrogel dressing, wound filler, gel, per fl oz  
A6250 Skin sealants, protectants, moisturizers, ointments, any type, any size  
A6251 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6252 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing  
A6253 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6254 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing  
A6255 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, with any size adhesive border, each dressing  
A6256 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing  
A6257 Transparent film, sterile, 16 sq in or less, each dressing  
A6258 Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing  
A6259 Transparent film, sterile, more than 48 sq in, each dressing  
A6260 Wound cleansers, any type, any size  
A6261 Wound filler, gel/paste, per fl oz, not otherwise specified  
A6262 Wound filler, dry form, per g, not otherwise specified  
A6266 Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yd  
A6402 Gauze, nonimpregnated, sterile, pad size 16 sq in or less, without adhesive border, each dressing  
A6403 Gauze, nonimpregnated, sterile, pad size more than 16 sq in, less than or equal to 48 sq in, without adhesive border, each dressing  
A6404 Gauze, nonimpregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing  
A6407 Packing strips, nonimpregnated, sterile, up to 2 in in width, per linear yd  
A6410 Eye pad, sterile, each  
A6411 Eye pad, nonsterile, each  
A6412 Eye patch, occlusive, each  
A6413 Adhesive bandage, first aid type, any size, each  
A6441 Padding bandage, nonelastic, nonwoven/nonknitted, width greater than or equal to 3 in and less than 5 in, per yd  
A6442 Conforming bandage, nonelastic, knitted/woven, nonsterile, width less than 3 in, per yd  
A6443 Conforming bandage, nonelastic, knitted/woven, nonsterile, width greater than or equal to 3 in and less than 5 in, per yd  
A6444 Conforming bandage, nonelastic, knitted/woven, nonsterile, width greater than or equal to 5 in, per yd  
A6445 Conforming bandage, nonelastic, knitted/woven, sterile, width less than 3 in, per yd  
A6446 Conforming bandage, nonelastic, knitted/woven, sterile, width greater than or equal to 3 in and less than 5 in, per yd  
A6447 Conforming bandage, nonelastic, knitted/woven, sterile, width greater than or equal to 5 in, per yd  
A6448 Light compression bandage, elastic, knitted/woven, width less than 3 in, per yd  
A6449 Light compression bandage, elastic, knitted/woven, width greater than or equal to 3 in and less than 5 in, per yd  
A6450 Light compression bandage, elastic, knitted/woven, width greater than or equal to 5 in, per yd  
A6451 Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 ft lbs at 50% maximum stretch, width greater than or equal to 3 in and less than 5 in, per yd  
A6452 High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 ft lbs at 50% maximum stretch, width greater than or equal to 3 in and less than 5 in, per yd  
A6453 Self-adherent bandage, elastic, nonknitted/nonwoven, width less than 3 in, per yd  
A6454 Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to 3 in and less than 5 in, per yd  
A6455 Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to 5 in, per yd  
A6456 Zinc paste impregnated bandage, nonelastic, knitted/woven, width greater than or equal to 3 in and less than 5 in, per yd  
A6457 Tubular dressing with or without elastic, any width, per linear yard  
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 mm Hg, each  
A6531 Gradient compression stocking, below knee, 30-40 mm Hg, each  
A6532 Gradient compression stocking, below knee, 40-50 mm Hg, each  
A6533 Gradient compression stocking, thigh length, 18-30 mm Hg, each  
A6534 Gradient compression stocking, thigh length, 30-40 mm Hg, each  
A6535 Gradient compression stocking, thigh length, 40-50 mm Hg, each  
A6536 Gradient compression stocking, full-length/chap style, 18-30 mm Hg, each  
A6537 Gradient compression stocking, full length/chap style, 30-40 mm Hg, each  
A6538 Gradient compression stocking, full-length/chap style, 40-50 mm Hg, each  
A6539 Gradient compression stocking, waist length, 18-30 mm Hg, each  
A6540 Gradient compression stocking, waist length, 30-40 mm Hg, each  
A6541 Gradient compression stocking, waist length, 40-50 mm Hg, each  
A6544 Gradient compression stocking, garter belt  
A6545 Gradient compression wrap, nonelastic, below knee, 30-50 mm Hg, each  
A6549 Gradient compression stocking/sleeve, not otherwise specified  
A6549 Gradient compression stocking/sleeve, not otherwise specified  
A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories  
A7000 Canister, disposable, used with suction pump, each  
A7001 Canister, nondisposable, 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, nondisposable  
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, nondisposable, used with large volume ultrasonic nebulizer  
A7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 ft  
A7011 Corrugated tubing, nondisposable, used with large volume nebulizer, 10 ft  
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 High Frequency Chest Wall Compression Devices
A7026 High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each High Frequency Chest Wall Compression Devices
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, nondisposable, 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  
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  
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, noncuffed, 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  
A9270 Noncovered item or service  
A9272 Mechanical wound suction, disposable, includes dressing, all accessories and components, each  
A9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories  
A9275 Home glucose disposable monitor, includes test strips  
A9276 Sensor; invasive (e.g., subcutaneous), disposable for use with interstitial continuous glucose monitoring system, one unit =1 day supply  
A9277 Transmitter; external, for use with interstitial continuous glucose monitoring system  
A9278 Receiver (monitor); external, for use with interstitial continuous glucose monitoring system  
A9279 Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified  
A9280 Alert or alarm device, not otherwise classified  
A9283 Foot pressure off loading/supportive device, any type, each  
A9284 Spirometer, non-electronic, includes all accessories.  
A9300 Exercise equipment  
A9900 Miscellaneous DME supply, accessory, and/or service component of another HCPCS code  
A9901 DME delivery, set up, and/or dispensing service component of another HCPCS code  
A9999 Miscellaneous DME supply or accessory, not otherwise specified  
B4034 Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape  
B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape  
B4036 Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape  
B4081 Nasogastric tubing with stylet  
B4082 Nasogastric tubing without stylet  
B4083 Stomach tube - Levine type  
B4087 Gastrostomy/jejunostomy tube, standard, any material, any type, each  
B4088 Gastrostomy/jejunostomy tube, low-profile, any material, any type, each  
B4100 Food thickener, administered orally, per oz  
B4102 Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit  
B4103 Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit  
B4104 Additive for enteral formula (e.g., fiber)  
B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4150 Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4152 Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4153 Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4154 Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4155 Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit  
B4157 Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4158 Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit  
B4159 Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit  
B4160 Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4161 Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B4162 Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit  
B9000 Enteral nutrition infusion pump - without alarm  
B9002 Enteral nutrition infusion pump - with alarm  
B9004 Parenteral nutrition infusion pump, portable  
B9006 Parenteral nutrition infusion pump, stationary  
B9998 NOC for enteral supplies  
D5931 Obturator prosthesis, surgical. See also code 21079  
D5932 Obturator prosthesis, definitive. See also code 21080.  
D5933 Obturator prosthesis, modification. See also code 21080.  
D5936 Obturator/prosthesis, interim. See also code 21079.  
D5937 Trismus appliance (not for TMD treatment)  
D5951 Feeding aid  
D5952 Speech aid prosthesis, pediatric  
D5953 Speech aid prosthesis, adult  
D5954 Palatal augmentation prosthesis. See also code 21082.  
D5955 Palatal lift prosthesis, definitive. See also code 21083.  
D5958 Palatal lift prosthesis, interim. See also code 21083.  
D5959 Palatal lift prosthesis, modification. See also code 21083.  
D5960 Speech aid prosthesis, modification  
D5983 Radiation carrier  
D5984 Radiation shield  
D5985 Radiation cone locator  
D5987 Commissure splint  
D5992 Adjust maxillofacial prosthetic appliance, by report  
D5993 Maintenance and cleaning of a maxillofacial prosthesis (extra or intraoral) other than required adjustments, by report  
E0100 Cane, includes canes of all materials, adjustable or fixed, with tip  
E0105 Cane, quad or 3-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, 4 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  
E0181 Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty  
E0182 Pump for alternating pressure pad, for replacement only  
E0185 Gel or gel-like pressure pad for mattress, standard mattress length and width  
E0186 Air pressure mattress  
E0187 Water pressure mattress  
E0190 Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories  
E0193 Powered air flotation bed (low air loss therapy)  
E0194 Air fluidized bed  
E0196 Gel pressure mattress  
E0197 Air pressure pad for mattress, standard mattress length and width  
E0198 Water pressure pad for mattress, standard mattress length and width  
E0202 Phototherapy (bilirubin) light with photometer  
E0203 Therapeutic lightbox, minimum 10,000 lux, table top model  
E0217 Water circulating heat pad with pump  
E0218 Water circulating cold pad with pump  
E0236 Pump for water circulating pad  
E0240 Bath/shower chair, with or without wheels, any size  
E0249 Pad for water circulating heat unit, for replacement only  
E0250 Hospital bed, fixed height, with any type side rails, with mattress  
E0251 Hospital bed, fixed height, with any type side rails, without mattress  
E0255 Hospital bed, variable height, hi-lo, with any type side rails, with mattress  
E0256 Hospital bed, variable height, hi-lo, with any type side rails, without mattress  
E0260 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress  
E0261 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress  
E0265 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress  
E0266 Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress  
E0270 Hospital bed, institutional type includes: oscillating, circulating and Stryker frame, with mattress  
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, with mattress  
E0291 Hospital bed, fixed height, without side rails, without mattress  
E0292 Hospital bed, variable height, hi-lo, without side rails, with mattress  
E0293 Hospital bed, variable height, hi-lo, without side rails, without mattress  
E0294 Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress  
E0295 Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress  
E0296 Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress  
E0297 Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress  
E0300 Pediatric crib, hospital grade, fully enclosed  
E0301 Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress  
E0302 Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress  
E0303 Hospital bed, heavy-duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress  
E0304 Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress  
E0305 Bedside rails, half-length  
E0310 Bedside 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  
E0328 Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress  
E0329 Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress  
E0350 Control unit for electronic bowel irrigation/evacuation system  
E0352 Disposable pack (water reservoir bag, speculum, valving mechanism, and collection bag/box) for use with the electronic bowel irrigation/evacuation system  
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  
E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing  
E0425 Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing  
E0430 Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing  
E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing  
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  
E0434 Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing  
E0435 Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor  
E0439 Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing  
E0440 Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing  
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  
E0445 Oximeter device for measuring blood oxygen levels non-invasively  
E0446 Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories  
E0450 Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)  
E0455 Oxygen tent, excluding croup or pediatric tents  
E0457 Chest shell (cuirass)  
E0459 Chest wrap  
E0460 Negative pressure ventilator; portable or stationary  
E0461 Volume control ventilator, without pressure support mode, may include pressure control mode, used with noninvasive interface (e.g., mask)  
E0462 Rocking bed, with or without side rails  
E0463 Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)  
E0464 Pressure support ventilator with volume control mode, may include pressure control mode, used with noninvasive interface (e.g., mask)  
E0470 Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)  
E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)  
E0472 Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)  
E0480 Percussor, electric or pneumatic, home model  
E0481 Intrapulmonary percussive ventilation system and related accessories  
E0482 Cough stimulating device, alternating positive and negative airway pressure  
E0483 High frequency chest wall oscillation air-pulse generator system, (includes hoses and vest), each High Frequency Chest Wall Compression Devices
E0484 Oscillatory positive expiratory pressure device, nonelectric, any type, each  
E0485 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment Non-Surgical Treatment of Obstructive Sleep Apnea
E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment Non-Surgical Treatment of Obstructive Sleep Apnea
E0487 Spirometer, Electronic, includes all accessories  
E0500 IPPB machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source  
E0550 Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery  
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, nonheated, used with positive airway pressure device  
E0562 Humidifier, heated, used with positive airway pressure device  
E0565 Compressor, air power source for equipment which is not self-contained or cylinder driven  
E0570 Nebulizer, with compressor  
E0572 Aerosol compressor, adjustable pressure, light duty for intermittent use  
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer  
E0575 Nebulizer, ultrasonic, large volume  
E0580 Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter  
E0585 Nebulizer, with compressor and heater  
E0600 Respiratory suction pump, home model, portable or stationary, electric  
E0601 Continuous airway pressure (CPAP) device  
E0602 Breast pump, manual, any type  
E0603 Breast pump, electric (AC and/or DC), any type  
E0604 Breast pump, hospital grade, electric (AC and/or DC), any type  
E0605 Vaporizer, room type  
E0606 Postural drainage board  
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  
E0617 External defibrillator with integrated electrocardiogram analysis  
E0618 Apnea monitor, without recording feature  
E0619 Apnea monitor, with recording feature  
E0621 Sling or seat, patient lift, canvas or nylon  
E0627 Seat lift mechanism incorporated into a combination lift-chair mechanism  
E0628 Separate seat lift mechanism for use with patient owned furniture - electric  
E0629 Separate seat lift mechanism for use with patient owned furniture - nonelectric  
E0630 Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s), or pad(s)  
E0635 Patient lift, electric, with seat or sling  
E0639 Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories  
E0640 Patient lift, fixed system, includes all components/accessories  
E0650 Pneumatic compressor, nonsegmental home model  
E0651 Pneumatic compressor, segmental home model without calibrated gradient pressure  
E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure  
E0655 Nonsegmental 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 Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg  
E0665 Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm  
E0666 Nonsegmental 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  
E0675 Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) Pneumatic Compression Devices
E0676 Intermittent limb compression device (includes all accessories), not otherwise specified Pneumatic Compression Devices
E0691 Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, treatment area 2 sq ft or less  
E0692 Ultraviolet light therapy system panel, includes bulbs/lamps, timer, and eye protection, 4 ft. panel  
E0693 Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 ft panel  
E0694 Ultraviolet multidirectional light therapy system in 6 ft. cabinet, includes bulbs/lamps, timer, and eye protection  
E0700 Safety equipment, device or accessory, any type  
E0705 Transfer device, any type, each  
E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation Occipital Neuralgia and Cervicogenic, Cluster and Migraine Headaches
E0730 Transcutaneous electrical nerve stimulation (TENS) device, 4 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 Incontinence treatment system, pelvic floor stimulator, monitor, sensor, and/or trainer  
E0745 Neuromuscular stimulator, electonic shock unit Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
E0746 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  
E0747 Osteogenesis stimulator, electrical, noninvasive, other than spinal applications Electrical and Ultrasound Bone Growth Stimulators
E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications Electrical and Ultrasound Bone Growth Stimulators
E0760 Osteogenesis stimulator, low intensity ultrasound, noninvasive Electrical and Ultrasound Bone Growth Stimulators
E0761 Nonthermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device  
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 Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
E0770 Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
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  
E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient  
E0784 External ambulatory infusion pump, insulin  
E0791 Parenteral infusion pump, stationary, single, or multichannel  
E0830 Ambulatory traction device, all types, each Home Traction Therapy
E0840 Traction frame, attached to headboard, cervical traction Home Traction Therapy
E0870 Traction frame, attached to footboard, extremity traction (e.g., Buck's)  
E0880 Traction stand, freestanding, extremity traction (e.g., Buck's)  
E0890 Traction frame, attached to footboard, pelvic traction  
E0900 Traction stand, freestanding, pelvic traction (e.g., Buck's)  
E0910 Trapeze bars, also known as Patient Helper, attached to bed, with grab bar  
E0911 Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar  
E0912 Trapeze bar, heavy-duty, for patient weight capacity greater than 250 pounds, freestanding, complete with grab bar  
E0920 Fracture frame, attached to bed, includes weights  
E0930 Fracture frame, freestanding, includes weights  
E0935 Continuous Passive Motion Exercise Device for use on knee only Mechanical Stretching and Continuous Passive Motion Devices
E0936 Continuous passive motion exercise device for use other than knee Mechanical Stretching and Continuous Passive Motion Devices
E0940 Trapeze bar, freestanding, complete with grab bar  
E0941 Gravity assisted traction device, any type Home Traction Therapy
E0942 Cervical head harness/halter  
E0944 Pelvic belt/harness/boot  
E0945 Extremity belt/harness  
E0946 Fracture, frame, dual with cross bars, attached to bed, (e.g., Balken, 4 Poster)  
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  
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  
E0958 Manual wheelchair accessory, one-arm drive attachment, 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  
E0966 Manual wheelchair accessory, headrest extension, each  
E0967 Manual wheelchair accessory, hand rim with projections, any type, each  
E0969 Narrowing device, wheelchair  
E0970 No. 2 footplates, except for elevating legrest  
E0971 Manual wheelchair accessory, antitipping device, each  
E0973 Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each  
E0974 Manual wheelchair accessory, anti-rollback device, each  
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  
E0983 Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control  
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 activated power assist, each  
E0988 Manual wheelchair accessory, lever-activated, wheel drive, pair  
E0990 Wheelchair accessory, elevating leg rest, complete assembly, each  
E0992 Manual wheelchair accessory, solid seat insert  
E0994 Armrest, each  
E0995 Wheelchair accessory, calf rest/pad, each  
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 seating 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 legrest, 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)  
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  
E1020 Residual limb support system for wheelchair, any type  
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  
E1031 Rollabout chair, any and all types with castors 5 in. or greater  
E1035 Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs  
E1036 Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs  
E1050 Fully reclining wheelchair; fixed full-length arms, swing-away, detachable, elevating legrests  
E1060 Fully-reclining wheelchair, detachable arms, desk or full-length, swing-away detachable elevating legrests  
E1070 Fully reclining wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests  
E1083 Hemi-wheelchair, fixed full-length arms, swing-away, detachable elevating legrest  
E1084 Hemi-wheelchair; detachable arms, desk, or full-length, swing-away, detachable, elevating leg rests  
E1085 Hemi-wheelchair, fixed full-length arms, swing-away detachable footrests  
E1086 Hemi-wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests  
E1087 High strength lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests  
E1088 High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests  
E1089 High-strength lightweight wheelchair, fixed-length arms, swing-away detachable footrest  
E1090 High-strength lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests  
E1092 Wide heavy-duty wheel chair, detachable arms (desk or full-length), swing-away detachable elevating legrests  
E1093 Wide, heavy-duty wheelchair; detachable arms, desk or full-length arms, swing-away, detachable footrests  
E1100 Semi-reclining wheelchair, fixed full-length arms, swing-away detachable elevating legrests  
E1110 Semi-reclining wheelchair; detachable arms, desk or full-length, elevating legrest  
E1130 Standard wheelchair, fixed full-length arms, fixed or swing-away detachable footrests  
E1140 Wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests  
E1150 Wheelchair, detachable arms, desk or full-length swing-away detachable elevating legrests  
E1160 Wheelchair, fixed full-length arms, swing away detachable elevating leg rests  
E1161 Manual adult size wheelchair, includes tilt in space  
E1170 Amputee wheelchair, fixed full-length arms, swing away detachable elevating leg rests  
E1171 Amputee wheelchair, fixed full-length arms, without footrests or legrest  
E1172 Amputee wheelchair, detachable arms (desk or full-length) without footrests or leg rest  
E1180 Amputee wheelchair, detachable arms (desk or full-length) swing-away detachable footrests  
E1190 Amputee wheelchair, detachable arms (desk or full-length) swing away detachable elevating leg rests  
E1195 Heavy-duty wheelchair, fixed full-length arms, swing-away detachable elevating legrests  
E1200 Amputee wheelchair, fixed full-length arms, swing away detachable footrest  
E1220 Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification  
E1221 Wheelchair with fixed arm, footrests  
E1222 Wheelchair with fixed arm, elevating legrests  
E1223 Wheelchair with detachable arms, footrests  
E1224 Wheelchair with detachable arms, elevating legrests  
E1225 Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each  
E1226 Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each  
E1227 Special height arms for wheelchair  
E1228 Special back height for wheelchair  
E1229 Wheelchair, pediatric size, not otherwise specified  
E1230 Power operated vehicle (3- or 4-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  
E1240 Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating leg rest  
E1250 Lightweight wheelchair, fixed full-length arms, swing-away detachable footrest  
E1260 Lightweight wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests  
E1270 Lightweight wheelchair, fixed full-length arms, swing-away detachable elevating legrests  
E1280 Heavy duty wheelchair, detachable arms (desk or full length) elevating leg rests  
E1285 Heavy-duty wheelchair, fixed full-length arms, swing-away detachable footrest  
E1290 Heavy-duty wheelchair; detachable arms, desk or full-length, swing-away, detachable footrests  
E1295 Heavy-duty wheelchair, fixed full-length arms, elevating legrest  
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, nonportable (built-in type)  
E1353 Regulator  
E1354 Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each  
E1355 Stand/rack  
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  
E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate  
E1391 Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each  
E1392 Portable oxygen concentrator, rental  
E1399 Durable medical equipment, miscellaneous  
E1405 Oxygen and water vapor enriching system with heated delivery  
E1406 Oxygen and water vapor enriching system without heated delivery  
E1500 Centrifuge, for dialysis  
E1510 Kidney, dialysate delivery system kidney machine, pump recirculating, air removal system, flowrate meter, power off, heater and temp control with alarm, IV poles, pressure gauge, concentrate container  
E1520 Heparin infusion pump for hemodialysis  
E1530 Air bubble detector for hemodialysis, each, replacement  
E1540 Pressure alarm for hemodialysis, each, replacement  
E1550 Bath conductivity meter for hemodialysis, each  
E1560 Blood leak detector for hemodialysis, each, replacement  
E1570 Adjustable chair, for ESRD patients  
E1575 Transducer protectors/fluid barriers, for hemodialysis, any size, per 10  
E1580 Unipuncture control system for hemodialysis  
E1590 Hemodialysis machine  
E1592 Automatic intermittent peritoneal dialysis system  
E1594 Cycler dialysis machine for peritoneal dialysis  
E1600 Delivery and/or installation charges for hemodialysis equipment  
E1610 Reverse osmosis water purification system, for hemodialysis  
E1615 Deionizer water purification system, for hemodialysis  
E1620 Blood pump for hemodialysis, replacement  
E1625 Water softening system, for hemodialysis  
E1630 Reciprocating peritoneal dialysis system  
E1632 Wearable artificial kidney, each  
E1634 Peritoneal dialysis clamps, each  
E1635 Compact (portable) travel hemodialyzer system  
E1636 Sorbent cartridges, for hemodialysis, per 10  
E1637 Hemostats, each  
E1639 Scale, each  
E1699 Dialysis equipment, not otherwise specified  
E1800 Dynamic adjustable elbow extension/flexion device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1802 Dynamic adjustable forearm pronation/supination device, includes soft interface materia Mechanical Stretching and Continuous Passive Motion Devices
E1805 Dynamic adjustable wrist extension/flexion device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1810 Dynamic adjustable knee extension/flexion device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1812 Dynamic knee, extension/flexion device with active resistance control Mechanical Stretching and Continuous Passive Motion Devices
E1815 Dynamic adjustable ankle extension/flexion device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1820 Replacement soft interface material, dynamic adjustable extension/flexion device  
E1825 Dynamic adjustable finger extension/flexion device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1830 Dynamic adjustable toe extension/flexion device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1840 Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material Mechanical Stretching and Continuous Passive Motion Devices
E1902 Communication board, non-electronic augmentative or alternative communication device  
E2000 Gastric suction pump, home model, portable or stationary, electric  
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 in and less than 24 in  
E2202 Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches  
E2203 Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 in  
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, 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, each  
E2221 Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, each  
E2222 Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, each  
E2224 Manual wheelchair accessory, propulsion wheel excludes tire, any size, 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 Power wheelchair accessory, power seat elevation system  
E2301 Power wheelchair accessory, power standing system  
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 2 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  
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 in  
E2341 Power wheelchair accessory, nonstandard seat frame width, 24-27 in.  
E2342 Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 in  
E2343 Power wheelchair accessory, nonstandard seat frame depth, 22-25 in.  
E2351 Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface  
E2358 Power wheelchair accessory, group 34 nonsealed lead acid battery, each  
E2359 Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glass mat)  
E2360 Power wheelchair accessory, 22 NF nonsealed 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 nonsealed 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 nonsealed 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, motor, replacement only  
E2369 Power wheelchair component, drive wheel gear box, replacement only  
E2370 Power wheelchair component, 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 nonsealed 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, nonexpandable 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  
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  
E2402 Negative pressure wound therapy electrical pump, stationary or portable  
E2500 Speech generating device, digitized speech, using pre-recorded messages, less than or equal to eight minutes recording time  
E2502 Speech generating device, digitized speech, using prerecorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time  
E2504 Speech generating device, digitized speech, using prerecorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time  
E2506 Speech generating device, digitized speech, using prerecorded 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 in., any depth  
E2602 General use wheelchair seat cushion, width 22 in. or greater, any depth  
E2603 Skin protection wheelchair seat cushion, width less than 22 in, any depth  
E2604 Skin protection wheelchair seat cushion, width 22 inches or greater, any depth  
E2605 Positioning wheelchair seat cushion, width less than 22 in, 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 in, 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 in, 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 in, 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 in, 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  
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 in, 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 in, 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 in, 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  
E8000 Gait trainer, pediatric size, posterior support, includes all accessories and components  
E8001 Gait trainer, pediatric size, upright support, includes all accessories and components  
E8002 Gait trainer, pediatric size, anterior support, includes all accessories and components  
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests  
K0001 Standard wheelchair  
K0002 Standard hemi (low seat) wheelchair  
K0003 Lightweight wheelchair  
K0004 High strength, lightweight wheelchair  
K0005 Ultralightweight 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 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, nonadjustable height armrest, each  
K0017 Detachable, adjustable height armrest, base, each  
K0018 Detachable, adjustable height armrest, upper portion, each  
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, upper hanger bracket, each  
K0045 Footrest, complete assembly  
K0046 Elevating legrest, lower extension tube, each  
K0047 Elevating legrest, upper hanger bracket, each  
K0050 Ratchet assembly  
K0051 Cam release assembly, footrest or legrest, each  
K0052 Swingaway, detachable footrests, each  
K0053 Elevating footrests, articulating (telescoping), each  
K0056 Seat height less than 17 in or equal to or greater than 21 in for a high-strength, lightweight, or ultralightweight wheelchair  
K0065 Spoke protectors, each  
K0069 Rear wheel assembly, complete, with solid tire, spokes or molded, each  
K0070 Rear wheel assembly, complete, with pneumatic tire, spokes or molded, each  
K0071 Front caster assembly, complete, with pneumatic tire, each  
K0072 Front caster assembly, complete, with semipneumatic tire, each  
K0073 Caster pin lock, each  
K0077 Front caster assembly, complete, with solid tire, each  
K0098 Drive belt for power wheelchair  
K0105 IV hanger, each  
K0108 Wheelchair component or accessory, not otherwise specified  
K0195 Elevating legrests, pair (for use with capped rental wheelchair base)  
K0455 Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)  
K0462 Temporary replacement for patient owned equipment being repaired, any type  
K0552 Supplies for external drug infusion pump, syringe type cartridge, sterile, each  
K0601 Replacement battery for external infusion pump owned by patient  
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  
K0669 Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from DME PDAC  
K0672 Addition to lower extremity orthotic, removable soft interface, all components, replacement only, each  
K0730 Controlled dose inhalation drug delivery system  
K0733 Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g. gel cell, absorbed glassmat)  
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  
K0739 Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes  
K0740 Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes  
K0743 Suction pump, home model, portable, for use on wounds  
K0744 Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less  
K0745 Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches  
K0746 Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches  
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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's chair, patient weight capacity 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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, captain's 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  
L0112 Cranial cervical orthotic, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated Plagiocephaly and Craniosynostosis Treatment
L0113 Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment. Plagiocephaly and Craniosynostosis Treatment
L0120 Cervical, flexible, nonadjustable (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  
L0170 Cervical, collar, molded to patient model  
L0172 Cervical, collar, semi-rigid thermoplastic foam, 2 piece  
L0174 Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension  
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  
L0220 Thoracic, rib belt, custom fabricated  
L0430 Spinal orthotic, 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, includes fitting and adjustment  
L0452 Thoracic-lumbar-sacral orthotic (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, includes fitting and adjustment  
L0456 Thoracic-lumbar-sacral orthotic (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, includes fitting and adjustment  
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 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, modular segmented spinal system, 2 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  
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 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, modular segmented spinal system, 4 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, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment  
L0468 Thoracic-lumbar-sacral orthotic (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, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment  
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, produces intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment  
L0472 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with 2 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  
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 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 1 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 Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 2 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 Thoracic-lumbar-sacral orthotic (TLSO), sagittal-coronal control, 1 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 Thoracic-lumbar-sacral orthotic (TLSO), sagittal-coronal control, modular segmented spinal system, 3 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  
L0621 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  
L0622 Sacroiliac orthotic, 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, includes fitting and adjustment  
L0624 Sacroiliac orthotic, 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, includes fitting and adjustment  
L0626 Lumbar orthotic, 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, includes fitting and adjustment  
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, includes fitting and adjustment  
L0628 Lumbar-sacral orthotic, 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, includes fitting and adjustment  
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 orthotic, 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, includes fitting and adjustment  
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, includes fitting and adjustment  
L0632 Lumbar-sacral orthotic (LSO), 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 LSO, 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, includes fitting and adjustment  
L0634 Lumbar-sacral orthotic (LSO), 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 LSO, 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 orthotic (LSO), 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 LSO, 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, includes fitting and adjustment  
L0638 Lumbar-sacral orthotic (LSO), 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 LSO, 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, includes fitting and adjustment  
L0640 Lumbar-sacral orthotic (LSO), 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  
L0700 CTLSO, anterior-posterior-lateral control, molded to patient model (Minerva type)  
L0710 Cervical-thoracic-lumbar-sacral orthotic (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  
L0861 Addition to halo procedure, replacement liner/interface material  
L0970 Thoracic-lumbar-sacral orthotic (TLSO), corset front  
L0972 LSO, corset front  
L0974 Thoracic-lumbar-sacral orthotic (TLSO), full corset  
L0976 LSO, full corset  
L0978 Axillary crutch extension  
L0980 Peroneal straps, pair  
L0982 Stocking supporter grips, set of 4  
L0984 Protective body sock, each  
L0999 Addition to spinal orthotic, not otherwise specified  
L1000 CTLSO (Milwaukee), inclusive of furnishing initial orthosis, including model  
L1001 Cervical-thoracic-lumbar-sacral orthotic (CTLSO), 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 orthotic (CTLSO) or scoliosis orthotic, axilla sling  
L1020 Addition to CTLSO or scoliosis orthosis, kyphosis pad  
L1025 Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, kyphosis pad, floating  
L1030 Addition to CTLSO or scoliosis orthosis, lumbar bolster pad  
L1040 Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, lumbar or lumbar rib pad  
L1050 Addition to CTLSO or scoliosis orthosis, sternal pad  
L1060 Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, thoracic pad  
L1070 Addition to CTLSO or scoliosis orthosis, trapezius sling  
L1080 Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, outrigger  
L1085 Addition to CTLSO or scoliosis orthosis, outrigger, bilateral with vertical extensions  
L1090 Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, lumbar sling  
L1100 Addition to CTLSO or scoliosis orthosis, ring flange, plastic or leather  
L1110 Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, ring flange, plastic or leather, molded to patient model  
L1120 Addition to CTLSO, scoliosis orthosis, cover for upright, each  
L1200 Thoracic-lumbar-sacral orthotic (TLSO), inclusive of furnishing initial orthotic only  
L1210 Addition to TLSO, (low profile), lateral thoracic extension  
L1220 Addition to thoracic-lumbar-sacral orthotic (TLSO), (low profile), anterior thoracic extension  
L1230 Addition to TLSO, (low profile), Milwaukee type superstructure  
L1240 Addition to thoracic-lumbar-sacral orthotic (TLSO), (low profile), lumbar derotation pad  
L1250 Addition to TLSO, (low profile), anterior ASIS pad  
L1260 Addition to thoracic-lumbar-sacral orthotic (TLSO), (low profile), anterior thoracic derotation pad  
L1270 Addition to TLSO, (low profile), abdominal pad  
L1280 Addition to thoracic-lumbar-sacral orthotic (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, postoperative body jacket  
L1499 Spinal orthotic, not otherwise specified  
L1600 HO, abduction control of hip joints, flexible, Frejka type with cover, prefabricated, includes fitting and adjustment  
L1610 Hip orthotic (HO), abduction control of hip joints, flexible, (Frejka cover only), prefabricated, includes fitting and adjustment  
L1620 HO, abduction control of hip joints, flexible, (Pavlik harness), prefabricated, includes fitting and adjustment  
L1630 Hip orthotic (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated  
L1640 HO, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated  
L1650 Hip orthotic (HO), 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 orthotic (HO), abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment  
L1680 HO, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (Rancho hip action type), custom fabricated  
L1685 Hip orthosis (HO), abduction control of hip joint, postoperative hip abduction type, custom fabricated  
L1686 HO, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustments  
L1690 Combination, bilateral, lumbo-sacral, hip, femur orthotic providing adduction and internal rotation control, prefabricated, includes fitting and adjustment  
L1700 Legg Perthes orthosis, (Toronto type), custom fabricated  
L1710 Legg Perthes orthotic, (Newington type), custom fabricated  
L1720 Legg Perthes orthosis, trilateral, (Tachdijan type), custom fabricated  
L1730 Legg Perthes orthotic, (Scottish Rite type), custom fabricated  
L1755 Legg Perthes orthosis, (Patten bottom type), custom fabricated  
L1810 Knee orthotic (KO), elastic with joints, prefabricated, includes fitting and adjustment  
L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment  
L1830 Knee orthotic (KO), immobilizer, canvas longitudinal, prefabricated, includes fitting and adjustment  
L1831 Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment  
L1832 Knee orthotic, adjustable knee joints (unicentric or polycentric), positional orthotic, rigid support, prefabricated, includes fitting and adjustment  
L1834 KO, without knee joint, rigid, custom fabricated  
L1836 Knee orthotic, rigid, without joint(s), includes soft interface material, prefabricated, includes fitting and adjustment  
L1840 KO, derotation, medial-lateral, anterior cruciate ligament, custom fabricated  
L1843 Knee orthotic (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, includes fitting and adjustment  
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 orthotic, 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, includes fitting and adjustment  
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 orthotic (KO), double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, includes fitting and adjustment  
L1850 KO, Swedish type, prefabricated, includes fitting and adjustment  
L1860 Knee orthotic (KO), modification of supracondylar prosthetic socket, custom fabricated (SK)  
L1900 AFO, spring wire, dorsiflexion assist calf band, custom fabricated  
L1902 Ankle-foot orthotic (AFO), ankle gauntlet, prefabricated, includes fitting and adjustment  
L1904 AFO, molded ankle gauntlet, custom fabricated  
L1906 Ankle-foot orthosis (AFO), multiligamentus ankle support, prefabricated, includes fitting and adjustment  
L1907 AFO, supramalleolar with straps, with or without interface/pads, custom fabricated  
L1910 Ankle-foot orthotic (AFO), posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment  
L1920 AFO, single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated  
L1930 Ankle-foot orthotic (AFO), 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 orthotic (AFO), plastic or other material, custom fabricated  
L1945 AFO, molded to patient model, plastic, rigid anterior tibial section (floor reaction), custom fabricated  
L1950 Ankle-foot orthotic (AFO), spiral, (Institute of Rehabilitative Medicine type), plastic, custom fabricated  
L1951 AFO, spiral, (Institute of Rehabilitative Medicine type), plastic or other material, prefabricated, includes fitting and adjustment  
L1960 Ankle-foot orthotic (AFO), posterior solid ankle, plastic, custom fabricated  
L1970 AFO, plastic, with ankle joint, custom fabricated  
L1971 Ankle-foot orthotic (AFO), plastic or other material with ankle joint, prefabricated, includes fitting and adjustment  
L1980 AFO, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar BK orthosis), custom fabricated  
L1990 Ankle-foot orthotic (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthotic), custom fabricated  
L2000 KAFO, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar AK orthosis), custom fabricated  
L2005 Knee-ankle-foot orthotic (KAFO), any material, single or double upright, stance control, automatic lock and swing phase release, mechanical activation, includes ankle joint, any type, custom fabricated  
L2010 KAFO, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar AK orthosis), without knee joint, custom fabricated  
L2020 Knee-ankle-foot orthotic (KAFO), double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'AK' orthotic), custom fabricated  
L2030 KAFO, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar AK orthosis), without knee joint, custom fabricated  
L2034 Knee-ankle-foot orthotic (KAFO), 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 orthotic (KAFO), 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 orthotic (KAFO), full plastic, with or without free motion knee, multi-axis ankle, custom fabricated  
L2040 HKAFO, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated  
L2050 Hip-knee-ankle-foot orthotic (HKAFO), torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated  
L2060 HKAFO, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated  
L2070 Hip-knee-ankle-foot orthotic (HKAFO), torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated  
L2080 HKAFO, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated  
L2090 Hip-knee-ankle-foot orthotic (HKAFO), torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated  
L2106 AFO, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated  
L2108 Ankle-foot orthotic (AFO), fracture orthotic, tibial fracture cast orthotic, custom fabricated  
L2112 AFO, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment  
L2114 Ankle-foot orthosis (AFO), fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment  
L2116 AFO, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment  
L2126 Knee-ankle-foot orthotic (KAFO), fracture orthotic, femoral fracture cast orthotic, thermoplastic type casting material, custom fabricated  
L2128 KAFO, fracture orthosis, femoral fracture cast orthosis, custom fabricated  
L2132 Knee-ankle-foot orthotic (KAFO), fracture orthotic, femoral fracture cast orthotic, soft, prefabricated, includes fitting and adjustment  
L2134 Knee ankle foot orthosis (KAFO), fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment  
L2136 KAFO, fracture orthotic, femoral fracture cast orthotic, 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 orthotic, drop lock knee joint  
L2184 Addition to lower extremity fracture orthosis, limited motion knee joint  
L2186 Addition to lower extremity fracture orthotic, adjustable motion knee joint, Lerman type  
L2188 Addition to lower extremity fracture orthosis, quadrilateral brim  
L2190 Addition to lower extremity fracture orthotic, 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 orthotic, rocker bottom for total contact ankle-foot orthotic (AFO), for custom fabricated orthotic 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, nonmolded lacer, for custom fabricated orthotic 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, pretibial 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 orthotic(KAFO), 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  
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, nonmolded  
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 orthotic, 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 orthotic, extension, per extension, per bar (for lineal adjustment for growth)  
L2768 Orthotic side bar disconnect device, per bar  
L2780 Addition to lower extremity orthotic, noncorrosive finish, per bar  
L2785 Addition to lower extremity orthosis, drop lock retainer, each  
L2795 Addition to lower extremity orthotic, 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 orthotic, knee control, condylar pad  
L2820 Addition to lower extremity orthosis, soft interface for molded plastic, below knee section  
L2830 Addition to lower extremity orthotic, 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 orthotic, femoral length sock, fracture or equal, 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  
L3100 Hallus-valgus night dynamic splint  
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, each  
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  
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 (orthotic)  
L3260 Surgical boot/shoe, each  
L3650 SO, figure of eight design abduction restrainer, prefabricated, includes fitting and adjustment  
L3660 Shoulder orthotic (SO), figure of eight design abduction restrainer, canvas and webbing, prefabricated, includes fitting and adjustment  
L3670 SO, acromio/clavicular (canvas and webbing type), prefabricated, includes fitting and adjustment  
L3671 Shoulder orthotic (SO), shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3674 Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with/without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3675 Shoulder orthotic (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, includes fitting and adjustment  
L3677 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, includes fitting and adjustment  
L3702 Elbow orthotic (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3710 EO, elastic with metal joints, prefabricated, includes fitting and adjustment  
L3720 Elbow orthotic (EO), double upright with forearm/arm cuffs, free motion, custom fabricated  
L3730 EO, double upright with forearm/arm cuffs, extension/flexion assist, custom fabricated  
L3740 Elbow orthotic (EO), 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, includes fitting and adjustments, any type  
L3762 Elbow orthotic (EO), rigid, without joints, includes soft interface material, prefabricated, includes fitting and adjustment  
L3763 Elbow wrist hand orthosis (EWHO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3764 Elbow-wrist-hand orthotic (EWHO), 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 (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3766 Elbow-wrist-hand-finger orthotic (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3806 WHFO, 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 orthotic (WHFO), without joint(s), prefabricated, includes fitting and adjustments, any type  
L3808 Wrist hand finger orthosis (WHFO), rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment  
L3891 Addition to upper extremity joint, wrist or elbow, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each  
L3900 WHFO, dynamic flexor hinge, reciprocal wrist extension/flexion, finger flexion/extension, wrist or finger driven, custom fabricated  
L3901 Wrist-hand-finger orthotic (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated  
L3904 WHFO, external powered, electric, custom fabricated  
L3905 Wrist-hand orthotic (WHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3906 Wrist hand orthosis (WHO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3908 Wrist-hand orthotic (WHO), wrist extension control cock-up, nonmolded, prefabricated, includes fitting and adjustment  
L3912 HFO, flexion glove with elastic finger control, prefabricated, includes fitting and adjustment  
L3913 Hand finger orthotic (HFO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3915 Wrist hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, includes fitting and adjustment  
L3917 Hand orthotic (HO), metacarpal fracture orthotic, prefabricated, includes fitting and adjustment  
L3919 Hand orthosis (HO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3921 Hand finger orthotic (HFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3923 Hand finger orthosis (HFO), without joints, may include soft interface, straps, prefabricated, includes fitting and adjustment  
L3925 Finger orthotic (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, 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, includes fitting and adjustment  
L3929 Hand-finger orthotic (HFO), includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, includes fitting and adjustment  
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  
L3933 Finger orthotic (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment  
L3935 Finger orthosis, nontorsion joint, may include soft interface, custom fabricated, includes fitting and adjustment  
L3956 Addition of joint to upper extremity orthotic, any material; per joint  
L3960 SEWHO, abduction positioning, airplane design, prefabricated, includes fitting and adjustment  
L3961 Shoulder elbow wrist hand orthotic (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3962 SEWHO, abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment  
L3967 Shoulder-elbow-wrist-hand orthotic (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3971 Shoulder elbow wrist hand orthosis (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3973 Shoulder-elbow-wrist-hand orthotic (SEWHO), 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  
L3975 Shoulder elbow wrist hand finger orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment  
L3976 Shoulder-elbow-wrist-hand-finger orthotic (SEWHO), 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 (SEWHO), 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 orthotic (SEWHO), 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  
L3982 Upper extremity fracture orthotic, radius/ulnar, prefabricated, includes fitting and adjustment  
L3984 Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment  
L3995 Addition to upper extremity orthotic, sock, fracture or equal, each  
L3999 Upper limb orthosis, NOS  
L4000 Replace girdle for spinal orthotic (cervical-thoracic-lumbar-sacral orthotic (CTLSO) or spinal orthotic 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 nonmolded thigh lacer, for custom fabricated orthotic only  
L4050 Replace molded calf lacer, for custom fabricated orthosis only  
L4055 Replace nonmolded calf lacer, for custom fabricated orthotic 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 orthotic, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, includes fitting and adjustment  
L4360 Walking boot, pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment  
L4370 Pneumatic full leg splint, prefabricated, includes fitting and adjustment  
L4386 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment  
L4392 Replacement, soft interface material, static AFO  
L4394 Replace soft interface material, foot drop splint  
L4396 Static or dynamic ankle-foot orthotic (AFO), including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, includes fitting and adjustment  
L4398 Foot drop splint, recumbent positioning device, prefabricated, includes fitting and adjustment  
L4631 Ankle-foot orthotic (AFO), 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  
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 postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee  
L5410 Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment  
L5420 Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change AK or knee disarticulation  
L5430 Immediate postsurgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, AK or knee disarticulation, each additional cast change and realignment  
L5450 Immediate postsurgical or early fitting, application of nonweight bearing rigid dressing, below knee  
L5460 Immediate postsurgical or early fitting, application of nonweight bearing rigid dressing, above knee  
L5500 Initial, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed  
L5505 Initial, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot plaster socket, direct formed  
L5510 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model  
L5520 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed  
L5530 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model  
L5535 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, prefabricated, adjustable open end socket  
L5540 Preparatory, below knee PTB type socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model  
L5560 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, molded to model  
L5570 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed  
L5580 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, molded to model  
L5585 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, prefabricated adjustable open end socket  
L5590 Preparatory, above knee - knee disarticulation, ischial level socket, nonalignable 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, endoskeletal 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 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 Addition 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, multidurometer, Symes  
L5665 Addition to lower extremity, socket insert, multidurometer, 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  
L5676 Addition to lower extremity, below knee, knee joints, single axis, pair  
L5677 Addition to lower extremity, below knee, knee joints, polycentric, pair  
L5678 Addition 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  
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 initia  
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 Addition, 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  
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  
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 hyrdraulic control, rotation control, with/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  
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, flexible keel foot (SAFE, STEN, Bock Dynamic or equal)  
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 prostheses, multiaxial 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, multiaxial 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  
L5990 Addition to lower extremity prosthesis, user adjustable heel height  
L5999 Lower extremity prosthesis, not otherwise specified  
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, replacement  
L7368 Lithium ion battery charger, replacement only  
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  
L7900 Male vacuum erection system  
L7902 Tension ring, for vacuum erection device, any type, replacement only, each  
L8000 Breast prosthesis, mastectomy bra  
L8001 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral  
L8002 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral  
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, reusable, any type, each  
L8035 Custom breast prosthesis, post mastectomy, molded to patient model  
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 nonphysician  
L8044 Hemi-facial prosthesis, provided by a nonphysician  
L8045 Auricular prosthesis, provided by a nonphysician  
L8046 Partial facial prosthesis, provided by a nonphysician  
L8047 Nasal septal prosthesis, provided by a nonphysician  
L8048 Unspecified maxillofacial prosthesis, by report, provided by a nonphysician  
L8049 Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a nonphysician  
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  
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  
L8440 Prosthetic shrinker, below knee, each  
L8460 Prosthetic shrinker, above knee, each  
L8470 Prosthetic sock, single ply, fitting, below knee, each  
L8480 Prosthetic sock, single ply, fitting, above knee, each  
L8500 Artificial larynx, any type  
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  
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  
L8614 Cochlear device, includes all internal and external components Cochlear Implants
L8615 Headset/headpiece for use with cochlear implant device, replacement Cochlear Implants
L8616 Microphone for use with cochlear implant device, replacement Cochlear Implants
L8617 Transmitting coil for use with cochlear implant device, replacement Cochlear Implants
L8618 Transmitter cable for use with cochlear implant device, replacement Cochlear Implants
L8619 Cochlear implant, external speech processor and controller, integrated system, replacement Cochlear Implants
L8621 Zinc air battery for use with cochlear implant device, 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 device speech processor, ear level, replacement, each  
L8627 Cochlear implant, external speech processor, component, replacement Cochlear Implants
L8628 Cochlear implant, external controller component, replacement Cochlear Implants
L8629 Transmitting coil and cable, integrated, for use with cochlear implant device, replacement Cochlear Implants
L8691 Auditory osseointegrated device, external sound processor, replacement  
L8693 Auditory osseointegrated device abutment, any length, replacement only  
L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code  
S1015 IV tubing extension set  
S1016 Non-PVC (polyvinyl chloride) intravenous administration set, for use with drugs that are not stable in PVC e.g., Paclitaxel  
S1040 Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) Plagiocephaly and Craniosynostosis Treatment
S5160 Emergency response system; installation and testing  
S5161 Emergency response system; service fee, per month (excludes installation and testing)  
S5162 Emergency response system; purchase only  
S5165 Home modifications; per service  
S5560 Insulin delivery device, reusable pen; 1.5 ml size  
S5561 Insulin delivery device, reusable pen; 3 ml size  
S5565 Insulin cartridge for use in insulin delivery device other than pump; 150 units  
S5566 Insulin cartridge for use in insulin delivery device other than pump; 300 units  
S5570 Insulin delivery device, disposable pen (including insulin); 1.5 ml size  
S5571 Insulin delivery device, disposable pen (including insulin); 3 ml size  
S8096 Portable peak flow meter  
S8097 Asthma kit (including but not limited to portable peak expiratory flow meter, instructional video, brochure, and/or spacer)  
S8100 Holding chamber or spacer for use with an inhaler or nebulizer; without mask  
S8101 Holding chamber or spacer for use with an inhaler or nebulizer; with mask  
S8120 Oxygen contents, gaseous, 1 unit equals 1 cubic foot  
S8121 Oxygen contents, liquid, 1 unit equals 1 pound  
S8130 Interferential current stimulator, 2 channel Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
S8131 Interferential current stimulator, 4 channel Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
S8185 Flutter device  
S8186 Swivel adaptor  
S8189 Tracheostomy supply, not otherwise classified  
S8210 Mucus trap  
S8262 Mandibular orthopedic repositioning device, each Non-Surgical Treatment of Obstructive Sleep Apnea
S8265 Haberman feeder for cleft lip/palate  
S8270 Enuresis alarm, using auditory buzzer and/or vibration device  
S8301 Infection control supplies, not otherwise specified  
S8415 Supplies for home delivery of infant  
S8430 Padding for compression bandage, roll  
S8431 Compression bandage, roll  
S8450 Splint, prefabricated, digit (specify digit by use of modifier)  
S8451 Splint, prefabricated, wrist or ankle  
S8452 Splint, prefabricated, elbow  
S8490 Insulin syringes (100 syringes, any size)  
S8999 Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)  
S9007 Ultrafiltration monitor  
S9145 Insulin pump initiation, instruction in initial use of pump (pump not included)  
S9999 Sales tax  
T2039 Vehicle modifications, waiver; per service  
T4521 Adult sized disposable incontinence product, brief/diaper, small, each  
T4522 Adult sized disposable incontinence product, brief/diaper, medium, each  
T4523 Adult sized disposable incontinence product, brief/diaper, large, each  
T4524 Adult sized disposable incontinence product, brief/diaper, extra large, each  
T4525 Adult sized disposable incontinence product, protective underwear/pull-on, small size, each  
T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each  
T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each  
T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each  
T4529 Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each  
T4530 Pediatric sized disposable incontinence product, brief/diaper, large size, each  
T4531 Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each  
T4532 Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each  
T4533 Youth sized disposable incontinence product, brief/diaper, each  
T4534 Youth sized disposable incontinence product, protective underwear/pull-on, each  
T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each  
T4536 Incontinence product, protective underwear/pull-on, reusable, any size, each  
T4537 Incontinence product, protective underpad, reusable, bed size, each  
T4538 Diaper service, reusable diaper, each diaper  
T4539 Incontinence product, diaper/brief, reusable, any size, each  
T4540 Incontinence product, protective underpad, reusable, chair size, each  
T4541 Incontinence product, disposable underpad, large, each  
T4542 Incontinence product, disposable underpad, small size, each  
T4543 Disposable incontinence product, brief/diaper, bariatric, each  
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  
V5266 Battery for use in hearing device