999 94761 NU MEASURE BLOOD OXYGEN LEVEL 0

Code Modifier Desc Age

94760 NU MEASURE BLOOD OXYGEN LEVEL 0 - 999



A4206 1 CC STERILE SYRINGE&NEEDLE 0 - 999

A4206 NU 1 CC STERILE SYRINGE&NEEDLE 0 - 999





A4209 5+ CC STERILE SYRINGE&NEEDLE 0 - 999

A4209 NU 5+ CC STERILE SYRINGE&NEEDLE 0 - 999

A4213 20+ CC SYRINGE ONLY 0 - 999

A4213 NU 20+ CC SYRINGE ONLY 0 - 999

A4215 NEEDLES ONLY, STERILE, ANY SIZE, EACH 0 - 999

A4215 NU NEEDLES ONLY, STERILE, ANY SIZE, EACH 0 - 999

A4216 STERILE WATER/SALINE, 10 ML 0 - 999

A4216 NU STERILE WATER/SALINE, 10 ML 0 - 999

A4217 STERILE WATER/SALINE, 500 ML 0 - 20

A4217 NU STERILE WATER/SALINE, 500 ML 0 - 999

A4221 Maint drug infus cath per wk 0 - 20

A4221 NU Maint drug infus cath per wk 0 - 999

A4222 Infusion supplies with pump 0 - 20

A4222 NU Infusion supplies with pump 0 - 999

A4223 INFUSION SUPPLIES, NOT USED WITH EXTERNAL

INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS

SEPARATELY)

0 - 999

A4223 NU INFUSION SUPPLIES, NOT USED WITH EXTERNAL

INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS

SEPARATELY)

0 - 999

A4230 INFUSION SET FOR EXTERNAL INSULIN PUMP, NON

NEEDLE CANNULA TYPE

0 - 999

A4230 NU INFUSION SET FOR EXTERNAL INSULIN PUMP, NON

NEEDLE CANNULA TYPE

0 - 999

A4231 INFUSION SET FOR EXTERNAL INSULIN PUMP,

NEEDLE TYPE

0 - 999

A4231 NU INFUSION SET FOR EXTERNAL INSULIN PUMP,

NEEDLE TYPE

0 - 999

A4232 SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN

PUMP, STERILE, 3CC

0 - 999

A4232 NU SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN

PUMP, STERILE, 3CC

0 - 999

A4244 ALCOHOL OR PEROXIDE, PER PINT 0 - 999

A4244 NU ALCOHOL OR PEROXIDE, PER PINT 0 - 999

A4245 ALCOHOL WIPES, PER BOX 0 - 999

A4245 NU ALCOHOL WIPES, PER BOX 0 - 999

A4246 BETADINE OR PHISOHEX SOLUTION, PER PINT 0 - 20

A4246 NU BETADINE OR PHISOHEX SOLUTION, PER PINT 0 - 999

A4247 BETADINE OR IODINE SWABS/WIPES, PER BOX 0 - 999

A4247 NU BETADINE OR IODINE SWABS/WIPES, PER BOX 0 - 999

A4250 Urine Reagent Strips/Tablets 0 - 999

A4253 Blood Glucose/Reagent Strips 0 - 999

A4255 PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR,

50 PER BOX

0 - 20

A4255 NU PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR,

50 PER BOX

0 - 999

A4256 NORMAL, LOW AND HIGH CALIBRATOR SOLUTION /

CHIPS

0 - 20

A4256 NU NORMAL, LOW AND HIGH CALIBRATOR SOLUTION /

CHIPS

0 - 999

A4258 Lancet Device Each 0 - 999

A4259 Lancets Per Box 0 - 999

A4265 PARAFFIN, PER POUND 0 - 20

A4265 NU PARAFFIN, PER POUND 0 - 999

A4280 Brst Prsths Adhsv Attchmnt 0 - 999

A4310 Insert tray w/o bag/cath 0 - 20

A4310 NU Insert tray w/o bag/cath 0 - 999

A4311 CATHETER W/O BAG 2-WAY LATEX 0 - 999

A4311 NU CATHETER W/O BAG 2-WAY LATEX 0 - 999

A4312 CATH W/O BAG 2-WAY SILICONE 0 - 999

A4312 NU CATH W/O BAG 2-WAY SILICONE 0 - 999

A4313 CATHETER W/BAG 3-WAY 0 - 999

A4313 NU CATHETER W/BAG 3-WAY 0 - 999

A4314 CATH W/DRAINAGE 2-WAY LATEX 0 - 20

A4314 NU CATH W/DRAINAGE 2-WAY LATEX 0 - 999

A4315 CATH W/DRAINAGE 2-WAY SILCNE 0 - 20

A4315 NU CATH W/DRAINAGE 2-WAY SILCNE 0 - 999

A4316 CATH W/DRAINAGE 3-WAY 0 - 20

A4316 NU CATH W/DRAINAGE 3-WAY 0 - 999

A4319 NU STERILE WATER IRRIG SOLUTION 1000 ML 0 - 999

A4320 IRRIGATION TRAY 0 - 20

A4320 NU IRRIGATION TRAY 0 - 999

A4321 NU CATH THERAPEUTIC IRRIG AGENT 0 - 999

A4322 IRRIGATION SYRINGE 0 - 20

A4322 NU IRRIGATION SYRINGE 0 - 999

A4326 MALE EXTERNAL CATHETER 0 - 20

A4326 NU MALE EXTERNAL CATHETER 0 - 999

A4327 FEM URINARY COLLECT DEV CUP 0 - 20

A4327 NU FEM URINARY COLLECT DEV CUP 0 - 999

A4328 FEM URINARY COLLECT POUCH 0 - 20

A4328 NU FEM URINARY COLLECT POUCH 0 - 999

A4330 Perianal fecal collection pouch with adhesive, each 0 - 20

A4330 NU Perianal fecal collection pouch with adhesive, each 0 - 999

A4331 EXTENSION DRAINAGE TUBING 0 - 999

A4331 NU EXTENSION DRAINAGE TUBING 0 - 999

A4332 LUBE STERILE PACKET 0 - 999

A4332 NU LUBE STERILE PACKET 0 - 999

A4333 URINARY CATH ANCHOR DEVICE 0 - 999

A4333 NU URINARY CATH ANCHOR DEVICE 0 - 999

A4334 NU URINARY CATH LEG STRAP 0 - 999

A4335 NU INCONTINENCE SUPPLY 0 - 999

A4336 NU URETHRAL INSERT 0 - 999

A4338 INDWELLING CATHETER LATEX 0 - 20

A4338 NU INDWELLING CATHETER LATEX 0 - 999

A4340 INDWELLING CATHETER SPECIAL 0 - 20

A4340 NU INDWELLING CATHETER SPECIAL 0 - 999

A4344 CATH INDW FOLEY 2 WAY SILICN 0 - 20

A4344 NU CATH INDW FOLEY 2 WAY SILICN 0 - 999

A4346 CATH INDW FOLEY 3 WAY 0 - 20

A4346 NU CATH INDW FOLEY 3 WAY 0 - 999

A4347 NU MENTOR URINARY DRAIN VALVE 0 - 999

A4348 NU EXTERNAL CATHETER MALE 29MM 0 - 999

A4349 DISPOSABLE MALE EXTERNAL CAT 0 - 999

A4349 NU DISPOSABLE MALE EXTERNAL CAT 0 - 999

A4351 STRAIGHT TIP URINE CATHETER 0 - 999

A4351 NU STRAIGHT TIP URINE CATHETER 0 - 999

A4352 COUDE TIP URINARY CATHETER 0 - 999

A4352 NU COUDE TIP URINARY CATHETER 0 - 999

A4353 INTERMITTENT URINARY CATH 0 - 999

A4353 NU INTERMITTENT URINARY CATH 0 - 999

A4354 CATH INSERTION TRAY W/BAG 0 - 20

A4354 NU CATH INSERTION TRAY W/BAG 0 - 999

A4355 BLADDER IRRIGATION TUBING 0 - 20

A4355 NU BLADDER IRRIGATION TUBING 0 - 999

A4356 EXT URETH CLMP OR COMPR DVC 0 - 20

A4356 NU EXT URETH CLMP OR COMPR DVC 0 - 999

A4357 BEDSIDE DRAINAGE BAG 0 - 999

A4357 NU BEDSIDE DRAINAGE BAG 0 - 999

A4358 URINARY LEG OR ABDOMEN BAG 0 - 999

A4358 NU URINARY LEG OR ABDOMEN BAG 0 - 999

A4360 NU DISPOSABLE EXT URETHRAL DEV 0 - 999

A4361 OSTOMY FACE PLATE 0 - 999

A4361 NU OSTOMY FACE PLATE 0 - 999

A4362 SOLID SKIN BARRIER 0 - 999

A4362 NU SOLID SKIN BARRIER 0 - 999

A4363 OSTOMY CLAMP, REPLACEMENT 0 - 999

A4363 NU OSTOMY CLAMP, REPLACEMENT 0 - 999

A4364 ADHESIVE, LIQUID OR EQUAL 0 - 999

A4364 NU ADHESIVE, LIQUID OR EQUAL 0 - 999

A4365 NU ADHESIVE REMOVER 0 - 999

A4366 NU OSTOMY VENT 0 - 999

A4367 OSTOMY BELT 0 - 999

A4367 NU OSTOMY BELT 0 - 999

A4368 OSTOMY FILTER 0 - 999

A4368 NU OSTOMY FILTER 0 - 999

A4369 SKIN BARRIER LIQUID PER OZ 0 - 999

A4369 NU SKIN BARRIER LIQUID PER OZ 0 - 999

A4371 SKIN BARRIER POWDER PER OZ 0 - 999

A4371 NU SKIN BARRIER POWDER PER OZ 0 - 999

A4372 SKIN BARRIER SOLID 4X4 EQUIV 0 - 999

A4372 NU SKIN BARRIER SOLID 4X4 EQUIV 0 - 999

A4373 SKIN BARRIER WITH FLANGE 0 - 999

A4373 NU SKIN BARRIER WITH FLANGE 0 - 999

A4375 DRAINABLE PLASTIC PCH W FCPL 0 - 999

A4375 NU DRAINABLE PLASTIC PCH W FCPL 0 - 999

A4376 DRAINABLE RUBBER PCH W FCPLT 0 - 999

A4376 NU DRAINABLE RUBBER PCH W FCPLT 0 - 999

A4377 DRAINABLE PLSTIC PCH W/O FP 0 - 999

A4377 NU DRAINABLE PLSTIC PCH W/O FP 0 - 999

A4378 DRAINABLE RUBBER PCH W/O FP 0 - 999

A4378 NU DRAINABLE RUBBER PCH W/O FP 0 - 999

A4379 URINARY PLASTIC POUCH W FCPL 0 - 999

A4379 NU URINARY PLASTIC POUCH W FCPL 0 - 999

A4380 URINARY RUBBER POUCH W FCPLT 0 - 999

A4380 NU URINARY RUBBER POUCH W FCPLT 0 - 999

A4381 URINARY PLASTIC POUCH W/O FP 0 - 999

A4381 NU URINARY PLASTIC POUCH W/O FP 0 - 999

A4382 URINARY HVY PLSTC PCH W/O FP 0 - 999

A4382 NU URINARY HVY PLSTC PCH W/O FP 0 - 999

A4383 URINARY RUBBER POUCH W/O FP 0 - 999

A4383 NU URINARY RUBBER POUCH W/O FP 0 - 999

A4384 OSTOMY FACEPLT/SILICONE RING 0 - 999

A4384 NU OSTOMY FACEPLT/SILICONE RING 0 - 999

A4385 OST SKN BARRIER SLD EXT WEAR 0 - 999

A4385 NU OST SKN BARRIER SLD EXT WEAR 0 - 999

A4387 OST CLSD POUCH W ATT ST BARR 0 - 999

A4387 NU OST CLSD POUCH W ATT ST BARR 0 - 999

A4388 DRAINABLE PCH W EX WEAR BARR 0 - 999

A4388 NU DRAINABLE PCH W EX WEAR BARR 0 - 999

A4389 DRAINABLE PCH W ST WEAR BARR 0 - 999

A4389 NU DRAINABLE PCH W ST WEAR BARR 0 - 999

A4390 DRAINABLE PCH EX WEAR CONVEX 0 - 999

A4390 NU DRAINABLE PCH EX WEAR CONVEX 0 - 999

A4391 URINARY POUCH W EX WEAR BARR 0 - 999

A4391 NU URINARY POUCH W EX WEAR BARR 0 - 999

A4392 URINARY POUCH W ST WEAR BARR 0 - 999

A4392 NU URINARY POUCH W ST WEAR BARR 0 - 999

A4393 URINE PCH W EX WEAR BAR CONV 0 - 999

A4393 NU URINE PCH W EX WEAR BAR CONV 0 - 999

A4394 OSTOMY POUCH LIQ DEODORANT 0 - 999

A4394 NU OSTOMY POUCH LIQ DEODORANT 0 - 999

A4395 OSTOMY POUCH SOLID DEODORANT 0 - 999

A4395 NU OSTOMY POUCH SOLID DEODORANT 0 - 999

A4396 Ostomy belt with peristomal hernia support 0 - 999

A4396 NU Ostomy belt with peristomal hernia support 0 - 999

A4397 IRRIGATION SUPPLY SLEEVE 0 - 999

A4397 NU IRRIGATION SUPPLY SLEEVE 0 - 999

A4398 OSTOMY IRRIGATION BAG 0 - 999

A4398 NU OSTOMY IRRIGATION BAG 0 - 999

A4399 OSTOMY IRRIG CONE/CATH W BRS 0 - 999

A4399 NU OSTOMY IRRIG CONE/CATH W BRS 0 - 999

A4400 OSTOMY IRRIGATION SET 0 - 999

A4400 NU OSTOMY IRRIGATION SET 0 - 999

A4402 LUBRICANT PER OUNCE 0 - 999

A4402 NU LUBRICANT PER OUNCE 0 - 999

A4404 OSTOMY RING EACH 0 - 999

A4404 NU OSTOMY RING EACH 0 - 999

A4405 NONPECTIN BASED OSTOMY PASTE 0 - 999

A4405 NU NONPECTIN BASED OSTOMY PASTE 0 - 999

A4406 PECTIN BASED OSTOMY PASTE 0 - 999

A4406 NU PECTIN BASED OSTOMY PASTE 0 - 999

A4407 EXT WEAR OST SKN BARR <=4SQ" 0 - 999

A4407 NU EXT WEAR OST SKN BARR <=4SQ" 0 - 999

A4408 EXT WEAR OST SKN BARR >4SQ" 0 - 999

A4408 NU EXT WEAR OST SKN BARR >4SQ" 0 - 999

A4409 OST SKN BARR CONVEX <=4 SQ I 0 - 999

A4409 NU OST SKN BARR CONVEX <=4 SQ I 0 - 999

A4410 OST SKN BARR EXTND >4 SQ 0 - 999

A4410 NU OST SKN BARR EXTND >4 SQ 0 - 999

A4411 OST SKN BARR EXTND =4SQ 0 - 999

A4411 NU OST SKN BARR EXTND =4SQ 0 - 999

A4412 OST POUCH DRAIN HIGH OUTPUT 0 - 999

A4412 NU OST POUCH DRAIN HIGH OUTPUT 0 - 999

A4413 2 PC DRAINABLE OST POUCH 0 - 999

A4413 NU 2 PC DRAINABLE OST POUCH 0 - 999

A4414 OST SKNBAR W/O CONV<=4 SQ IN 0 - 999

A4414 NU OST SKNBAR W/O CONV<=4 SQ IN 0 - 999

A4415 OST SKN BARR W/O CONV >4 SQI 0 - 999

A4415 NU OST SKN BARR W/O CONV >4 SQI 0 - 999

A4416 OST PCH CLSD W BARRIER/FILTR 0 - 999

A4416 NU OST PCH CLSD W BARRIER/FILTR 0 - 999

A4417 OST PCH W BAR/BLTINCONV/FLTR 0 - 999

A4417 NU OST PCH W BAR/BLTINCONV/FLTR 0 - 999

A4418 OST PCH CLSD W/O BAR W FILTR 0 - 999

A4418 NU OST PCH CLSD W/O BAR W FILTR 0 - 999

A4419 NU OST PCH FOR BAR W FLANGE/FLT 0 - 999

A4420 OST PCH CLSD FOR BAR W LK FL 0 - 999

A4420 NU OST PCH CLSD FOR BAR W LK FL 0 - 999

A4421 OSTOMY SUPPLY MISC 0 - 999

A4421 NU OSTOMY SUPPLY MISC 0 - 999

A4422 NU OST POUCH ABSORBENT MATERIAL 0 - 999

A4423 OST PCH FOR BAR W LK FL/FLTR 0 - 999

A4423 NU OST PCH FOR BAR W LK FL/FLTR 0 - 999

A4424 OST PCH DRAIN W BAR & FILTER 0 - 999

A4424 NU OST PCH DRAIN W BAR & FILTER 0 - 999

A4425 OST PCH DRAIN FOR BARRIER FL 0 - 999

A4425 NU OST PCH DRAIN FOR BARRIER FL 0 - 999

A4426 OST PCH DRAIN 2 PIECE SYSTEM 0 - 999

A4426 NU OST PCH DRAIN 2 PIECE SYSTEM 0 - 999

A4427 OST PCH DRAIN/BARR LK FLNG/F 0 - 999

A4427 NU OST PCH DRAIN/BARR LK FLNG/F 0 - 999

A4428 URINE OST POUCH W FAUCET/TAP 0 - 999

A4428 NU URINE OST POUCH W FAUCET/TAP 0 - 999

A4429 URINE OST POUCH W BLTINCONV 0 - 999

A4429 NU URINE OST POUCH W BLTINCONV 0 - 999

A4430 OST URINE PCH W B/BLTIN CONV 0 - 999

A4430 NU OST URINE PCH W B/BLTIN CONV 0 - 999

A4431 OST PCH URINE W BARRIER/TAPV 0 - 999

A4431 NU OST PCH URINE W BARRIER/TAPV 0 - 999

A4432 OS PCH URINE W BAR/FANGE/TAP 0 - 999

A4432 NU OS PCH URINE W BAR/FANGE/TAP 0 - 999

A4433 URINE OST PCH BAR W LOCK FLN 0 - 999

A4433 NU URINE OST PCH BAR W LOCK FLN 0 - 999

A4434 OST PCH URINE W LOCK FLNG/FT 0 - 999

A4434 NU OST PCH URINE W LOCK FLNG/FT 0 - 999

A4435 NU 1PC OST PCH DRAIN HGH OUTPUT 0 - 999

A4438 NU BARD FOLEY 16FR #0196L16 0 - 999

A4450 NON-WATERPROOF TAPE 0 - 999

A4450 NU NON-WATERPROOF TAPE 0 - 999

A4452 WATERPROOF TAPE 0 - 999

A4452 NU WATERPROOF TAPE 0 - 999

A4454 NU TAPE ALL TYPES ALL SIZES 0 - 999

A4455 ADHESIVE REMOVER PER OUNCE 0 - 999

A4455 NU ADHESIVE REMOVER PER OUNCE 0 - 999

A4456 ADHESIVE REMOVER, WIPES 0 - 999

A4456 NU ADHESIVE REMOVER, WIPES 0 - 999

A4460 NU ELASTIC BANDAGE PER ROLL (COMPRESSION

BANDAGE)

0 - 999

A4461 NU SURGICL DRESS HOLD NON-REUSE 0 - 999

A4462 NU ABDMNL DRSSNG HOLDER/BINDER 0 - 999

A4463 NU SURGICAL DRESS HOLDER REUSE 0 - 999

A4466 NU ELASTIC GARMENT/COVERING 0 - 999

A4481 TRACHEOSTOMA FILTER 0 - 999

A4481 NU TRACHEOSTOMA FILTER 0 - 999

A4483 NU Moisture exchanger, disposable, for use with

invasive mechanical ventilation

0 - 999

A4554 DISPOSABLE UNDERPADS 0 - 20

A4554 NU DISPOSABLE UNDERPADS 0 - 999

A4556 NU ELECTRODES, PAIR 0 - 999

A4557 NU LEAD WIRES, PAIR 0 - 999

A4558 NU CONDUCTIVE GEL OR PASTE 0 - 999

A4559 NU COUPLING GEL OR PASTE 0 - 999

A4561 Pessary rubber, any type 0 - 999

A4561 NU Pessary rubber, any type 0 - 999

A4562 Pessary, non rubber,any type 0 - 999

A4562 NU Pessary, non rubber,any type 0 - 999

A4565 Slings 0 - 20

A4565 NU Slings 0 - 999

A4570 SPLINT 0 - 20

A4570 NU SPLINT 0 - 999

A4595 NU TENS SUPPL 2 LEAD PER MONTH 0 - 999

A4604 NU Tubing with integrated heating element for use with

positive airway pressure device

0 - 999

A4605 TRACH SUCTION CATH CLOSE SYS 0 - 999

A4605 NU TRACH SUCTION CATH CLOSE SYS 0 - 999

A4606 NU OXYGEN PROBE USED W OXIMETER 0 - 999

A4608 Transtracheal oxygen cath 0 - 999

A4608 NU Transtracheal oxygen cath 0 - 999

A4609 NU TRACH SUCTION CATH CLSED SYS 0 - 999

A4611 HEAVY DUTY BATTERY 0 - 999

A4611 NU HEAVY DUTY BATTERY 0 - 999

A4612 BATTERY CABLES 0 - 999

A4612 NU BATTERY CABLES 0 - 999

A4613 BATTERY CHARGER 0 - 999

A4613 NU BATTERY CHARGER 0 - 999

A4614 Hand-held pefr meter 0 - 999

A4614 NU Hand-held pefr meter 0 - 999

A4615 NU CANNULA NASAL 0 - 999

A4616 TUBING (OXYGEN) PER FOOT 0 - 999

A4616 NU TUBING (OXYGEN) PER FOOT 0 - 999

A4617 NU MOUTH PIECE 0 - 999

A4618 BREATHING CIRCUITS 0 - 999

A4618 NU BREATHING CIRCUITS 0 - 999

A4620 NU VARIABLE CONCENTRATION MASK 0 - 999

A4623 TRACHEOSTOMY INNER CANNULA 0 - 999

A4623 NU TRACHEOSTOMY INNER CANNULA 0 - 999

A4624 TRACHEAL SUCTION TUBE 0 - 999

A4624 NU TRACHEAL SUCTION TUBE 0 - 999

A4625 TRACH CARE KIT FOR NEW TRACH 0 - 999

A4625 NU TRACH CARE KIT FOR NEW TRACH 0 - 999

A4626 TRACHEOSTOMY CLEANING BRUSH 0 - 999

A4626 NU TRACHEOSTOMY CLEANING BRUSH 0 - 999

A4627 SPACER BAG/RESERVOIR 0 - 999

A4627 NU SPACER BAG/RESERVOIR 0 - 999

A4628 NU OROPHARYNGEAL SUCTION CATH 0 - 999

A4629 TRACHEOSTOMY CARE KIT 0 - 999

A4629 NU TRACHEOSTOMY CARE KIT 0 - 999

A4630 NU REPL BAT T.E.N.S. OWN BY PT 0 - 999

A4635 UNDERARM CRUTCH PAD 0 - 999

A4635 NU UNDERARM CRUTCH PAD 0 - 999

A4636 HANDGRIP FOR CANE ETC 0 - 999

A4636 NU HANDGRIP FOR CANE ETC 0 - 999

A4637 REPL TIP CANE/CRUTCH/WALKER 0 - 999

A4637 NU REPL TIP CANE/CRUTCH/WALKER 0 - 999

A4640 ALTERNATING PRESSURE PAD 0 - 20

A4640 NU ALTERNATING PRESSURE PAD 0 - 999

A4927 GLOVES, NON-STERILE, PER 100 0 - 999

A4927 NU GLOVES, NON-STERILE, PER 100 0 - 999

A4928 NU SURGICAL MASK 0 - 999

A4930 STERILE, GLOVES PER PAIR 0 - 999

A4930 NU STERILE, GLOVES PER PAIR 0 - 999

A5051 POUCH CLSD W BARR ATTACHED 0 - 999

A5051 NU POUCH CLSD W BARR ATTACHED 0 - 999

A5052 CLSD OSTOMY POUCH W/O BARR 0 - 999

A5052 NU CLSD OSTOMY POUCH W/O BARR 0 - 999

A5053 CLSD OSTOMY POUCH FACEPLATE 0 - 999

A5053 NU CLSD OSTOMY POUCH FACEPLATE 0 - 999

A5054 CLSD OSTOMY POUCH W/FLANGE 0 - 999

A5054 NU CLSD OSTOMY POUCH W/FLANGE 0 - 999

A5055 STOMA CAP 0 - 999

A5055 NU STOMA CAP 0 - 999

A5056 NU 1 PC OST POUCH W FILTER 0 - 999

A5057 NU 1 PC OST POU W BUILT-IN CONV 0 - 999

A5061 POUCH DRAINABLE W BARRIER AT 0 - 999

A5061 NU POUCH DRAINABLE W BARRIER AT 0 - 999

A5062 DRNBLE OSTOMY POUCH W/O BARR 0 - 999

A5062 NU DRNBLE OSTOMY POUCH W/O BARR 0 - 999

A5063 DRAIN OSTOMY POUCH W/FLANGE 0 - 999

A5063 NU DRAIN OSTOMY POUCH W/FLANGE 0 - 999

A5071 URINARY POUCH W/BARRIER 0 - 999

A5071 NU URINARY POUCH W/BARRIER 0 - 999

A5072 URINARY POUCH W/O BARRIER 0 - 999

A5072 NU URINARY POUCH W/O BARRIER 0 - 999

A5073 URINARY POUCH ON BARR W/FLNG 0 - 999

A5073 NU URINARY POUCH ON BARR W/FLNG 0 - 999

A5081 STOMA PLUG OR SEAL, ANY TYPE 0 - 999

A5081 NU STOMA PLUG OR SEAL, ANY TYPE 0 - 999

A5082 CONTINENT STOMA CATHETER 0 - 999

A5082 NU CONTINENT STOMA CATHETER 0 - 999

A5083 NU STOMA ABSORPTIVE COVER 0 - 999

A5093 OSTOMY ACCESSORY CONVEX INSE 0 - 999

A5093 NU OSTOMY ACCESSORY CONVEX INSE 0 - 999

A5102 BEDSIDE DRAIN BTL W/WO TUBE 0 - 20

A5102 NU BEDSIDE DRAIN BTL W/WO TUBE 0 - 999

A5105 URINARY SUSPENSORY 0 - 20

A5105 NU URINARY SUSPENSORY 0 - 999

A5112 URINARY LEG BAG 0 - 999

A5112 NU URINARY LEG BAG 0 - 999

A5113 LATEX LEG STRAP 0 - 20

A5113 NU LATEX LEG STRAP 0 - 999

A5114 FOAM/FABRIC LEG STRAP 0 - 20

A5114 NU FOAM/FABRIC LEG STRAP 0 - 999

A5119 NU OKIN PREPO 0 - 999

A5120 SKIN BARRIER, WIPE OR SWAB 0 - 999

A5120 NU SKIN BARRIER, WIPE OR SWAB 0 - 999

A5121 SOLID SKIN BARRIER 6X6 0 - 999

A5121 NU SOLID SKIN BARRIER 6X6 0 - 999

A5122 SOLID SKIN BARRIER 8X8 0 - 999

A5122 NU SOLID SKIN BARRIER 8X8 0 - 999

A5123 NU WAFERS 2 3/4" BOX OF 5 EACH 0 - 999

A5126 DISK/FOAM PAD +OR- ADHESIVE 0 - 20

A5126 NU DISK/FOAM PAD +OR- ADHESIVE 0 - 999

A5131 APPLIANCE CLEANER 0 - 999

A5131 NU APPLIANCE CLEANER 0 - 999

A5200 PERCUTANEOUS CATHETER ANCHOR 0 - 20

A5200 NU PERCUTANEOUS CATHETER ANCHOR 0 - 999

A5258 NU CHLORAPREP 0 - 999

A5500 Diab Shoe For Density Insert 0 - 999

A5501 Diabetic Custom Molded Shoe 0 - 999

A5503 Diabetic Shoe W/Roller/Rockr 0 - 999

A5504 Diabetic Shoe With Wedge 0 - 999

A5505 Diab Shoe W/Metatarsal Bar 0 - 999

A5506 Diabetic Shoe W/Off Set Heel 0 - 999

A5507 Modification Diabetic Shoe 0 - 999

A5512 For diabetics only, multiple density insert, direct

formed, molded to foot after external heat source of

230 degrees Fah

0 - 999

A5513 For diabetics only, multiple density insert, custom

molded from model of patient's foot, total contact

with patient's foot, including arch, base layer

minimum of 3/16 inch material of shore a 35

durometer (or higher), includes arch filler and other

shaping material, custom fabricated, each

0 - 999

A6010 NU COLLAGEN BASED WOUND FILLER 0 - 999

A6011 NU COLLAGEN GEL/PASTE WOUND FIL 0 - 999

A6021 NU COLLAGEN DRESSING <=16 SQ IN 0 - 999

A6022 COLLAGEN DRSG>16<=48 SQ IN 0 - 999

A6022 NU COLLAGEN DRSG>16<=48 SQ IN 0 - 999

A6023 COLLAGEN DRESSING >48 SQ IN 0 - 999

A6023 NU COLLAGEN DRESSING >48 SQ IN 0 - 999

A6024 COLLAGEN DSG WOUND FILLER 0 - 999

A6024 NU COLLAGEN DSG WOUND FILLER 0 - 999

A6025 NU SILICONE GEL SHEET, EACH 0 - 999

A6154 WOUND POUCH EACH 0 - 20

A6154 NU WOUND POUCH EACH 0 - 999

A6196 ALGINATE DRESSING <=16 SQ IN 0 - 20

A6196 NU ALGINATE DRESSING <=16 SQ IN 0 - 999

A6197 ALGINATE DRSG >16 <=48 SQ IN 0 - 20

A6197 NU ALGINATE DRSG >16 <=48 SQ IN 0 - 999

A6198 NU ALGINATE DRESSING > 48 SQ IN 0 - 999

A6199 ALGINATE DRSG WOUND FILLER 0 - 20

A6199 NU ALGINATE DRSG WOUND FILLER 0 - 999

A6200 NU COMPOS DRSG <=16 NO BORDER 0 - 999

A6201 NU COMPOS DRSG >16<=48 NO BDR 0 - 999

A6202 NU COMPOS DRSG >48 NO BORDER 0 - 999

A6203 COMPOSITE DRSG <= 16 SQ IN 0 - 20

A6203 NU COMPOSITE DRSG <= 16 SQ IN 0 - 999

A6204 COMPOSITE DRSG >16<=48 SQ IN 0 - 20

A6204 NU COMPOSITE DRSG >16<=48 SQ IN 0 - 999

A6206 NU CONTACT LAYER <= 16 SQ IN 0 - 999

A6207 CONTACT LAYER >16<= 48 SQ IN 0 - 20

A6207 NU CONTACT LAYER >16<= 48 SQ IN 0 - 999

A6208 NU CONTACT LAYER > 48 SQ IN 0 - 999

A6209 FOAM DRSG <=16 SQ IN W/O BDR 0 - 20

A6209 NU FOAM DRSG <=16 SQ IN W/O BDR 0 - 999

A6210 FOAM DRG >16<=48 SQ IN W/O B 0 - 20

A6210 NU FOAM DRG >16<=48 SQ IN W/O B 0 - 999

A6211 FOAM DRG > 48 SQ IN W/O BRDR 0 - 20

A6211 NU FOAM DRG > 48 SQ IN W/O BRDR 0 - 999

A6212 FOAM DRG <=16 SQ IN W/BORDER 0 - 20

A6212 NU FOAM DRG <=16 SQ IN W/BORDER 0 - 999

A6213 NU FOAM DRG >16<=48 SQ IN W/BDR 0 - 999

A6214 FOAM DRG > 48 SQ IN W/BORDER 0 - 20

A6214 NU FOAM DRG > 48 SQ IN W/BORDER 0 - 999

A6215 NU FOAM DRESSING WOUND FILLER 0 - 999

A6216 NON-STERILE GAUZE<=16 SQ IN 0 - 20

A6216 NU NON-STERILE GAUZE<=16 SQ IN 0 - 999

A6217 NU NON-STERILE GAUZE>16<=48 SQ 0 - 999

A6218 NU NON-STERILE GAUZE > 48 SQ IN 0 - 999

A6219 GAUZE <= 16 SQ IN W/BORDER 0 - 20

A6219 NU GAUZE <= 16 SQ IN W/BORDER 0 - 999

A6220 GAUZE >16 <=48 SQ IN W/BORDR 0 - 20

A6220 NU GAUZE >16 <=48 SQ IN W/BORDR 0 - 999

A6221 NU GAUZE > 48 SQ IN W/BORDER 0 - 999

A6222 GAUZE <=16 IN NO W/SAL W/O B 0 - 20

A6222 NU GAUZE <=16 IN NO W/SAL W/O B 0 - 999

A6223 GAUZE >16<=48 NO W/SAL W/O B 0 - 20

A6223 NU GAUZE >16<=48 NO W/SAL W/O B 0 - 999

A6224 GAUZE > 48 IN NO W/SAL W/O B 0 - 20

A6224 NU GAUZE > 48 IN NO W/SAL W/O B 0 - 999

A6229 GAUZE >16<=48 SQ IN WATR/SAL 0 - 20

A6229 NU GAUZE >16<=48 SQ IN WATR/SAL 0 - 999

A6231 HYDROGEL DSG<=16 SQ IN 0 - 999

A6231 NU HYDROGEL DSG<=16 SQ IN 0 - 999

A6232 HYDROGEL DSG>16<=48 SQ IN 0 - 999

A6232 NU HYDROGEL DSG>16<=48 SQ IN 0 - 999

A6233 HYDROGEL DRESSING >48 SQ IN 0 - 999

A6233 NU HYDROGEL DRESSING >48 SQ IN 0 - 999

A6234 HYDROCOLLD DRG <=16 W/O BDR 0 - 20

A6234 NU HYDROCOLLD DRG <=16 W/O BDR 0 - 999

A6235 HYDROCOLLD DRG >16<=48 W/O B 0 - 20

A6235 NU HYDROCOLLD DRG >16<=48 W/O B 0 - 999

A6236 HYDROCOLLD DRG > 48 IN W/O B 0 - 20

A6236 NU HYDROCOLLD DRG > 48 IN W/O B 0 - 999

A6237 HYDROCOLLD DRG <=16 IN W/BDR 0 - 20

A6237 NU HYDROCOLLD DRG <=16 IN W/BDR 0 - 999

A6238 HYDROCOLLD DRG >16<=48 W/BDR 0 - 20

A6238 NU HYDROCOLLD DRG >16<=48 W/BDR 0 - 999

A6239 NU HYDROCOLLD DRG > 48 IN W/BDR 0 - 999

A6240 HYDROCOLLD DRG FILLER PASTE 0 - 20

A6240 NU HYDROCOLLD DRG FILLER PASTE 0 - 999

A6241 HYDROCOLLOID DRG FILLER DRY 0 - 20

A6241 NU HYDROCOLLOID DRG FILLER DRY 0 - 999

A6242 HYDROGEL DRG <=16 IN W/O BDR 0 - 20

A6242 NU HYDROGEL DRG <=16 IN W/O BDR 0 - 999

A6243 HYDROGEL DRG >16<=48 W/O BDR 0 - 20

A6243 NU HYDROGEL DRG >16<=48 W/O BDR 0 - 999

A6244 HYDROGEL DRG >48 IN W/O BDR 0 - 20

A6244 NU HYDROGEL DRG >48 IN W/O BDR 0 - 999

A6245 HYDROGEL DRG <= 16 IN W/BDR 0 - 20

A6245 NU HYDROGEL DRG <= 16 IN W/BDR 0 - 999

A6246 HYDROGEL DRG >16<=48 IN W/B 0 - 20

A6246 NU HYDROGEL DRG >16<=48 IN W/B 0 - 999

A6247 HYDROGEL DRG > 48 SQ IN W/B 0 - 20

A6247 NU HYDROGEL DRG > 48 SQ IN W/B 0 - 999

A6248 HYDROGEL DRSG GEL FILLER 0 - 20

A6248 NU HYDROGEL DRSG GEL FILLER 0 - 999

A6250 NU SKIN SEAL PROTECT MOISTURIZR 0 - 999

A6251 ABSORPT DRG <=16 SQ IN W/O B 0 - 20

A6251 NU ABSORPT DRG <=16 SQ IN W/O B 0 - 999

A6252 ABSORPT DRG >16 <=48 W/O BDR 0 - 20

A6252 NU ABSORPT DRG >16 <=48 W/O BDR 0 - 999

A6253 ABSORPT DRG > 48 SQ IN W/O B 0 - 20

A6253 NU ABSORPT DRG > 48 SQ IN W/O B 0 - 999

A6254 ABSORPT DRG <=16 SQ IN W/BDR 0 - 20

A6254 NU ABSORPT DRG <=16 SQ IN W/BDR 0 - 999

A6255 ABSORPT DRG >16<=48 IN W/BDR 0 - 20

A6255 NU ABSORPT DRG >16<=48 IN W/BDR 0 - 999

A6257 TRANSPARENT FILM <= 16 SQ IN 0 - 999

A6257 NU TRANSPARENT FILM <= 16 SQ IN 0 - 999

A6258 TRANSPARENT FILM >16<=48 IN 0 - 20

A6258 NU TRANSPARENT FILM >16<=48 IN 0 - 999

A6259 TRANSPARENT FILM > 48 SQ IN 0 - 20

A6259 NU TRANSPARENT FILM > 48 SQ IN 0 - 999

A6260 NU WOUND CLEANSER ANY TYPE/SIZE 0 - 999

A6261 NU WOUND FILLER GEL/PASTE /OZ 0 - 999

A6262 NU WOUND FILLER DRY FORM / GRAM 0 - 999

A6266 IMPREG GAUZE NO H20/SAL/YARD 0 - 20

A6266 NU IMPREG GAUZE NO H20/SAL/YARD 0 - 999

A6402 STERILE GAUZE <= 16 SQ IN 0 - 20

A6402 NU STERILE GAUZE <= 16 SQ IN 0 - 999

A6403 STERILE GAUZE>16 <= 48 SQ IN 0 - 20

A6403 NU STERILE GAUZE>16 <= 48 SQ IN 0 - 999

A6404 NU STERILE GAUZE > 48 SQ IN 0 - 999

A6407 NU PACKING STRIPS, NON-IMPREG 0 - 999

A6410 NU STERILE EYE PAD 0 - 999

A6411 NU NON-STERILE EYE PAD 0 - 999

A6412 NU OCCLUSIVE EYE PATCH 0 - 999

A6441 PAD BAND W>=3" <5"/YD 0 - 20

A6441 NU PAD BAND W>=3" <5"/YD 0 - 999

A6442 NU CONFORM BAND N/S W<3"/YD 0 - 999

A6443 CONFORM BAND N/S W>=3"<5"/YD 0 - 20

A6443 NU CONFORM BAND N/S W>=3"<5"/YD 0 - 999

A6444 CONFORM BAND N/S W>=5"/YD 0 - 20

A6444 NU CONFORM BAND N/S W>=5"/YD 0 - 999

A6445 NU CONFORM BAND S W <3"/YD 0 - 999

A6446 CONFORM BAND S W>=3" <5"/YD 0 - 20

A6446 NU CONFORM BAND S W>=3" <5"/YD 0 - 999

A6447 CONFORM BAND S W >=5"/YD 0 - 20

A6447 NU CONFORM BAND S W >=5"/YD 0 - 999

A6448 NU LT COMPRES BAND <3"/YD 0 - 999

A6449 LT COMPRES BAND >=3" <5"/YD 0 - 20

A6449 NU LT COMPRES BAND >=3" <5"/YD 0 - 999

A6450 LT COMPRES BAND >=5"/YD 0 - 20

A6450 NU LT COMPRES BAND >=5"/YD 0 - 999

A6451 MOD COMPRES BAND W>=3"<5"/YD 0 - 20

A6451 NU MOD COMPRES BAND W>=3"<5"/YD 0 - 999

A6452 HIGH COMPRES BAND W>=3"<5"YD 0 - 20

A6452 NU HIGH COMPRES BAND W>=3"<5"YD 0 - 999

A6453 NU SELF-ADHER BAND W <3"/YD 0 - 999

A6454 SELF-ADHER BAND W>=3" <5"/YD 0 - 20

A6454 NU SELF-ADHER BAND W>=3" <5"/YD 0 - 999

A6455 NU SELF-ADHER BAND >=5"/YD 0 - 999

A6456 ZINC PASTE BAND W >=3"<5"/YD 0 - 20

A6456 NU ZINC PASTE BAND W >=3"<5"/YD 0 - 999

A6457 TUBULAR DRESSING 0 - 999

A6457 NU TUBULAR DRESSING 0 - 999

A6530 GRADIENT COMPRESSION STOCKING, BELOW KNEE,

18-30 MMHG, EACH

0 - 999

A6530 NU GRADIENT COMPRESSION STOCKING, BELOW KNEE,

18-30 MMHG, EACH

0 - 999

A6531 Compression stocking bk30-40 0 - 999

A6531 NU Compression stocking bk30-40 0 - 999

A6532 Compression stocking bk40-50 0 - 999

A6532 NU Compression stocking bk40-50 0 - 999

A6533 GRADIENT COMPRESSION STOCKING, THIGH

LENGTH, 18-30 MMHG, EACH

0 - 999

A6533 NU GRADIENT COMPRESSION STOCKING, THIGH


0 - 999



0 - 999



0 - 999



0 - 999



0 - 999

A6536 GRADIENT COMPRESSION STOCKING, FULL

LENGTH/CHAP STYLE, 18-30 MMHG, EACH

0 - 999

A6536 NU GRADIENT COMPRESSION STOCKING, FULL


0 - 999



0 - 999



0 - 999



0 - 999



0 - 999

A6539 GRADIENT COMPRESSION STOCKING, WAIST


0 - 999

A6539 NU GRADIENT COMPRESSION STOCKING, WAIST


0 - 999



0 - 999



0 - 999



0 - 999



0 - 999

A7000 Disposable canister for pump 0 - 999

A7000 NU Disposable canister for pump 0 - 999

A7001 Nondisposable pump canister 0 - 999

A7001 NU Nondisposable pump canister 0 - 999

A7002 TUBING USED W SUCTION PUMP 0 - 999

A7002 NU TUBING USED W SUCTION PUMP 0 - 999

A7003 NEBULIZER ADMINISTRATION SET 0 - 999

A7003 NU NEBULIZER ADMINISTRATION SET 0 - 999

A7004 DISPOSABLE NEBULIZER SML VOL 0 - 999

A7004 NU DISPOSABLE NEBULIZER SML VOL 0 - 999

A7005 NONDISPOSABLE NEBULIZER SET 0 - 999

A7005 NU NONDISPOSABLE NEBULIZER SET 0 - 999

A7006 FILTERED NEBULIZER ADMIN SET 0 - 999

A7006 NU FILTERED NEBULIZER ADMIN SET 0 - 999

A7007 LG VOL NEBULIZER DISPOSABLE 0 - 999

A7007 NU LG VOL NEBULIZER DISPOSABLE 0 - 999

A7008 DISPOSABLE NEBULIZER PREFILL 0 - 999

A7008 NU DISPOSABLE NEBULIZER PREFILL 0 - 999

A7009 NEBULIZER RESERVOIR BOTTLE 0 - 999

A7009 NU NEBULIZER RESERVOIR BOTTLE 0 - 999

A7010 DISPOSABLE CORRUGATED TUBING 0 - 999

A7010 NU DISPOSABLE CORRUGATED TUBING 0 - 999

A7011 NU NONDISPOS CORRUGATED TUBING 0 - 999

A7012 NEBULIZER WATER COLLEC DEVIC 0 - 999

A7012 NU NEBULIZER WATER COLLEC DEVIC 0 - 999

A7013 DISPOSABLE COMPRESSOR FILTER 0 - 999

A7013 NU DISPOSABLE COMPRESSOR FILTER 0 - 999

A7014 COMPRESSOR NONDISPOS FILTER 0 - 999

A7014 NU COMPRESSOR NONDISPOS FILTER 0 - 999

A7015 AEROSOL MASK USED W NEBULIZE 0 - 999

A7015 NU AEROSOL MASK USED W NEBULIZE 0 - 999

A7016 NEBULIZER DOME & MOUTHPIECE 0 - 999

A7016 NU NEBULIZER DOME & MOUTHPIECE 0 - 999

A7017 NEBULIZER NOT USED W OXYGEN 0 - 999

A7017 NU NEBULIZER NOT USED W OXYGEN 0 - 999

A7018 NU WATER DISTILLED W/NEBULIZER 0 - 999

A7020 NU INTERFACE, COUGH STIM DEVICE 0 - 999

A7025 NU REPLACE CHEST COMPRESS VEST 0 - 999

A7026 NU REPLACE CHST CMPRSS SYS HOSE 0 - 999

A7027 NU COMBINATION ORAL/NASAL MASK 0 - 999

A7028 NU REPL ORAL CUSHION COMBO MASK 0 - 999

A7029 NU REPL NASAL PILLOW COMB MASK 0 - 999

A7030 NU CPAP FULL FACE MASK 0 - 999

A7031 NU REPLACEMENT FACEMASK INTERFA 0 - 999

A7032 NU REPLACEMENT NASAL CUSHION 0 - 999

A7033 NU REPLACEMENT NASAL PILLOWS 0 - 999

A7034 NU NASAL APPLICATION DEVICE 0 - 999

A7035 NU POS AIRWAY PRESS HEADGEAR 0 - 999

A7036 NU POS AIRWAY PRESS CHINSTRAP 0 - 999

A7037 NU POS AIRWAY PRESSURE TUBING 0 - 999

A7038 NU POS AIRWAY PRESSURE FILTER 0 - 999

A7039 NU FILTER, NON DISPOSABLE W PAP 0 - 999

A7044 NU Pap oral interface 0 - 999

A7045 NU Repl exhalation port for pap 0 - 999

A7046 NU Repl water chamber, pap dev 0 - 999

A7047 NU Resp suction oral interface 0 - 999

A7048 NU Vacuum Drain Bottles 0 - 999

A7501 TRACHEOSTOMA VALVE W DIAPHRA 0 - 999

A7501 NU TRACHEOSTOMA VALVE W DIAPHRA 0 - 999

A7502 REPLACEMENT DIAPHRAGM/FPLATE 0 - 999

A7502 NU REPLACEMENT DIAPHRAGM/FPLATE 0 - 999

A7503 HMES FILTER HOLDER OR CAP 0 - 999

A7503 NU HMES FILTER HOLDER OR CAP 0 - 999

A7504 TRACHEOSTOMA HMES FILTER 0 - 999

A7504 NU TRACHEOSTOMA HMES FILTER 0 - 999

A7505 HMES OR TRACH VALVE HOUSING 0 - 999

A7505 NU HMES OR TRACH VALVE HOUSING 0 - 999

A7506 HMES/TRACHVALVE ADHESIVEDISK 0 - 999

A7506 NU HMES/TRACHVALVE ADHESIVEDISK 0 - 999

A7507 INTEGRATED FILTER & HOLDER 0 - 999

A7507 NU INTEGRATED FILTER & HOLDER 0 - 999

A7508 HOUSING & INTEGRATED ADHESIV 0 - 999

A7508 NU HOUSING & INTEGRATED ADHESIV 0 - 999

A7509 NU HEAT & MOISTURE EXCHANGE SYS 0 - 999

A7520 TRACH/LARYN TUBE NON-CUFFED 0 - 999

A7520 NU TRACH/LARYN TUBE NON-CUFFED 0 - 999

A7521 TRACH/LARYN TUBE CUFFED 0 - 999

A7521 NU TRACH/LARYN TUBE CUFFED 0 - 999

A7522 TRACH/LARYN TUBE STAINLESS 0 - 999

A7522 NU TRACH/LARYN TUBE STAINLESS 0 - 999

A7523 NU TRACHEOSTOMY SHOWER PROTECT 0 - 999

A7524 NU TRACHEOSTOMA STENT/STUD/BTTN 0 - 999

A7525 TRACHEOSTOMY MASK 0 - 999

A7525 NU TRACHEOSTOMY MASK 0 - 999

A7526 TRACHEOSTOMY TUBE COLLAR 0 - 999

A7526 NU TRACHEOSTOMY TUBE COLLAR 0 - 999

A7527 NU TRACH/LARYN TUBE PLUG/STOP 0 - 999

A8000 HELMET, PROTECTIVE, SOFT, PREFABRICATED,

INCLUDES ALL COMPONENTS AND ACCESSORIES

0 - 999

A8001 HELMET, PROTECTIVE, HARD, PREFABRICATED,

INCLUDES ALL COMPONENTS AND ACCESSORIES

0 - 999

A8002 HELMET, PROTECTIVE, SOFT, CUSTOM FABRICATED,

INCLUDES ALL COMPONENTS AND

0 - 999

A8003 HELMET, PROTECTIVE, HARD, CUSTOM FABRICATED,

INCLUDES ALL COMPONENTS AND

0 - 999

A9276 Sensor; invasive (e.g., subcutaneous), disposable, for

use with interstitial continuous glucose monitoring

system, 1 unit = 1 day supply

0 - 20

A9277 Transmitter; external, for use with interstitial

continuous glucose monitoring system

0 - 20

A9278 Receiver (monitor); external, for use with interstitial

continuous glucose monitoring system

0 - 20

A9900 Miscellaneous DME supply, accessory, and/or service

component of another HCPCS code

0 - 999

B4034 NU Enteral Supply Kit Syringe Fed 0 - 999

B4034 Enteral Supply Kit Syringe Fed 0-999

B4035 NU Enteral feed supp pump per d 0 - 999

B4035 Enteral feed supp pump per d 0-20

B4036 NU Enteral Supply Kit Gravity Fed 0 - 999

B4036 Enteral Supply Kit Gravity Fed 0-999

B4081 NU Nasogastric tubing with stylet 0 - 999

B4081 Nasogastric tubing with stylet 0-20

B4082 NU Nasogastric tubing without stylet 0 - 999

B4082 Nasogastric tubing without stylet 0-20

B4083 NU Enteral stomach tube levine 0 - 999

B4083 Enteral stomach tube levine 0-20

B4087 NU Gastro tube standard 0 - 999

B4087 Gastro tube standard 0-999

B4088 NU Gastro tube low 0 - 999

B4088 Gastro tube low 0-999

B4103 NU Enteral Pediatric Fluid and Electrolyte 0 - 999

B4149 NU EF blenderized foods 0 - 999

B4149 SC EF blenderized foods 0 - 999

B4149 EF blenderized foods 0-20

B4150 NU EF complete w/intact nutrient 0 - 999

B4150 EF complete w/intact nutrient 0-999

B4150 EF complete w/intact nutrient

B4150 SC EF complete w/intact nutrient 0 - 999

B4150 SC Enteral Formulae Category I 0-999

B4150 SC Enteral Formulae Category I

B4152 NU EF calorie dense>/=1.5Kcal 0 - 999

B4152 NU Enteral Formulary 1.5 kcal 0 - 999

B4152 SC Enteral Formulary 1.5 kcal 0 - 999

B4152 Enteral Formulary 1.5 kcal 0-999

B4152 Enteral Formulary 1.5 kcal

B4152 SC Enteral Formulae Category Ii 0-999

B4152 SC Enteral Formulae Category Ii

B4153 NU EF hydrolyzed/amino acids 0 - 999

B4153 SC EF hydrolyzed/amino acids 0 - 999

B4153 EF hydrolyzed/amino acids 0-999

B4153 EF hydrolyzed/amino acids

B4153 SC Enteral Formulae Categoryiii 0-999

B4153 SC Enteral Formulae Categoryiii

B4154 NU EF spec metabolic noninherit 0 - 999

B4154 SC EF spec metabolic noninherit 0 - 999

B4154 EF spec metabolic noninherit 0-999

B4154 EF spec metabolic noninherit

B4154 SC Enteral Formulae Category Iv 0-999

B4154 SC Enteral Formulae Category Iv

B4155 NU EF incomplete/modular 0 - 999

B4155 SC EF incomplete/modular 0 - 999

B4155 EF incomplete/modular 0-999

B4155 EF incomplete/modular

B4155 SC Enteral Formulae Category V 0-999

B4155 SC Enteral Formulae Category V

B4157 NU Enteral Nutrition 0 - 999

B4157 SC Enteral Nutrition 0 - 999

B4157 Enteral Nutrition 0-999

B4157 Enteral Nutrition

B4157 SC EF special metabolic inherit 0-999

B4157 SC EF special metabolic inherit

B4160 NU 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

0 - 999

B4160 SC Enteral formula, for pediatrics, nutritionally complete






0 - 999

B4160 Enteral formula, for pediatrics, nutritionally complete






0-20

B4160 Enteral formula, for pediatrics, nutritionally complete






B4160 SC EF ped caloric dense>/=0.7kc 0-20

B4160 SC EF ped caloric dense>/=0.7kc

B4161 NU Enteral formula, for pediatrics, hydrolyzed/amino

acids and peptide chain proteins, includes fats,




0 - 999

B4161 SC Enteral formula, for pediatrics, hydrolyzed/amino





0 - 999

B4161 Enteral formula, for pediatrics, hydrolyzed/amino





0-20

B4161 Enteral formula, for pediatrics, hydrolyzed/amino





B4161 SC EF ped hydrolyzed/amino acid 0-20

B4161 SC EF ped hydrolyzed/amino acid

B4162 NU 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

0 - 999

B4162 SC Enteral formula, for pediatrics, special metabolic





0 - 999

B4162 Enteral formula, for pediatrics, special metabolic





0-20

B4162 Enteral formula, for pediatrics, special metabolic





B4162 SC EF ped specmetabolic inherit 0-20

B4162 SC EF ped specmetabolic inherit

B9002 RR Enteral Pumps 0 - 999

B9002 Enteral Pumps 0-20

B9004 Parenteral nutrition infusion pump, portable 0-20

B9998 NU Miscellaneous Enteral 0 - 999

B9998 Miscellaneous Enteral 0-20

E0100 CANE ADJUST/FIXED WITH TIP 0 - 999

E0100 NU CANE ADJUST/FIXED WITH TIP 0 - 999

E0105 CANE ADJUST/FIXED QUAD/3 PRO 0 - 999

E0105 NU CANE ADJUST/FIXED QUAD/3 PRO 0 - 999

E0110 CRUTCH FOREARM PAIR 0 - 999

E0110 NU CRUTCH FOREARM PAIR 0 - 999

E0111 CRUTCH FOREARM EACH 0 - 999

E0111 NU CRUTCH FOREARM EACH 0 - 999

E0112 CRUTCH UNDERARM PAIR WOOD 0 - 999

E0112 NU CRUTCH UNDERARM PAIR WOOD 0 - 999

E0113 CRUTCH UNDERARM EACH WOOD 0 - 999

E0113 NU CRUTCH UNDERARM EACH WOOD 0 - 999

E0114 CRUTCH UNDERARM PAIR NO WOOD 0 - 999

E0114 NU CRUTCH UNDERARM PAIR NO WOOD 0 - 999

E0116 CRUTCH UNDERARM EACH NO WOOD 0 - 999

E0116 NU CRUTCH UNDERARM EACH NO WOOD 0 - 999

E0117 RR UNDERARM SPRINGASSIST CRUTCH 0 - 999

E0118 NU CRUTCH SUBSTITUTE 0 - 999

E0128 NU ADJ ELBOW SUP HARDWARE - RIGHT 0 - 999

E0130 WALKER RIGID ADJUST/FIXED HT 0 - 999

E0130 NU WALKER RIGID ADJUST/FIXED HT 0 - 999

E0135 WALKER FOLDING ADJUST/FIXED 0 - 999

E0135 NU WALKER FOLDING ADJUST/FIXED 0 - 999

E0140 RR WALKER W TRUNK SUPPORT 0 - 999

E0141 RIGID WHEELED WALKER ADJ/FIX 0 - 999

E0141 NU RIGID WHEELED WALKER ADJ/FIX 0 - 999

E0143 WALKER FOLDING WHEELED W/O S 0 - 999

E0143 NU WALKER FOLDING WHEELED W/O S 0 - 999

E0144 RR Walker, enclosed, four sided framed, rigid or folding,

wheeled with posterior seat

0 - 999

E0145 NU MERRY WALKER 0 - 999

E0146 NU FOLDING WALKER WHEELED W/SEAT 0 - 999

E0147 WALKER VARIABLE WHEEL RESIST 0 - 999

E0147 NU WALKER VARIABLE WHEEL RESIST 0 - 999

E0148 HEAVYDUTY WALKER NO WHEELS 0 - 999

E0148 NU HEAVYDUTY WALKER NO WHEELS 0 - 999

E0149 HEAVY DUTY WHEELED WALKER 0 - 999

E0149 NU HEAVY DUTY WHEELED WALKER 0 - 999

E0153 FOREARM CRUTCH PLATFORM ATTA 0 - 999

E0153 NU FOREARM CRUTCH PLATFORM ATTA 0 - 999

E0154 WALKER PLATFORM ATTACHMENT 0 - 999

E0154 NU WALKER PLATFORM ATTACHMENT 0 - 999

E0155 WALKER WHEEL ATTACHMENT,PAIR 0 - 999

E0155 NU WALKER WHEEL ATTACHMENT,PAIR 0 - 999

E0156 WALKER SEAT ATTACHMENT 0 - 999

E0156 NU WALKER SEAT ATTACHMENT 0 - 999

E0157 WALKER CRUTCH ATTACHMENT 0 - 999

E0157 NU WALKER CRUTCH ATTACHMENT 0 - 999

E0158 WALKER LEG EXTENDERS SET OF4 0 - 999

E0158 NU WALKER LEG EXTENDERS SET OF4 0 - 999

E0159 BRAKE FOR WHEELED WALKER 0 - 999

E0159 NU BRAKE FOR WHEELED WALKER 0 - 999

E0160 SITZ TYPE BATH OR EQUIPMENT 0 - 999

E0160 NU SITZ TYPE BATH OR EQUIPMENT 0 - 999

E0161 SITZ BATH/EQUIPMENT W/FAUCET 0 - 999

E0161 NU SITZ BATH/EQUIPMENT W/FAUCET 0 - 999

E0162 NU SITZ BATH CHAIR 0 - 999

E0163 COMMODE CHAIR WITH FIXED ARM 0 - 999

E0163 NU COMMODE CHAIR WITH FIXED ARM 0 - 999

E0164 NU BEDSIDE COMMODE CHAIR WITH WHEELS 0 - 999

E0165 COMMODE CHAIR WITH DETACHARM 0 - 999

E0165 NU COMMODE CHAIR WITH DETACHARM 0 - 999

E0167 COMMODE CHAIR PAIL OR PAN 0 - 999

E0167 NU COMMODE CHAIR PAIL OR PAN 0 - 999

E0168 HEAVYDUTY/WIDE COMMODE CHAIR 0 - 999

E0168 NU HEAVYDUTY/WIDE COMMODE CHAIR 0 - 999

E0171 COMMODE CHAIR NON-ELECTRIC 0 - 999

E0171 NU COMMODE CHAIR NON-ELECTRIC 0 - 999

E0172 NU SEAT LIFT MECHANISM TOILET 0 - 999

E0175 NU COMMODE CHAIR FOOT REST 0 - 999

E0179 NU Dry Pressure pad or cushion, nonpositioning 0 - 999

E0181 PRESS PAD ALTERNATING W/ PUM 0 - 20

E0181 RR PRESS PAD ALTERNATING W/ PUM 0 - 999

E0182 RR REPLACE PUMP, ALT PRESS PAD 0 - 999

E0184 RR DRY PRESSURE MATTRESS 0 - 999

E0184 DRY PRESSURE MATTRESS 0 -20

E0185 GEL PRESSURE MATTRESS PAD 0 - 999

E0185 NU GEL PRESSURE MATTRESS PAD 0 - 999

E0186 AIR PRESSURE MATTRESS 0 - 20

E0186 NU AIR PRESSURE MATTRESS 0 - 999

E0187 WATER PRESSURE MATTRESS 0 - 20

E0187 NU WATER PRESSURE MATTRESS 0 - 999

E0188 NU SYNTHETIC SHEEPSKIN PAD 0 - 999

E0189 LAMBSWOOL SHEEPSKIN PAD 0 - 20

E0189 NU LAMBSWOOL SHEEPSKIN PAD 0 - 999

E0190 POSITIONING CUSHION/PILLOW/WEDGE, ANY

SHAPE OR SIZE

0 - 20

E0190 NU POSITIONING CUSHION/PILLOW/WEDGE, ANY

SHAPE OR SIZE

0 - 999

E0191 PROTECTOR HEEL OR ELBOW 0 - 20

E0191 NU PROTECTOR HEEL OR ELBOW 0 - 999

E0196 GEL PRESSURE MATTRESS 0 - 20

E0196 NU GEL PRESSURE MATTRESS 0 - 999

E0197 AIR PRESSURE PAD FOR MATTRES 0 - 999

E0197 NU AIR PRESSURE PAD FOR MATTRES 0 - 999

E0198 WATER PRESSURE PAD FOR MATTR 0 - 999

E0198 NU WATER PRESSURE PAD FOR MATTR 0 - 999

E0199 DRY PRESSURE PAD FOR MATTRES 0 - 999

E0199 NU DRY PRESSURE PAD FOR MATTRES 0 - 999

E0200 RR HEAT LAMP WITHOUT STAND 0 - 999

E0202 PHOTOTHERAPY LIGHT W/ PHOTOM 0 - 20

E0202 RD PHOTOTHERAPY LIGHT W/ PHOTOM 0 - 999

E0205 HEAT LAMP WITH STAND 0 - 20

E0205 NU HEAT LAMP WITH STAND 0 - 999

E0210 NU Electric heat pad, standard 0 - 999

E0215 ELECTRIC HEAT PAD MOIST 0 - 20

E0215 NU ELECTRIC HEAT PAD MOIST 0 - 999

E0217 WATER CIRC HEAT PAD W PUMP 0 - 20

E0217 NU WATER CIRC HEAT PAD W PUMP 0 - 999

E0220 NU HOT WATER BOTTLE 0 - 999

E0225 NU HYDROCOLLATOR UNIT 0 - 999

E0230 NU ICE CAP OR COLLAR 0 - 999

E0235 PARAFFIN BATH UNIT PORTABLE 0 - 20

E0235 RR PARAFFIN BATH UNIT PORTABLE 0 - 999

E0236 RR PUMP FOR WATER CIRCULATING P 0 - 999

E0238 NU HEAT PAD NON-ELECTRIC MOIST 0 - 999

E0239 NU HYDROCOLLATOR UNIT PORTABLE 0 - 999

E0244 RAISED TOILET SEAT 0 - 999

E0244 NU RAISED TOILET SEAT 0 - 999

E0245 TUB STOOL OR BENCH 0 - 999

E0245 NU TUB STOOL OR BENCH 0 - 999

E0246 TRANSFER TUB RAIL ATTACHMENT 0 - 999

E0246 NU TRANSFER TUB RAIL ATTACHMENT 0 - 999

E0247 NU TRANS BENCH W/WO COMM OPEN 0 - 999

E0248 NU HDTRANS BENCH W/WO COMM OPEN 0 - 999

E0249 PAD WATER CIRCULATING HEAT U 0 - 20

E0249 NU PAD WATER CIRCULATING HEAT U 0 - 999

E0250 HOSP BED FIXED HT W/ MATTRES 0 - 999

E0250 RR HOSP BED FIXED HT W/ MATTRES 0 - 999

E0251 RR HOSP BED FIXD HT W/O MATTRES 0 - 999

E0255 HOSPITAL BED VAR HT W/ MATTR 0 - 999

E0255 RR HOSPITAL BED VAR HT W/ MATTR 0 - 999

E0256 RR HOSPITAL BED VAR HT W/O MATT 0 - 999

E0260 HOSP BED SEMI-ELECTR W/ MATT 0 - 20

E0260 RR HOSP BED SEMI-ELECTR W/ MATT 0 - 999

E0261 RR HOSP BED SEMI-ELECTR W/O MAT 0 - 999

E0265 Hosp bed total electr w/ mat 0 - 20

E0265 NU Hosp bed total electr w/ mat 0 - 999

E0266 NU Hosp bed total elec w/o matt 0 - 999

E0271 MATTRESS INNERSPRING 0 - 999

E0271 NU MATTRESS INNERSPRING 0 - 999

E0272 MATTRESS FOAM RUBBER 0 - 999

E0272 NU MATTRESS FOAM RUBBER 0 - 999

E0275 Bed pan standard 0 - 999

E0275 NU Bed pan standard 0 - 999

E0276 BED PAN FRACTURE 0 - 999

E0276 NU BED PAN FRACTURE 0 - 999

E0277 RR POWERED PRES-REDU AIR MATTRS 0 - 999

E0280 NU Bed cradle 0 - 999

E0290 RR HOSP BED FX HT W/O RAILS W/M 0 - 999

E0291 RR HOSP BED FX HT W/O RAIL W/O 0 - 999

E0292 RR HOSP BED VAR HT W/O RAIL W/O 0 - 999

E0293 RR HOSP BED VAR HT W/O RAIL W/ 0 - 999

E0294 RR HOSP BED SEMI-ELECT W/ MATTR 0 - 999

E0295 RR HOSP BED SEMI-ELECT W/O MATT 0 - 999

E0296 NU Hosp bed total elect w/ matt 0 - 999

E0297 NU Hosp bed total elect w/o mat 0 - 999

E0300 RR Enclosed ped crib hosp grade 0 - 999

E0301 RR HD HOSP BED, 350-600 LBS 0 - 999

E0302 RR EX HD HOSP BED > 600 LBS 0 - 999

E0303 HOSP BED HVY DTY XTRA WIDE 0 - 999

E0303 RR HOSP BED HVY DTY XTRA WIDE 0 - 999

E0304 RR HOSP BED XTRA HVY DTY X WIDE 0 - 999

E0305 RAILS BED SIDE HALF LENGTH 0 - 20

E0305 RR RAILS BED SIDE HALF LENGTH 0 - 999

E0310 RAILS BED SIDE FULL LENGTH 0 - 20

E0310 RR RAILS BED SIDE FULL LENGTH 0 - 999

E0315 BED ACCESSORY BRD/TBL/SUPPRT 0 - 20

E0315 NU BED ACCESSORY BRD/TBL/SUPPRT 0 - 999

E0316 Bed safety enclosure 0 - 20

E0316 RR Bed safety enclosure 0 - 999

E0325 URINAL MALE JUG-TYPE 0 - 999

E0325 NU URINAL MALE JUG-TYPE 0 - 999

E0326 URINAL FEMALE JUG-TYPE 0 - 999

E0326 NU URINAL FEMALE JUG-TYPE 0 - 999

E0370 Air Elevator For Heel 0 - 20

E0371 RR NONPOWER MATTRESS OVERLAY 0 - 999

E0372 RR POWERED AIR MATTRESS OVERLAY 0 - 999

E0373 RR NONPOWERED PRESSURE MATTRESS 0 - 999

E0424 STATIONARY COMPRESSED GAS 02 0 - 999

E0424 RR STATIONARY COMPRESSED GAS 02 0 - 999

E0430 RR OXYGEN SYSTEM GAS PORTABLE 0 - 999

E0431 PORTABLE GASEOUS 02 0 - 999

E0431 RR PORTABLE GASEOUS 02 0 - 999

E0433 RR PORTABLE LIQUID OXYGEN SYS 0 - 999

E0434 PORTABLE LIQUID 02 0 - 999

E0434 RR PORTABLE LIQUID 02 0 - 999

E0439 STATIONARY LIQUID 02 0 - 999

E0439 RR STATIONARY LIQUID 02 0 - 999

E0441 STATIONARY O2 CONTENTS, GAS 0 - 999

E0441 RR STATIONARY O2 CONTENTS, GAS 0 - 999

E0442 STATIONARY O2 CONTENTS, LIQ 0 - 999

E0442 RR STATIONARY O2 CONTENTS, LIQ 0 - 999

E0443 PORTABLE 02 CONTENTS, GAS 0 - 999

E0443 RR PORTABLE 02 CONTENTS, GAS 0 - 999

E0444 PORTABLE 02 CONTENTS, LIQUID 0 - 999

E0444 RR PORTABLE 02 CONTENTS, LIQUID 0 - 999

E0445 OXIMETER NON-INVASIVE 0 - 20

E0445 RR OXIMETER NON-INVASIVE 0 - 999

E0457 CHEST SHELL 0 - 999

E0457 RR CHEST SHELL 0 - 999

E0459 CHEST WRAP 0 - 999

E0459 RR CHEST WRAP 0 - 999

E0462 RR Rocking bed w/ or w/o side r 0 - 999

E0464 RR PRESS SUPP VENT NONINV INT 0 - 999

E0465 Home Ventilator with Invasive Interface 0 - 999

E0465 RR Home Ventilator with Invasive Interface 0 - 999

E0466 Home Ventilator with non invasive interface 0 - 999

E0466 RR Home Ventilator with non invasive interface 0 - 999

E0470 RAD W/O BACKUP NON-INV INTFC 0 - 999

E0470 RR RAD W/O BACKUP NON-INV INTFC 0 - 999

E0471 RAD W/BACKUP NON INV INTRFC 0 - 999

E0471 RR RAD W/BACKUP NON INV INTRFC 0 - 999

E0472 RAD W BACKUP INVASIVE INTRFC 0 - 999

E0472 RR RAD W BACKUP INVASIVE INTRFC 0 - 999

E0480 PERCUSSOR ELECT/PNEUM HOME M 0 - 999

E0480 RR PERCUSSOR ELECT/PNEUM HOME M 0 - 999

E0481 RR INTRPULMNRY PERCUSS VENT SYS 0 - 999

E0482 COUGH STIMULATING DEVICE 0 - 999

E0482 NU COUGH STIMULATING DEVICE 0 - 999

E0483 CHEST COMPRESSION GEN SYSTEM 0 - 999

E0483 NU CHEST COMPRESSION GEN SYSTEM 0 - 999

E0484 NU NON-ELEC OSCILLATORY PEP DVC 0 - 999

E0485 Oral device/appliance used to reduce upper airway

collapsibility, adjustable or non-adjustable,

prefabricated, includes

0 - 999

E0500 Ippb all types 0 - 999

E0500 RR Ippb all types 0 - 999

E0546 RR BARIATRIC 4 WHEELED WALKER 500LBS 0 - 999

E0550 HUMIDIF EXTENS SUPPLE W IPPB 0 - 999

E0550 RR HUMIDIF EXTENS SUPPLE W IPPB 0 - 999

E0555 HUMIDIFIER FOR USE W/ REGULA 0 - 999

E0555 RR HUMIDIFIER FOR USE W/ REGULA 0 - 999

E0560 HUMIDIFIER SUPPLEMENTAL W/ I 0 - 999

E0560 RR HUMIDIFIER SUPPLEMENTAL W/ I 0 - 999

E0561 HUMIDIFIER NONHEATED W PAP 0 - 999

E0561 RR HUMIDIFIER NONHEATED W PAP 0 - 999

E0562 HUMIDIFIER HEATED USED W PAP 0 - 999

E0562 RR HUMIDIFIER HEATED USED W PAP 0 - 999

E0565 COMPRESSOR AIR POWER SOURCE 0 - 999

E0565 RR COMPRESSOR AIR POWER SOURCE 0 - 999

E0570 NEBULIZER WITH COMPRESSION 0 - 999

E0570 NU NEBULIZER WITH COMPRESSION 0 - 999

E0572 AEROSOL COMPRESSOR ADJUST PR 0 - 999

E0572 RR AEROSOL COMPRESSOR ADJUST PR 0 - 999

E0574 ULTRASONIC GENERATOR W SVNEB 0 - 999

E0574 RR ULTRASONIC GENERATOR W SVNEB 0 - 999

E0575 RR NEBULIZER ULTRASONIC 0 - 999

E0580 RR Nebulizer, durable, glass or autoclavable plastic,

bottle type, for use with regulator or flowmeter

0 - 999

E0585 NEBULIZER W/ COMPRESSOR & HE 0 - 999

E0585 RR NEBULIZER W/ COMPRESSOR & HE 0 - 999

E0600 SUCTION PUMP PORTAB HOM MODL 0 - 999

E0600 RR SUCTION PUMP PORTAB HOM MODL 0 - 999

E0601 CONT AIRWAY PRESSURE DEVICE 0 - 999

E0601 RR CONT AIRWAY PRESSURE DEVICE 0 - 999

E0602 NU Manual breast pump 0 - 999

E0603 Breast Pump Electric 0 - 999

E0603 NU Breast Pump Electric 0 - 999

E0604 Breast Pump Hospital Grade Electric 0 - 999

E0604 RR Breast Pump Hospital Grade Electric 0 - 999

E0605 VAPORIZER ROOM TYPE 0 - 999

E0605 NU VAPORIZER ROOM TYPE 0 - 999

E0606 DRAINAGE BOARD POSTURAL 0 - 999

E0606 RR DRAINAGE BOARD POSTURAL 0 - 999

E0607 HOME BLOOD GLUCOSE MONITOR 0 - 999

E0607 NU HOME BLOOD GLUCOSE MONITOR 0 - 999

E0610 NU Pacemaker monitr audible/vis 0 - 999

E0615 NU Pacemaker monitr digital/vis 0 - 999

E0618 APNEA MONITOR 0 - 20

E0618 RR APNEA MONITOR 0 - 999

E0619 APNEA MONITOR, WITH RECORDING FEATURE 0 - 20

E0619 RR APNEA MONITOR, WITH RECORDING FEATURE 0 - 999

E0620 NU Cap bld skin piercing laser 0 - 999

E0621 PATIENT LIFT SLING OR SEAT 0 - 999

E0621 NU PATIENT LIFT SLING OR SEAT 0 - 999

E0627 NU SEAT LIFT INCORP LIFT-CHAIR 0 - 999

E0628 NU SEAT LIFT FOR PT FURN-ELECTR 0 - 999

E0629 NU SEAT LIFT FOR PT FURN-NON-EL 0 - 999

E0630 PATIENT LIFT HYDRAULIC 0 - 999

E0630 RR PATIENT LIFT HYDRAULIC 0 - 999

E0635 PATIENT LIFT ELECTRIC 0 - 999

E0635 RR PATIENT LIFT ELECTRIC 0 - 999

E0636 RR PT SUPPORT & POSITIONING SYS 0 - 999

E0637 RR COMBINATION SIT TO STAND SYS 0 - 999

E0642 RR DYNAMIC STANDING FRAME 0 - 999

E0650 PNEUMA COMPRESOR NON-SEGMENT 0 - 20

E0650 RR PNEUMA COMPRESOR NON-SEGMENT 0 - 999

E0651 PNEUM COMPRESSOR SEGMENTAL 0 - 20

E0651 RR PNEUM COMPRESSOR SEGMENTAL 0 - 999

E0652 PNEUM COMPRES W/CAL PRESSURE 0 - 20

E0652 RR PNEUM COMPRES W/CAL PRESSURE 0 - 999

E0655 PNEUMATIC APPLIANCE HALF ARM 0 - 20

E0655 NU PNEUMATIC APPLIANCE HALF ARM 0 - 999

E0656 RR SEGMENTAL PNEUMATIC TRUNK 0 - 999

E0657 RR SEGMENTAL PNEUMATIC CHEST 0 - 999

E0660 PNEUMATIC APPLIANCE FULL LEG 0 - 20

E0660 NU PNEUMATIC APPLIANCE FULL LEG 0 - 999

E0665 PNEUMATIC APPLIANCE FULL ARM 0 - 20

E0665 NU PNEUMATIC APPLIANCE FULL ARM 0 - 999

E0666 PNEUMATIC APPLIANCE HALF LEG 0 - 20

E0666 NU PNEUMATIC APPLIANCE HALF LEG 0 - 999

E0667 SEG PNEUMATIC APPL FULL LEG 0 - 20

E0667 NU SEG PNEUMATIC APPL FULL LEG 0 - 999

E0668 SEG PNEUMATIC APPL FULL ARM 0 - 20

E0668 NU SEG PNEUMATIC APPL FULL ARM 0 - 999

E0669 RR SEG PNEUMATIC APPLI HALF LEG 0 - 999

E0670 RR SEG PNEUM INT LEGS/TRUNK 0 - 999

E0671 RR PRESSURE PNEUM APPL FULL LEG 0 - 999

E0672 RR PRESSURE PNEUM APPL FULL ARM 0 - 999

E0673 RR PRESSURE PNEUM APPL HALF LEG 0 - 999

E0675 RR PNEUMATIC COMPRESSION DEVICE 0 - 999

E0691 NU Uvl pnl 2 sq ft or less 0 - 999

E0692 NU Uvl sys panel 4 ft 0 - 999

E0693 NU Uvl sys panel 6 ft 0 - 999

E0694 NU Uvl md cabinet sys 6 ft 0 - 999

E0705 TRANSFER DEVICE 0 - 999

E0705 NU TRANSFER DEVICE 0 - 999

E0710 RR RESTRAINTS ANY TYPE 0 - 999

E0720 NU TENS TWO LEAD 0 - 999

E0730 NU TENS FOUR LEAD 0 - 999

E0731 NU Conductive garment for tens/ 0 - 999

E0740 RR Incontinence treatment systm 0 - 999

E0744 NEUROMUSCULAR STIM FOR SCOLI 0 - 20

E0744 RR NEUROMUSCULAR STIM FOR SCOLI 0 - 999

E0745 NEUROMUSCULAR STIM FOR SHOCK 0 - 20

E0745 RR NEUROMUSCULAR STIM FOR SHOCK 0 - 999

E0747 ELEC OSTEOGEN STIM NOT SPINE 0 - 999

E0747 RR ELEC OSTEOGEN STIM NOT SPINE 0 - 999

E0748 NU ELEC OSTEOGEN STIM SPINAL 0 - 999

E0749 NU Elec osteogen stim implanted 0 - 999

E0760 NU OSTEOGEN ULTRASOUND STIMLTOR 0 - 999

E0762 NU Trans elec jt stim dev sys 0 - 999

E0764 RR FUNCTIONAL NEUROMUSCULARSTIM 0 - 999

E0765 NU NERVE STIMULATOR FOR TX N&V 0 - 999

E0766 NU ELEC STIM CANCER TREATMENT 0 - 999

E0770 NU FUNCTIONAL ELECTRIC STIM NOS 0 - 999

E0776 IV POLE 0 - 20

E0776 RR IV POLE 0 - 999

E0779 Amb infusion pump mechanical 0 - 20

E0779 RR Amb infusion pump mechanical 0 - 999

E0780 Mech amb infusion pump <8hrs 0 - 20

E0780 RR Mech amb infusion pump <8hrs 0 - 999

E0781 External ambulatory infus pu 0 - 20

E0781 RR External ambulatory infus pu 0 - 999

E0784 Ext amb infusn pump insulin 0 - 999

E0784 NU Ext amb infusn pump insulin 0 - 999

E0785 NU Replacement impl pump cathet 0 - 999

E0786 NU Implantable pump replacement 0 - 999

E0791 Parenteral infusion pump sta 0 - 20

E0791 RR Parenteral infusion pump sta 0 - 999

E0840 TRACT FRAME ATTACH HEADBOARD 0 - 20

E0840 NU TRACT FRAME ATTACH HEADBOARD 0 - 999

E0849 RR CERVICAL PNEUM TRAC EQUIP 0 - 999

E0850 TRACTION STAND FREE STANDING 0 - 20

E0850 NU TRACTION STAND FREE STANDING 0 - 999

E0855 RR CERVICAL TRACTION EQUIPMENT 0 - 999

E0856 RR CERVIC COLLAR W AIR BLADDER 0 - 999

E0860 TRACT EQUIP CERVICAL TRACT 0 - 999

E0860 NU TRACT EQUIP CERVICAL TRACT 0 - 999

E0870 TRACT FRAME ATTACH FOOTBOARD 0 - 20

E0870 NU TRACT FRAME ATTACH FOOTBOARD 0 - 999

E0880 TRAC STAND FREE STAND EXTREM 0 - 20

E0880 NU TRAC STAND FREE STAND EXTREM 0 - 999

E0890 TRACTION FRAME ATTACH PELVIC 0 - 20

E0890 RR TRACTION FRAME ATTACH PELVIC 0 - 999

E0900 TRAC STAND FREE STAND PELVIC 0 - 20

E0900 NU TRAC STAND FREE STAND PELVIC 0 - 999

E0910 TRAPEZE BAR ATTACHED TO BED 0 - 999

E0910 RR TRAPEZE BAR ATTACHED TO BED 0 - 999

E0911 RR HD TRAPEZE BAR ATTACH TO BED 0 - 999

E0912 RR HD TRAPEZE BAR FREE STANDING 0 - 999

E0920 FRACTURE FRAME ATTACHED TO B 0 - 20

E0920 RR FRACTURE FRAME ATTACHED TO B 0 - 999

E0930 FRACTURE FRAME FREE STANDING 0 - 20

E0930 RR FRACTURE FRAME FREE STANDING 0 - 999

E0935 CONT PAS MOTION EXERCISE DEV 0 - 20

E0935 RD CONT PAS MOTION EXERCISE DEV 0 - 999

E0940 TRAPEZE BAR FREE STANDING 0 - 999

E0940 RR TRAPEZE BAR FREE STANDING 0 - 999

E0941 RR GRAVITY ASSISTED TRACTION DE 0 - 999

E0942 Cervical head harness/halter 0 - 20

E0942 NU Cervical head harness/halter 0 - 999

E0944 Pelvic belt/harness/boot 0 - 20

E0944 NU Pelvic belt/harness/boot 0 - 999

E0945 Belt/harness extremity 0 - 20

E0945 NU Belt/harness extremity 0 - 999

E0947 Fracture frame attachmnts pe 0 - 20

E0947 RR Fracture frame attachmnts pe 0 - 999

E0948 Fracture frame attachmnts ce 0 - 20

E0948 RR Fracture frame attachmnts ce 0 - 999

E0950 Tray 0 - 999

E0950 NU Tray 0 - 999

E0951 Loop heel 0 - 999

E0951 NU Loop heel 0 - 999

E0952 Toe loop/holder, each 0 - 999

E0952 NU Toe loop/holder, each 0 - 999

E0955 Cushioned headrest 0 - 999

E0955 NU Cushioned headrest 0 - 999

E0956 W/c lateral trunk/hip suppor 0 - 999

E0956 NU W/c lateral trunk/hip suppor 0 - 999

E0957 W/c medial thigh support 0 - 999

E0957 NU W/c medial thigh support 0 - 999

E0958 Whlchr att- conv 1 arm drive 0 - 999

E0958 NU Whlchr att- conv 1 arm drive 0 - 999

E0959 Amputee adapter 0 - 999

E0959 NU Amputee adapter 0 - 999

E0960 W/c shoulder harness/straps 0 - 999

E0960 NU W/c shoulder harness/straps 0 - 999

E0961 Wheelchair brake extension 0 - 999

E0961 NU Wheelchair brake extension 0 - 999

E0966 Wheelchair head rest extensi 0 - 999

E0966 NU Wheelchair head rest extensi 0 - 999

E0967 Manual wc hand rim w project 0 - 999

E0967 NU Manual wc hand rim w project 0 - 999

E0968 Wheelchair commode seat 0 - 999

E0968 NU Wheelchair commode seat 0 - 999

E0969 Wheelchair narrowing device 0 - 999

E0969 NU Wheelchair narrowing device 0 - 999

E0971 Wheelchair anti-tipping devi 0 - 999

E0971 NU Wheelchair anti-tipping devi 0 - 999

E0973 W/ch access det adj armrest 0 - 999

E0973 NU W/ch access det adj armrest 0 - 999

E0974 W/ch access anti-rollback 0 - 999

E0974 NU W/ch access anti-rollback 0 - 999

E0978 W/c acc,saf belt pelv strap 0 - 999

E0978 NU W/c acc,saf belt pelv strap 0 - 999

E0980 Wheelchair safety vest 0 - 999

E0980 NU Wheelchair safety vest 0 - 999

E0981 Seat upholstery, replacement 0 - 999

E0981 NU Seat upholstery, replacement 0 - 999

E0982 Back upholstery, replacement 0 - 999

E0982 NU Back upholstery, replacement 0 - 999

E0983 Add pwr joystick 0 - 999

E0983 NU Add pwr joystick 0 - 999

E0984 Add pwr tiller 0 - 999

E0984 NU Add pwr tiller 0 - 999

E0986 Man w/c push-rim powr system 0 - 999

E0986 NU Man w/c push-rim powr system 0 - 999

E0988 NU Lever-activated wheel drive 0 - 999

E0988 Lever-activated wheel drive

E0990 Wheelchair elevating leg res 0 - 999

E0990 NU Wheelchair elevating leg res 0 - 999

E0992 Wheelchair solid seat insert 0 - 999

E0992 NU Wheelchair solid seat insert 0 - 999

E0994 Wheelchair arm rest 0 - 999

E0994 NU Wheelchair arm rest 0 - 999

E0995 Wheelchair calf rest 0 - 999

E0995 NU Wheelchair calf rest 0 - 999

E1002 Pwr seat tilt 0 - 999

E1002 NU Pwr seat tilt 0 - 999

E1003 Pwr seat recline 0 - 999

E1003 RR Pwr seat recline 0 - 999

E1004 Pwr seat recline mech 0 - 999

E1004 RR Pwr seat recline mech 0 - 999

E1005 Pwr seat recline pwr 0 - 999

E1005 RR Pwr seat recline pwr 0 - 999

E1006 NU Pwr seat combo w/o shear 0 - 999

E1006 Pwr seat combo w/o shear

E1007 NU Pwr seat combo w/shear 0 - 999

E1007 Pwr seat combo w/shear

E1008 NU Pwr seat combo pwr shear 0 - 999

E1008 Pwr seat combo pwr shear

E1010 NU Add pwr leg elevation 0 - 999

E1010 Add pwr leg elevation

E1014 NU Reclining back add ped w/c 0 - 999

E1014 Reclining back add ped w/c

E1015 Shock absorber for man w/c 0 - 999

E1015 NU Shock absorber for man w/c 0 - 999

E1016 Shock absorber for power w/c 0 - 999

E1016 NU Shock absorber for power w/c 0 - 999

E1017 NU Heavy duty shock absorber for heavy duty or extra

heavy duty manual wheelchair, each

0 - 999

E1017 Heavy duty shock absorber for heavy duty or extra

heavy duty manual wheelchair, each

E1020 Residual limb support system 0 - 999

E1020 RR Residual limb support system 0 - 999

E1028 W/c manual swingaway 0 - 999

E1028 RR W/c manual swingaway 0 - 999

E1029 W/c vent tray fixed 0 - 999

E1029 RR W/c vent tray fixed 0 - 999

E1030 W/c vent tray gimbaled 0 - 20

E1030 RR W/c vent tray gimbaled 0 - 999

E1031 Rollabout chair with casters 0 - 999

E1031 RR Rollabout chair with casters 0 - 999

E1035 RR PATIENT TRANSFER SYSTEM <300 0 - 999

E1036 RR PATIENT TRANSFER SYSTEM >300 0 - 999

E1038 RR TRANSPORT CHAIR PT WT<=300LB 0 - 999

E1039 RR TRANSPORT CHAIR PT WT >300LB 0 - 999

E1050 WHELCHR FXD FULL LENGTH ARMS 0 - 999

E1050 RR WHELCHR FXD FULL LENGTH ARMS 0 - 999

E1060 WHEELCHAIR DETACHABLE ARMS 0 - 999

E1060 RR WHEELCHAIR DETACHABLE ARMS 0 - 999

E1066 RR BATTERY CHARGER 0 - 999

E1070 WHEELCHAIR DETACHABLE FOOT R 0 - 999

E1070 RR WHEELCHAIR DETACHABLE FOOT R 0 - 999

E1083 HEMI-WHEELCHAIR FIXED ARMS 0 - 999

E1083 RR HEMI-WHEELCHAIR FIXED ARMS 0 - 999

E1084 HEMI-WHEELCHAIR DETACHABLE A 0 - 20

E1084 RR HEMI-WHEELCHAIR DETACHABLE A 0 - 999

E1085 HEMI-WHEELCHAIR FIXED ARMS 0 - 999

E1085 RR HEMI-WHEELCHAIR FIXED ARMS 0 - 999

E1086 RR HEMI-WHEELCHAIR DETACHABLE A 0 - 999

E1086 HEMI-WHEELCHAIR DETACHABLE A

E1087 WHEELCHAIR LIGHTWT FIXED ARM 0 - 999

E1087 RR WHEELCHAIR LIGHTWT FIXED ARM 0 - 999

E1088 WHEELCHAIR LIGHTWEIGHT DET A 0 - 999

E1088 RR WHEELCHAIR LIGHTWEIGHT DET A 0 - 999


E1089 WHEELCHAIR LIGHTWT FIXED ARM

E1090 RR WHEELCHAIR LIGHTWEIGHT DET A 0 - 999

E1090 WHEELCHAIR LIGHTWEIGHT DET A

E1092 WHEELCHAIR WIDE W/ LEG RESTS 0 - 999

E1092 RR WHEELCHAIR WIDE W/ LEG RESTS 0 - 999

E1093 WHEELCHAIR WIDE W/ FOOT REST 0 - 999

E1093 RR WHEELCHAIR WIDE W/ FOOT REST 0 - 999

E1100 WHCHR S-RECL FXD ARM LEG RES 0 - 999

E1100 RR WHCHR S-RECL FXD ARM LEG RES 0 - 999

E1110 WHEELCHAIR SEMI-RECL DETACH 0 - 999

E1110 RR WHEELCHAIR SEMI-RECL DETACH 0 - 999

E1130 RR WHLCHR STAND FXD ARM FT REST 0 - 999

E1130 WHLCHR STAND FXD ARM FT REST

E1140 RR WHEELCHAIR STANDARD DETACH A 0 - 999

E1140 WHEELCHAIR STANDARD DETACH A

E1150 WHEELCHAIR STANDARD W/ LEG R 0 - 999

E1150 RR WHEELCHAIR STANDARD W/ LEG R 0 - 999

E1160 Wheelchair, fixed full length arms, swing away

detachable elevating legrests

0 - 999

E1160 RR Wheelchair, fixed full length arms, swing away

detachable elevating legrests

0 - 999

E1161 NU Manual adult wc w tiltinspac 0 - 999

E1161 Manual adult wc w tiltinspac

E1170 WHLCHR AMPU FXD ARM LEG REST 0 - 999

E1170 RR WHLCHR AMPU FXD ARM LEG REST 0 - 999

E1171 WHEELCHAIR AMPUTEE W/O LEG R 0 - 999

E1171 RR WHEELCHAIR AMPUTEE W/O LEG R 0 - 999

E1172 WHEELCHAIR AMPUTEE DETACH AR 0 - 999

E1172 RR WHEELCHAIR AMPUTEE DETACH AR 0 - 999

E1180 WHEELCHAIR AMPUTEE W/ FOOT R 0 - 999

E1180 RR WHEELCHAIR AMPUTEE W/ FOOT R 0 - 999

E1190 WHEELCHAIR AMPUTEE W/ LEG RE 0 - 999

E1190 RR WHEELCHAIR AMPUTEE W/ LEG RE 0 - 999

E1195 WHEELCHAIR AMPUTEE HEAVY DUT 0 - 999

E1195 RR WHEELCHAIR AMPUTEE HEAVY DUT 0 - 999

E1200 WHEELCHAIR AMPUTEE FIXED ARM 0 - 999

E1200 RR WHEELCHAIR AMPUTEE FIXED ARM 0 - 999

E1221 WHEELCHAIR SPEC SIZE W FOOT 0 - 999

E1221 RR WHEELCHAIR SPEC SIZE W FOOT 0 - 999

E1222 WHEELCHAIR SPEC SIZE W/ LEG 0 - 999

E1222 RR WHEELCHAIR SPEC SIZE W/ LEG 0 - 999

E1223 WHEELCHAIR SPEC SIZE W FOOT 0 - 999

E1223 RR WHEELCHAIR SPEC SIZE W FOOT 0 - 999

E1224 WHEELCHAIR SPEC SIZE W/ LEG 0 - 999

E1224 RR WHEELCHAIR SPEC SIZE W/ LEG 0 - 999

E1225 MANUAL SEMI-RECLINING BACK 0 - 999

E1225 RR MANUAL SEMI-RECLINING BACK 0 - 999

E1226 MANUAL FULLY RECLINING BACK 0 - 999

E1226 NU MANUAL FULLY RECLINING BACK 0 - 999

E1227 WHEELCHAIR SPEC SZ SPEC HT A 0 - 999

E1227 NU WHEELCHAIR SPEC SZ SPEC HT A 0 - 999

E1228 WHEELCHAIR SPEC SZ SPEC HT B 0 - 999

E1228 RR WHEELCHAIR SPEC SZ SPEC HT B 0 - 999

E1230 RR POWER OPERATED VEHICLE 0 - 999

E1231 RIGID PED W/C TILT-IN-SPACE 0 - 999

E1231 NU RIGID PED W/C TILT-IN-SPACE 0 - 999

E1232 FOLDING PED WC TILT-IN-SPACE 0 - 999

E1232 NU FOLDING PED WC TILT-IN-SPACE 0 - 999

E1233 Rig ped wc tltnspc w/o seat 0 - 999

E1233 NU Rig ped wc tltnspc w/o seat 0 - 999

E1234 FLD PED WC TLTNSPC W/O SEAT 0 - 999

E1234 NU FLD PED WC TLTNSPC W/O SEAT 0 - 999

E1235 RIGID PED WC ADJUSTABLE 0 - 999

E1235 RR RIGID PED WC ADJUSTABLE 0 - 999

E1236 FOLDING PED WC ADJUSTABLE 0 - 999

E1236 RR FOLDING PED WC ADJUSTABLE 0 - 999

E1237 RGD PED WC ADJSTABL W/O SEAT 0 - 999

E1237 RR RGD PED WC ADJSTABL W/O SEAT 0 - 999

E1238 FLD PED WC ADJSTABL W/O SEAT 0 - 999

E1238 RR FLD PED WC ADJSTABL W/O SEAT 0 - 999

E1240 WHCHR LITWT DET ARM LEG REST 0 - 999

E1240 RR WHCHR LITWT DET ARM LEG REST 0 - 999


E1250 WHEELCHAIR LIGHTWT FIXED ARM

E1260 RR WHEELCHAIR LIGHTWT FOOT REST 0 - 999

E1260 WHEELCHAIR LIGHTWT FOOT REST

E1270 WHEELCHAIR LIGHTWEIGHT LEG R 0 - 999

E1270 RR WHEELCHAIR LIGHTWEIGHT LEG R 0 - 999

E1280 WHCHR H-DUTY DET ARM LEG RES 0 - 999

E1280 RR WHCHR H-DUTY DET ARM LEG RES 0 - 999

E1285 RR WHEELCHAIR HEAVY DUTY FIXED 0 - 999

E1285 WHEELCHAIR HEAVY DUTY FIXED

E1290 RR WHEELCHAIR HVY DUTY DETACH A 0 - 999

E1290 WHEELCHAIR HVY DUTY DETACH A

E1295 WHEELCHAIR HEAVY DUTY FIXED 0 - 999

E1295 RR WHEELCHAIR HEAVY DUTY FIXED 0 - 999

E1296 Wheelchair special seat heig 0 - 999

E1296 NU Wheelchair special seat heig 0 - 999

E1297 Wheelchair special seat dept 0 - 999

E1297 NU Wheelchair special seat dept 0 - 999

E1298 Wheelchair spec seat depth/w 0 - 999

E1298 NU Wheelchair spec seat depth/w 0 - 999

E1356 RR BATT PACK/CART, PORT CONC 0 - 999

E1357 RR BATTERY CHARGER, PORT CONC 0 - 999

E1358 RR DC POWER ADAPTER, PORT CONC 0 - 999

E1390 OXYGEN CONCENTRATOR 0 - 999

E1390 RR OXYGEN CONCENTRATOR 0 - 999

E1392 PORTABLE OXYGEN CONCENTRATOR 0 - 999

E1392 RR PORTABLE OXYGEN CONCENTRATOR 0 - 999

E1399 DURABLE MEDICAL EQUIPMENT MI, BRAD Specific

items

0 - 999

E1399 NU DURABLE MEDICAL EQUIPMENT MI, BRAD Specific

items

0 - 999

E1405 RR Oxygen and water vapor enriching system with

heated delivery

0 - 999

E1499 RR CPAP CARRYING CASE 0 - 999

E1700 NU Jaw motion rehab system 0 - 999

E1701 NU Repl cushions for jaw motion 0 - 999

E1702 NU Repl measr scales jaw motion 0 - 999

E1800 Adjust elbow ext/flex device 0 - 20

E1800 NU Adjust elbow ext/flex device 0 - 999

E1801 Sps elbow device 0 - 999

E1801 NU Sps elbow device 0 - 999

E1802 NU Adjst forearm pro/sup device 0 - 999

E1805 Adjust wrist ext/flex device 0 - 999

E1805 NU Adjust wrist ext/flex device 0 - 999

E1806 Sps wrist device 0 - 999

E1806 NU Sps wrist device 0 - 999

E1810 Adjust knee ext/flex device 0 - 999

E1810 NU Adjust knee ext/flex device 0 - 999

E1811 Sps knee device 0 - 999

E1811 NU Sps knee device 0 - 999

E1812 NU Knee ext/flex w act res ctrl 0 - 999

E1815 Adjust ankle ext/flex device 0 - 20

E1815 NU Adjust ankle ext/flex device 0 - 999

E1816 Sps ankle device 0 - 999

E1816 NU Sps ankle device 0 - 999

E1818 Sps forearm device 0 - 999

E1818 NU Sps forearm device 0 - 999

E1820 Soft interface material 0 - 20

E1820 NU Soft interface material 0 - 999

E1821 Replacement interface spsd 0 - 999

E1821 NU Replacement interface spsd 0 - 999

E1825 Adjust finger ext/flex devc 0 - 20

E1825 NU Adjust finger ext/flex devc 0 - 999

E1830 Adjust toe ext/flex device 0 - 20

E1830 NU Adjust toe ext/flex device 0 - 999

E1831 NU Static str toe dev ext/flex 0 - 999

E1840 Adj shoulder ext/flex device 0 - 999

E1840 NU Adj shoulder ext/flex device 0 - 999

E1841 NU Static str shldr dev rom adj 0 - 999

E1902 COMMUNICATION BOARD, NON-ELECTRONIC

AUGMENTATIVE OR ALTERNATIVE COMMUNICATION

DEVICE

0 - 999

E1902 NU COMMUNICATION BOARD, NON-ELECTRONIC

AUGMENTATIVE OR ALTERNATIVE COMMUNICATION

DEVICE

0 - 999

E2000 Gastric suction pump hme mdl 0 - 999

E2000 NU Gastric suction pump hme mdl 0 - 999

E2101 Blood glucose monitor with integrated lancing/blood

sample

0 - 999

E2120 NU Pulse gen sys tx endolymp fl 0 - 999

E2201 NU Man w/ch acc seat w>=20"<24" 0 - 999

E2201 Man w/ch acc seat w>=20"<24"

E2202 NU Seat width 24-27 in 0 - 999

E2202 Seat width 24-27 in

E2203 NU Frame depth less than 22 in 0 - 999

E2203 Frame depth less than 22 in

E2204 NU Frame depth 22 to 25 in 0 - 999

E2204 Frame depth 22 to 25 in

E2205 Manual wc accessory, handrim 0 - 999

E2205 NU Manual wc accessory, handrim 0 - 999

E2206 Complete wheel lock assembly 0 - 999

E2206 NU Complete wheel lock assembly 0 - 999

E2207 Crutch and cane holder 0 - 999

E2207 NU Crutch and cane holder 0 - 999

E2208 Cylinder tank carrier 0 - 999

E2208 RR Cylinder tank carrier 0 - 999

E2209 Arm trough each 0 - 999

E2209 NU Arm trough each 0 - 999

E2210 Wheelchair bearings 0 - 999

E2210 NU Wheelchair bearings 0 - 999

E2211 Pneumatic propulsion tire 0 - 999

E2211 NU Pneumatic propulsion tire 0 - 999

E2212 Pneumatic prop tire tube 0 - 999

E2212 RR Pneumatic prop tire tube 0 - 999

E2213 Pneumatic prop tire insert 0 - 999

E2213 NU Pneumatic prop tire insert 0 - 999

E2214 Pneumatic caster tire each 0 - 999

E2214 NU Pneumatic caster tire each 0 - 999

E2215 Pneumatic caster tire tube 0 - 999

E2215 NU Pneumatic caster tire tube 0 - 999

E2216 NU Manual wheelchair accessory, foam filled propulsion

tire, any size, each

0 - 999

E2216 Manual wheelchair accessory, foam filled propulsion

tire, any size, each

E2217 MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED

CASTER TIRE, ANY SIZE, EACH

0 - 999

E2217 NU MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED

CASTER TIRE, ANY SIZE, EACH

0 - 999

E2218 NU Manual wheelchair accessory, foam propulsion tire,

any size, each

0 - 999

E2218 Manual wheelchair accessory, foam propulsion tire,

any size, each

E2219 Foam caster tire any size ea 0 - 999

E2219 NU Foam caster tire any size ea 0 - 999

E2219 Foam caster tire any size ea

E2220 Solid propulsion tire each 0 - 999

E2220 NU Solid propulsion tire each 0 - 999

E2221 Solid caster tire each 0 - 999

E2221 NU Solid caster tire each 0 - 999

E2224 Propulsion whl excludes tire 0 - 999

E2224 NU Propulsion whl excludes tire 0 - 999

E2225 NU Caster wheel excludes tire 0 - 999

E2225 Caster wheel excludes tire

E2226 NU Caster fork replacement only 0 - 999

E2226 Caster fork replacement only

E2227 NU Gear reduction drive wheel 0 - 999

E2227 Gear reduction drive wheel

E2228 NU Mwc acc, wheelchair brake 0 - 999

E2228 Mwc acc, wheelchair brake

E2231 NU Solid seat support base 0 - 999

E2231 Solid seat support base

E2310 NU Electro connect btw control 0 - 999

E2310 Electro connect btw control

E2311 NU Electro connect btw 2 sys 0 - 999

E2311 Electro connect btw 2 sys

E2312 NU Mini-prop remote joystick 0 - 999

E2312 Mini-prop remote joystick

E2313 NU Pwc harness, expand control 0 - 999

E2313 Pwc harness, expand control

E2321 NU Hand interface joystick 0 - 999

E2321 Hand interface joystick

E2322 Mult mech switches 0 - 999

E2322 RR Mult mech switches 0 - 999

E2323 Special joystick handle 0 - 999

E2323 NU Special joystick handle 0 - 999

E2324 Chin cup interface 0 - 999

E2324 NU Chin cup interface 0 - 999

E2325 Sip and puff interface 0 - 999

E2325 NU Sip and puff interface 0 - 999

E2326 Breath tube kit 0 - 999

E2326 NU Breath tube kit 0 - 999

E2327 Head control interface mech 0 - 999

E2327 RR Head control interface mech 0 - 999

E2328 Head/extremity control inter 0 - 999

E2328 RR Head/extremity control inter 0 - 999

E2329 Head control nonproportional 0 - 999

E2329 RR Head control nonproportional 0 - 999

E2330 Head control proximity switc 0 - 999

E2330 RR Head control proximity switc 0 - 999

E2340 NU W/c wdth 20-23 in seat frame 0 - 999

E2340 W/c wdth 20-23 in seat frame

E2341 NU W/c wdth 24-27 in seat frame 0 - 999

E2341 W/c wdth 24-27 in seat frame

E2342 NU W/c dpth 20-21 in seat frame 0 - 999

E2342 W/c dpth 20-21 in seat frame

E2343 NU W/c dpth 22-25 in seat frame 0 - 999

E2343 W/c dpth 22-25 in seat frame

E2351 NU Electronic sgd interface 0 - 999

E2351 Electronic sgd interface

E2359 NU Gr34 sealed leadacid battery 0 - 999

E2359 Gr34 sealed leadacid battery

E2360 22NF NONSEALED LEADACID 0 - 999

E2360 NU 22NF NONSEALED LEADACID 0 - 999

E2361 22NF SEALED LEADACID BATTERY 0 - 999

E2361 RR 22NF SEALED LEADACID BATTERY 0 - 999

E2362 GR24 NONSEALED LEADACID 0 - 999

E2362 NU GR24 NONSEALED LEADACID 0 - 999

E2363 GR24 SEALED LEADACID BATTERY 0 - 999

E2363 RR GR24 SEALED LEADACID BATTERY 0 - 999

E2364 U1NONSEALED LEADACID BATTERY 0 - 999

E2364 NU U1NONSEALED LEADACID BATTERY 0 - 999

E2365 U1 SEALED LEADACID BATTERY 0 - 999

E2365 RR U1 SEALED LEADACID BATTERY 0 - 999

E2366 BATTERY CHARGER, SINGLE MODE 0 - 999

E2366 RR BATTERY CHARGER, SINGLE MODE 0 - 999

E2367 BATTERY CHARGER, DUAL MODE 0 - 999

E2367 RR BATTERY CHARGER, DUAL MODE 0 - 999

E2368 Pwr wc drivewheel motor repl 0 - 999

E2368 RR Pwr wc drivewheel motor repl 0 - 999

E2369 Pwr wc drivewheel gear repl 0 - 999

E2369 RR Pwr wc drivewheel gear repl 0 - 999

E2370 Pwr wc dr wh motor/gear comb 0 - 999

E2370 RR Pwr wc dr wh motor/gear comb 0 - 999

E2371 NU GR27 SEALED LEADACID BATTERY 0 - 999

E2371 GR27 SEALED LEADACID BATTERY

E2372 NU GR27 NON-SEALED LEADACID 0 - 999

E2373 Hand/chin ctrl spec joystick 0 - 999

E2373 RR Hand/chin ctrl spec joystick 0 - 999

E2374 Hand/chin ctrl std joystick 0 - 999

E2374 RR Hand/chin ctrl std joystick 0 - 999

E2375 NU Non-expandable controller 0 - 999

E2375 Non-expandable controller

E2376 NU Expandable controller, repl 0 - 999

E2376 Expandable controller, repl

E2381 Pneum drive wheel tire 0 - 999

E2381 RR Pneum drive wheel tire 0 - 999

E2382 Tube, pneum wheel drive tire 0 - 999

E2382 RR Tube, pneum wheel drive tire 0 - 999

E2383 Insert, pneum wheel drive 0 - 999

E2383 NU Insert, pneum wheel drive 0 - 999

E2384 Pneumatic caster tire 0 - 999

E2384 NU Pneumatic caster tire 0 - 999

E2385 Tube, pneumatic caster tire 0 - 999

E2385 NU Tube, pneumatic caster tire 0 - 999

E2386 Foam filled drive wheel tire 0 - 999

E2386 NU Foam filled drive wheel tire 0 - 999

E2387 Foam filled caster tire 0 - 999E2387 NU Foam filled caster tire 0 - 999

E2388 Foam drive wheel tire 0 - 999

E2388 NU Foam drive wheel tire 0 - 999

E2389 Foam caster tire 0 - 999

E2389 NU Foam caster tire 0 - 999

E2390 Solid drive wheel tire 0 - 999

E2390 RR Solid drive wheel tire 0 - 999

E2391 Solid caster tire 0 - 999

E2391 RR Solid caster tire 0 - 999

E2392 NU Solid caster tire, integrate 0 - 999

E2392 Solid caster tire, integrate

E2394 Drive wheel excludes tire 0 - 999

E2394 RR Drive wheel excludes tire 0 - 999

E2395 Caster wheel excludes tire 0 - 999

E2395 RR Caster wheel excludes tire 0 - 999

E2396 Caster fork 0 - 999

E2396 RR Caster fork 0 - 999

E2402 NU Negative Pressure Wound Pump 0 - 999

E2500 Sgd digitized pre-rec <=8min 0 - 999

E2500 NU Sgd digitized pre-rec <=8min 0 - 999

E2502 Sgd prerec msg >8min <=20min 0 - 999

E2502 NU Sgd prerec msg >8min <=20min 0 - 999

E2504 Sgd prerec msg>20min <=40min 0 - 999

E2504 NU Sgd prerec msg>20min <=40min 0 - 999

E2506 Sgd prerec msg > 40 min 0 - 999

E2506 NU Sgd prerec msg > 40 min 0 - 999

E2508 Sgd spelling phys contact 0 - 999

E2508 NU Sgd spelling phys contact 0 - 999

E2510 Sgd w multi methods msg/accs 0 - 999

E2510 NU Sgd w multi methods msg/accs 0 - 999

E2511 SPEECH GENERATING SOFTWARE PROGRAM, FOR

PERSONAL COMPUTER OR PERSONAL DIGITAL

ASSISTANT

0 - 999

E2511 NU SPEECH GENERATING SOFTWARE PROGRAM, FOR

PERSONAL COMPUTER OR PERSONAL DIGITAL

ASSISTANT

0 - 999

E2512 ACCESSORY FOR SPEECH GENERATING DEVICE,

MOUNTING SYSTEM

0 - 999

E2512 NU ACCESSORY FOR SPEECH GENERATING DEVICE,

MOUNTING SYSTEM

0 - 999

E2599 ACCESSORY FOR SPEECH GENERATING DEVICE, NOT

OTHERWISE CLASSIFIED

0 - 999

E2599 NU ACCESSORY FOR SPEECH GENERATING DEVICE, NOT

OTHERWISE CLASSIFIED

0 - 999

E2601 Gen w/c cushion wdth < 22 in 0 - 999

E2601 NU Gen w/c cushion wdth < 22 in 0 - 999

E2602 Gen w/c cushion wdth >=22 in 0 - 999

E2602 NU Gen w/c cushion wdth >=22 in 0 - 999

E2603 Skin protect wc cus wd <22in 0 - 999

E2603 NU Skin protect wc cus wd <22in 0 - 999

E2604 Skin protect wc cus wd>=22in 0 - 999

E2604 NU Skin protect wc cus wd>=22in 0 - 999

E2605 Position wc cush wdth <22 in 0 - 999

E2605 NU Position wc cush wdth <22 in 0 - 999

E2606 Position wc cush wdth>=22 in 0 - 999

E2606 NU Position wc cush wdth>=22 in 0 - 999

E2607 Skin pro/pos wc cus wd <22in 0 - 999

E2607 NU Skin pro/pos wc cus wd <22in 0 - 999

E2608 Skin pro/pos wc cus wd>=22in 0 - 999

E2608 NU Skin pro/pos wc cus wd>=22in 0 - 999

E2611 Gen use back cush wdth <22in 0 - 999

E2611 NU Gen use back cush wdth <22in 0 - 999

E2612 Gen use back cush wdth>=22in 0 - 999

E2612 NU Gen use back cush wdth>=22in 0 - 999

E2613 Position back cush wd <22in 0 - 999

E2613 NU Position back cush wd <22in 0 - 999

E2614 Position back cush wd>=22in 0 - 999

E2614 NU Position back cush wd>=22in 0 - 999

E2615 Pos back post/lat wdth <22in 0 - 999

E2615 NU Pos back post/lat wdth <22in 0 - 999

E2616 Pos back post/lat wdth>=22in 0 - 999

E2616 NU Pos back post/lat wdth>=22in 0 - 999

E2619 Replace cover w/c seat cush 0 - 999

E2619 RR Replace cover w/c seat cush 0 - 999

E2620 Wc planar back cush wd <22in 0 - 999

E2620 NU Wc planar back cush wd <22in 0 - 999

E2621 Wc planar back cush wd>=22in 0 - 999

E2621 NU Wc planar back cush wd>=22in 0 - 999

E2622 NU Adj skin pro w/c cus wd<22in 0 - 999

E2622 Adj skin pro w/c cus wd<22in

E2623 NU Adj skin pro wc cus wd>=22in 0 - 999

E2623 Adj skin pro wc cus wd>=22in

E2624 NU Adj skin pro/pos cus<22in 0 - 999

E2624 Adj skin pro/pos cus<22in

E2625 NU Adj skin pro/pos wc cus>=22 0 - 999

E2625 Adj skin pro/pos wc cus>=22

E2626 NU Seo mobile arm sup att to wc 0 - 999

E2626 Seo mobile arm sup att to wc

E2627 NU Arm supp att to wc rancho ty 0 - 999

E2627 Arm supp att to wc rancho ty

E2628 NU Mobile arm supports reclinin 0 - 999

E2628 Mobile arm supports reclinin

E2629 NU Friction dampening arm supp 0 - 999

E2629 Friction dampening arm supp

E2630 NU Monosuspension arm/hand supp 0 - 999

E2630 Monosuspension arm/hand supp

E2631 NU Elevat proximal arm support 0 - 999

E2631 Elevat proximal arm support

E2632 NU Offset/lat rocker arm w/ela 0 - 999

E2632 Offset/lat rocker arm w/ela

E2633 NU Mobile arm support supinator 0 - 999

E2633 Mobile arm support supinator

K0001 STANDARD WHEELCHAIR 0 - 999

K0001 RR STANDARD WHEELCHAIR 0 - 999

K0002 STND HEMI (LOW SEAT) WHLCHR 0 - 999

K0002 RR STND HEMI (LOW SEAT) WHLCHR 0 - 999

K0003 LIGHTWEIGHT WHEELCHAIR 0 - 999

K0003 RR LIGHTWEIGHT WHEELCHAIR 0 - 999

K0004 HIGH STRENGTH LTWT WHLCHR 0 - 999

K0004 RR HIGH STRENGTH LTWT WHLCHR 0 - 999

K0005 ULTRALIGHTWEIGHT WHEELCHAIR 0 - 999

K0005 NU ULTRALIGHTWEIGHT WHEELCHAIR 0 - 999

K0006 HEAVY DUTY WHEELCHAIR 0 - 999

K0006 RR HEAVY DUTY WHEELCHAIR 0 - 999

K0007 EXTRA HEAVY DUTY WHEELCHAIR 0 - 999

K0007 RR EXTRA HEAVY DUTY WHEELCHAIR 0 - 999

K0008 CSTM MANUAL WHEELCHAIR/BASE 0 - 999

K0008 NU CSTM MANUAL WHEELCHAIR/BASE 0 - 999

K0009 OTHER MANUAL WHEELCHAIR/BASE 0 - 999

K0009 NU OTHER MANUAL WHEELCHAIR/BASE 0 - 999

K0010 STND WT FRAME POWER WHLCHR 0 - 999

K0010 RR STND WT FRAME POWER WHLCHR 0 - 999

K0011 RR STND WT PWR WHLCHR W CONTROL 0 - 999

K0012 LTWT PORTBL POWER WHLCHR 0 - 999

K0012 RR LTWT PORTBL POWER WHLCHR 0 - 999

K0013 CUSTOM POWER WHLCHR BASE 0 - 999

K0013 NU CUSTOM POWER WHLCHR BASE 0 - 999

K0014 OTHER POWER WHLCHR BASE 0 - 999

K0014 NU OTHER POWER WHLCHR BASE 0 - 999

K0015 Detach non-adjus hght armrst 0 - 999

K0015 NU Detach non-adjus hght armrst 0 - 999

K0017 Detach adjust armrest base 0 - 999

K0017 NU Detach adjust armrest base 0 - 999

K0018 Detach adjust armrst upper 0 - 999

K0018 NU Detach adjust armrst upper 0 - 999

K0019 Arm pad each 0 - 999

K0019 RR Arm pad each 0 - 999

K0020 Fixed adjust armrest pair 0 - 999

K0020 NU Fixed adjust armrest pair 0 - 999

K0037 High mount flip-up footrest 0 - 999

K0037 NU High mount flip-up footrest 0 - 999

K0038 Leg strap each 0 - 999

K0038 RR Leg strap each 0 - 999

K0039 Leg strap h style each 0 - 999

K0039 NU Leg strap h style each 0 - 999

K0040 Adjustable angle footplate 0 - 999

K0040 RR Adjustable angle footplate 0 - 999

K0041 Large size footplate each 0 - 999

K0041 NU Large size footplate each 0 - 999

K0042 Standard size footplate each 0 - 999

K0042 NU Standard size footplate each 0 - 999

K0043 Ftrst lower extension tube 0 - 999

K0043 RR Ftrst lower extension tube 0 - 999

K0044 Ftrst upper hanger bracket 0 - 999

K0044 NU Ftrst upper hanger bracket 0 - 999

K0045 Footrest complete assembly 0 - 999

K0045 NU Footrest complete assembly 0 - 999

K0046 Elevat legrst low extension 0 - 999

K0046 RR Elevat legrst low extension 0 - 999

K0047 Elevat legrst up hangr brack 0 - 999

K0047 NU Elevat legrst up hangr brack 0 - 999

K0050 Ratchet assembly 0 - 999

K0050 NU Ratchet assembly 0 - 999

K0051 Cam relese assem ftrst/lgrst 0 - 999

K0051 NU Cam relese assem ftrst/lgrst 0 - 999

K0052 Swingaway detach footrest 0 - 999

K0052 RR Swingaway detach footrest 0 - 999

K0053 Elevate footrest articulate 0 - 999

K0053 NU Elevate footrest articulate 0 - 999

K0056 Seat ht <17 or >=21 ltwt wc 0 - 999

K0056 NU Seat ht <17 or >=21 ltwt wc 0 - 999

K0065 Spoke protectors 0 - 999

K0065 NU Spoke protectors 0 - 999

K0069 Rear whl complete solid tire 0 - 999

K0069 NU Rear whl complete solid tire 0 - 999

K0070 Rear whl compl pneum tire 0 - 999

K0070 RR Rear whl compl pneum tire 0 - 999

K0071 Front castr compl pneum tire 0 - 999

K0071 RR Front castr compl pneum tire 0 - 999

K0072 Frnt cstr cmpl sem-pneum tir 0 - 999

K0072 NU Frnt cstr cmpl sem-pneum tir 0 - 999

K0073 Caster pin lock each 0 - 999

K0073 NU Caster pin lock each 0 - 999

K0077 Front caster assem complete 0 - 999

K0077 NU Front caster assem complete 0 - 999

K0098 Drive belt power wheelchair 0 - 999

K0098 NU Drive belt power wheelchair 0 - 999

K0105 IV HANGER 0 - 999

K0105 NU IV HANGER 0 - 999

K0108 Misc Wheelchair Component 0 - 999

K0108 NU Misc Wheelchair Component 0 - 999

K0195 Elevating whlchair leg rests 0 - 999

K0195 RR Elevating whlchair leg rests 0 - 999

K0455 NU Pump uninterrupted infusion 0 - 999

K0552 NU Supply/ext inf pump syr type 0 - 999

K0601 NU Repl batt silver oxide 1.5 v 0 - 999

K0602 NU Repl batt silver oxide 3 v 0 - 999

K0603 NU Repl batt alkaline 1.5 v 0 - 999

K0604 NU Repl batt lithium 3.6 v 0 - 999

K0605 NU Repl batt lithium 4.5 v 0 - 999

K0606 NU Aed garment w elec analysis 0 - 999

K0607 NU Repl batt for aed 0 - 999

K0608 NU Repl garment for aed 0 - 999

K0609 NU Repl electrode for aed 0 - 999

K0672 NU Removable soft interface le 0 - 999

K0730 NU Ctrl dose inh drug deliv sys 0 - 999

K0733 NU 12-24hr sealed lead acid 0 - 999

K0733 12-24hr sealed lead acid

K0739 REPAIR/SVC DME NON-OXYGEN EQ 0 - 999

K0739 NU REPAIR/SVC DME NON-OXYGEN EQ 0 - 999

K0740 NU REPAIR/SVC OXYGEN EQUIPMENT 0 - 999

K0800 POV GROUP 1 STD UP TO 300LBS 0 - 999

K0800 RR POV GROUP 1 STD UP TO 300LBS 0 - 999

K0801 POV GROUP 1 HD 301-450 LBS 0 - 999

K0801 RR POV GROUP 1 HD 301-450 LBS 0 - 999

K0802 POV GROUP 1 VHD 451-600 LBS 0 - 999

K0802 RR POV GROUP 1 VHD 451-600 LBS 0 - 999

K0806 RR POV GROUP 2 STD UP TO 300LBS 0 - 999

K0806 POV GROUP 2 STD UP TO 300LBS

K0807 NU POV GROUP 2 HD 301-450 LBS 0 - 999

K0807 POV GROUP 2 HD 301-450 LBS

K0808 NU POV GROUP 2 VHD 451-600 LBS 0 - 999

K0808 POV GROUP 2 VHD 451-600 LBS

K0813 RR PWC GP 1 STD PORT SEAT/BACK 0 - 999

K0813 PWC GP 1 STD PORT SEAT/BACK

K0814 RR PWC GP 1 STD PORT CAP CHAIR 0 - 999

K0814 PWC GP 1 STD PORT CAP CHAIR

K0815 RR PWC GP 1 STD SEAT/BACK 0 - 999

K0815 PWC GP 1 STD SEAT/BACK

K0816 RR PWC GP 1 STD CAP CHAIR 0 - 999

K0816 PWC GP 1 STD CAP CHAIR

K0820 RR PWC GP 2 STD PORT SEAT/BACK 0 - 999

K0820 PWC GP 2 STD PORT SEAT/BACK

K0821 RR PWC GP 2 STD PORT CAP CHAIR 0 - 999

K0821 PWC GP 2 STD PORT CAP CHAIR

K0822 PWC GP 2 STD SEAT/BACK 0 - 999


K0823 PWC GP 2 STD CAP CHAIR 0 - 999


K0824 PWC GP 2 HD SEAT/BACK 0 - 999

K0824 RR PWC GP 2 HD SEAT/BACK 0 - 999

K0825 PWC GP 2 HD CAP CHAIR 0 - 999

K0825 RR PWC GP 2 HD CAP CHAIR 0 - 999

K0826 PWC GP 2 VHD SEAT/BACK 0 - 999

K0826 RR PWC GP 2 VHD SEAT/BACK 0 - 999

K0827 PWC GP VHD CAP CHAIR 0 - 999

K0827 RR PWC GP VHD CAP CHAIR 0 - 999

K0828 RR PWC GP 2 XTRA HD SEAT/BACK 0 - 999

K0828 PWC GP 2 XTRA HD SEAT/BACK

K0829 RR PWC GP 2 XTRA HD CAP CHAIR 0 - 999

K0829 PWC GP 2 XTRA HD CAP CHAIR

K0835 RR PWC GP2 STD SING POW OPT S/B 0 - 999

K0835 PWC GP2 STD SING POW OPT S/B

K0836 RR PWC GP2 STD SING POW OPT CAP 0 - 999

K0836 PWC GP2 STD SING POW OPT CAP

K0837 RR PWC GP 2 HD SING POW OPT S/B 0 - 999

K0837 PWC GP 2 HD SING POW OPT S/B

K0838 RR PWC GP 2 HD SING POW OPT CAP 0 - 999

K0838 PWC GP 2 HD SING POW OPT CAP

K0839 RR PWC GP2 VHD SING POW OPT S/B 0 - 999

K0839 PWC GP2 VHD SING POW OPT S/B

K0840 RR PWC GP2 XHD SING POW OPT S/B 0 - 999

K0840 PWC GP2 XHD SING POW OPT S/B

K0841 RR PWC GP2 STD MULT POW OPT S/B 0 - 999

K0841 PWC GP2 STD MULT POW OPT S/B

K0842 RR PWC GP2 STD MULT POW OPT CAP 0 - 999

K0842 PWC GP2 STD MULT POW OPT CAP

K0843 RR PWC GP2 HD MULT POW OPT S/B 0 - 999

K0843 PWC GP2 HD MULT POW OPT S/B


K0848 PWC GP 3 STD SEAT/BACK


K0849 PWC GP 3 STD CAP CHAIR

K0850 RR PWC GP 3 HD SEAT/BACK 0 - 999

K0850 PWC GP 3 HD SEAT/BACK

K0851 RR PWC GP 3 HD CAP CHAIR 0 - 999

K0851 PWC GP 3 HD CAP CHAIR

K0852 RR PWC GP 3 VHD SEAT/BACK 0 - 999

K0852 PWC GP 3 VHD SEAT/BACK

K0853 RR PWC GP 3 VHD CAP CHAIR 0 - 999

K0853 PWC GP 3 VHD CAP CHAIR

K0854 RR PWC GP 3 XHD SEAT/BACK 0 - 999

K0854 PWC GP 3 XHD SEAT/BACK

K0855 RR PWC GP 3 XHD CAP CHAIR 0 - 999

K0855 PWC GP 3 XHD CAP CHAIR

K0856 RR PWC GP3 STD SING POW OPT S/B 0 - 999

K0856 PWC GP3 STD SING POW OPT S/B

K0857 RR PWC GP3 STD SING POW OPT CAP 0 - 999

K0857 PWC GP3 STD SING POW OPT CAP

K0858 RR PWC GP3 HD SING POW OPT S/B 0 - 999

K0858 PWC GP3 HD SING POW OPT S/B

K0859 RR PWC GP3 HD SING POW OPT CAP 0 - 999

K0859 PWC GP3 HD SING POW OPT CAP

K0860 RR PWC GP3 VHD SING POW OPT S/B 0 - 999

K0860 PWC GP3 VHD SING POW OPT S/B

K0861 RR PWC GP3 STD MULT POW OPT S/B 0 - 999

K0861 PWC GP3 STD MULT POW OPT S/B

K0862 RR PWC GP3 HD MULT POW OPT S/B 0 - 999

K0862 PWC GP3 HD MULT POW OPT S/B

K0863 RR PWC GP3 VHD MULT POW OPT S/B 0 - 999

K0863 PWC GP3 VHD MULT POW OPT S/B

K0864 RR PWC GP3 XHD MULT POW OPT S/B 0 - 999

K0864 PWC GP3 XHD MULT POW OPT S/B

K0900 Customized durable medical equipment, other than

wheelchair

0 - 999

K0901 NU Ko single upright pre ots 0 - 999

K0902 NU Ko double upright pre ots 0 - 999

L0120 Cervical, flexible, non-adjustable, prefabricated, off-

the-shelf (foam collar)

0 - 999

L0130 Flex Thermoplastic Collar Mo 0 - 999

L0140 Cervical Semi-Rigid Adjustab 0 - 999

L0150 Cerv Semi-Rig Adj Molded Chn 0 - 999

L0160 Cervical, semi-rigid, wire frame occipital/mandibular

support, prefabricated, off-the-shelf

0 - 999

L0170 Cervical Collar Molded To Pt 0 - 999

L0172 Cervical, collar, semi-rigid thermoplastic foam, two-

piece, prefabricated, off-the-shelf

0 - 999

L0174 Cervical, collar, semi-rigid, thermoplastic foam, two

piece with thoracic extension, prefabricated, off-the-

shelf

0 - 999

L0180 Cer Post Col Occ/Man Sup Adj 0 - 999

L0190 Cerv Collar Supp Adj Cerv Ba 0 - 999

L0200 Cerv Col Supp Adj Bar & Thor 0 - 999

L0220 Thor Rib Belt Custom Fabrica 0 - 999

L0450 Tlso, flexible, provides trunk support, upper thoracic

region, produces intracavitary pressure to reduce

load on the intervertebral disks with rigid stays or

panel(s), includes shoulder straps and closures,

prefabricated, off-the-shelf

0 - 999

L0452 TLSO, Flexible, Provides Trunk Support, Upper

Thoracic Region, Produce

0 - 999

L0454 Tlso flexible, provides trunk support, extends from

sacrococcygeal junction to above t-9 vertebra,

restricts gross trunk motion in the sagittal plane,

produces intracavitary pressure to reduce load on

the intervertebral disks with rigid stays or panel(s),

includes shoulder straps and closures, prefabricated

item that has been trimmed, bent, molded,

assembled, or otherwise customized to fit a specific

patient by an individual with expertise

0 - 999

L0456 Tlso, flexible, provides trunk support, thoracic region,

rigid posterior panel and soft anterior apron, extends

from the sacrococcygeal junction and terminates just

inferior to the scapular spine, restricts gross trunk

motion in the sagittal plane, produces intracavitary

pressure to reduce load on the intervertebral disks,

includes straps and closures, prefabricated item that

has been trimmed, bent, molded, assembled, or

otherwise customized to fit a specific patient by an

individual with expertise

0 - 999

L0458 TLSO, Triplanar Control, Modular Segmented Spinal

System, Two Rigid Pl

0 - 999

L0460 Tlso, triplanar control, modular segmented spinal

system, two rigid plastic shells, posterior extends

from the sacrococcygeal junction and terminates just

inferior to the scapular spine, anterior extends from

the symphysis pubis to the sternal notch, soft liner,

restricts gross trunk motion in the sagittal, coronal,

and transverse planes, lateral strength is provided by

overlapping plastic and stabilizing closures, includes

straps and closures, prefabricated item that has been

trimmed, bent, molded, assembled, or otherwise

customized to fit a specific patient by an individual

with expertise

0 - 999


Syst, Three Rigid Pl

0 - 999


Syst, Four Rigid Pla

0 - 999

L0466 Tlso, sagittal control, rigid posterior frame and

flexible soft anterior apron with straps, closures and

padding, restricts gross trunk motion in sagittal

plane, produces intracavitary pressure to reduce load

on intervertebral disks, prefabricated item that has

been trimmed, bent, molded, assembled, or



0 - 999

L0468 Tlso, sagittal-coronal control, rigid posterior frame

and flexible soft anterior apron with straps, closures

and padding, extends from sacrococcygeal junction

over scapulae, lateral strength provided by pelvic,

thoracic, and lateral frame pieces, restricts gross

trunk motion in sagittal, and coronal planes,


intervertebral disks, prefabricated item that has been



with expertise

0 - 999

L0470 Tlso, triplanar control, rigid posterior frame and

flexible soft anterior apron with straps, closures and

padding, extends from sacrococcygeal junction to

scapula, lateral strength provided by pelvic, thoracic,

and lateral frame pieces, rotational strength

provided by subclavicular extensions, restricts gross

trunk motion in sagittal, coronal, and transverse

planes, provides intracavitary pressure to reduce

load on the intervertebral disks, includes fitting and

shaping the frame, prefabricated, includes fitting and

adjustment

0 - 999

L0472 TLSO, Triplanar Control, Hyperextension, Rigid

Anterior And Lateral Fr

0 - 999

L0480 TLSO, Triplanar Control, One Piece Rigid Plastic Shell

Wo Interface Li

0 - 999


W Interface Lin

0 - 999

L0484 TLSO, Triplanar Control, Two Piece Rigid Plastic Shell

Wo Interface Li

0 - 999

L0486 TLSO, Triplanar Control, Two Piece Rigid Plastic Shell

W Interface Lin

0 - 999


W Interface Lin

0 - 999

L0490 TLSO, Sagittal-Coronal Control, One Piece Rigid

Plastic Shell, W Overl

0 - 999

L0491 TLSO, sagittal-coronal control, modular segmented

spinal sytem, two rigid plastic shells, posterior

extends from the sac

0 - 999

L0621 Sacroiliac orthosis, flexible, provides pelvic-sacral

support, reduces motion about the sacroiliac joint,

includes straps, closures, may include pendulous

abdomen design, prefabricated, off-the-shelf

0 - 999

L0622 Sacroiliac orthosis, flexible, provides pelvic-sacral

support, reduces motion about the sacroiliac joint,

includes strap

0 - 999

L0623 Sacroiliac orthosis, provides pelvic-sacral support,

with rigid or semi-rigid panels over the sacrum and

abdomen, reduces motion about the sacroiliac joint,

includes straps, closures, may include pendulous

abdomen design, prefabricated, off-the-shelf

0 - 999

L0624 Sacroiliac orthosis, provides pelvic-sacral support,

with rigid or semi-rigid panels placed over the

sacrum and abdomen,

0 - 999

L0625 Lumbar orthosis, flexible, provides lumbar support,

posterior extends from l-1 to below l-5 vertebra,


the intervertebral discs, includes straps, closures,

may include pendulous abdomen design, shoulder

straps, stays, prefabricated, off-the-shelf

0 - 999

L0626 Lumbar orthosis, sagittal control, with rigid posterior

panel(s), posterior extends from l-1 to below l-5

vertebra, produces intracavitary pressure to reduce

load on the intervertebral discs, includes straps,

closures, may include padding, stays, shoulder straps,

pendulous abdomen design, prefabricated item that

has been trimmed, bent, molded, assembled, or



0 - 999

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




0 - 999

L0628 Lumbar-sacral orthosis, flexible, provides lumbo-

sacral support, posterior extends from

sacrococcygeal junction to t-9 vertebra, produces

intracavitary pressure to reduce load on the

intervertebral discs, includes straps, closures, may

include stays, shoulder straps, pendulous abdomen

design, prefabricated, off-the-shelf

0 - 999

L0629 LSO, flexible, provides lumbo-sacral support,

posterior extends from sacrococcygeal junction to T-

9 vertebra, produces i

0 - 999

L0630 Lumbar-sacral orthosis, sagittal control, with rigid

posterior panel(s), posterior extends from




include padding, stays, shoulder straps, pendulous

abdomen design, prefabricated item that has been



with expertise

0 - 999

L0631 Lumbar-sacral orthosis, sagittal control, with rigid

anterior and posterior panels, posterior extends from




include padding, shoulder straps, pendulous

abdomen design, prefabricated item that has been



with expertise

0 - 999

L0700 Ctlso A-P-L Control Molded 0 - 999

L0710 Ctlso A-P-L Control W/ Inter 0 - 999

L0810 Halo Cervical Into Jckt Vest 0 - 999

L0820 Halo Cervical Into Body Jack 0 - 999

L0830 Halo Cerv Into Milwaukee Typ 0 - 999

L0859 Addition to halo procedure, magnetic resonance

image compatible systems, rings and pins, any

material

0 - 999

L0970 Tlso Corset Front 0 - 999

L0972 Lso Corset Front 0 - 999

L0974 Tlso Full Corset 0 - 999

L0976 Lso Full Corset 0 - 999

L0978 Axillary Crutch Extension 0 - 999

L0980 Peroneal straps, prefabricated, off-the-shelf, pair 0 - 999

L0984 Protective body sock, prefabricated, off-the-shelf,

each

0 - 999

L0999 Add To Spinal Orthosis Nos 0 - 999

L1000 Ctlso Milwauke Initial Model 0 - 999

L1005 Tension based scoliosis orthosis and accessory pads,

includes fitting and adjustment

0 - 999

L1010 Ctlso Axilla Sling 0 - 999

L1020 Kyphosis Pad 0 - 999

L1025 Kyphosis Pad Floating 0 - 999

L1030 Lumbar Bolster Pad 0 - 999

L1040 Lumbar Or Lumbar Rib Pad 0 - 999

L1050 Sternal Pad 0 - 999

L1060 Thoracic Pad 0 - 999

L1070 Trapezius Sling 0 - 999

L1080 Outrigger 0 - 999

L1085 Outrigger Bil W/ Vert Extens 0 - 999

L1090 Lumbar Sling 0 - 999

L1100 Ring Flange Plastic/Leather 0 - 999

L1110 Ring Flange Plas/Leather Mol 0 - 999

L1120 Covers For Upright Each 0 - 999

L1200 Furnsh Initial Orthosis Only 0 - 999

L1210 Lateral Thoracic Extension 0 - 999

L1220 Anterior Thoracic Extension 0 - 999

L1230 Milwaukee Type Superstructur 0 - 999

L1240 Lumbar Derotation Pad 0 - 999

L1250 Anterior Asis Pad 0 - 999

L1260 Anterior Thoracic Derotation 0 - 999

L1270 Abdominal Pad 0 - 999

L1280 Rib Gusset (Elastic) Each 0 - 999

L1290 Lateral Trochanteric Pad 0 - 999

L1300 Body Jacket Mold To Patient 0 - 999

L1310 Post-Operative Body Jacket 0 - 999

L1499 Spinal Orthosis Nos 0 - 999

L1600 Hip orthosis, abduction control of hip joints, flexible,

frejka type with cover, prefabricated item that has

been trimmed, bent, molded, assembled, or


inidividual with expertise

0 - 999

L1620 Hip orthosis, abduction control of hip joints, flexible,

(pavlik harness), prefabricated item that has been



with expertise

0 - 999

L1630 Abduct Control Hip Semi-Flex 0 - 999

L1640 Pelv Band/Spread Bar Thigh C 0 - 999

L1650 Ho Abduction Hip Adjustable 0 - 999

L1652 Hip Orthosis, Bilateral Thigh Cuffs W Adjustable

Abductor Spreader Bar

0 - 999

L1660 Ho Abduction Static Plastic 0 - 999

L1680 Pelvic & Hip Control Thigh C 0 - 999

L1685 Post-Op Hip Abduct Custom Fa 0 - 999

L1686 Ho Post-Op Hip Abduction 0 - 999

L1690 Combination Bilateral Ho 0 - 999

L1700 Leg Perthes Orth Toronto Typ 0 - 999

L1710 Legg Perthes Orth Newington 0 - 999

L1720 Legg Perthes Orthosis Trilat 0 - 999

L1730 Legg Perthes Orth Scottish R 0 - 999

L1755 Legg Perthes Patten Bottom T 0 - 999

L1810 Knee orthosis, elastic with joints, prefabricated item

that has been trimmed, bent, molded, assembled, or



0 - 999

L1820 Ko Elas W/ Condyle Pads & Jo 0 - 999

L1830 Knee orthosis, immobilizer, canvas longitudinal,


0 - 999

L1832 Knee orthosis, adjustable knee joints (unicentric or

polycentric), positional orthosis, rigid support,

prefabricated item that has been trimmed, bent,

molded, assembled, or otherwise customized to fit a

specific patient by an individual with expertise

0 - 999

L1834 Ko W/0 Joint Rigid Molded To 0 - 999

L1836 Knee orthosis, rigid, without joint(s), includes soft

interface material, prefabricated, off-the-shelf

0 - 999

L1840 Ko Derot Ant Cruciate Custom 0 - 999

L1843 Knee orthosis, single upright, thigh and calf, with

adjustable flexion and extension joint (unicentric or

polycentric), medial-lateral and rotation control, with

or without varus/valgus adjustment, prefabricated




0 - 999

L1844 Knee orthosis, single upright, thigh and calf, with


polycentric),

0 - 999

L1845 Knee orthosis, double upright, thigh and calf, with


polycentric), medial-lateral and rotation control, with

or without varus/valgus adjustment, prefabricated




0 - 999

L1846 Knee orthosis, double upright, thigh and calf, with


polycentric),

0 - 999

L1847 Knee orthosis, double upright with adjustable joint,

with inflatable air support chamber(s), prefabricated




0 - 999

L1850 Knee orthosis, swedish type, prefabricated, off-the-

shelf

0 - 999

L1860 Ko Supracondylar Socket Mold 0 - 999

L1900 Afo Sprng Wir Drsflx Calf Bd 0 - 999

L1902 Ankle foot orthosis, ankle gauntlet, prefabricated, off-

the-shelf

0 - 999

L1904 Ankle orthosis, ankle gauntlet, custom-fabricated 0 - 999

L1906 Ankle foot orthosis, multiligamentous ankle support,


0 - 999

L1910 Afo Sing Bar Clasp Attach Sh 0 - 999

L1920 Afo Sing Upright W/ Adjust S 0 - 999

L1930 Afo Plastic 0 - 999

L1932 Afo rig ant tib prefab TCF/= 0 - 999

L1940 Afo Molded To Patient Plasti 0 - 999

L1945 Afo Molded Plas Rig Ant Tib 0 - 999

L1950 Afo Spiral Molded To Pt Plas 0 - 999

L1951 Ankle foot orthosis, spiral, (institute of rehabilitative

medicine type), prefabricated

0 - 999

L1960 Afo Pos Solid Ank Plastic Mo 0 - 999

L1970 Afo Plastic Molded W/Ankle J 0 - 999

L1980 Afo Sing Solid Stirrup Calf 0 - 999

L1990 Afo Doub Solid Stirrup Calf 0 - 999

L2000 Kafo Sing Fre Stirr Thi/Calf 0 - 999

L2010 Kafo Sng Solid Stirrup W/O J 0 - 999

L2020 Kafo Dbl Solid Stirrup Band/ 0 - 999

L2030 Kafo Dbl Solid Stirrup W/O J 0 - 999

L2034 KAFO, full plastic, single upright, with or without free

motion knee, medial lateral rotation control, with or

without f

0 - 999

L2036 KAFO, full plastic, double upright, with or without

free motion knee, with or without free motion ankle,

custom fabricat

0 - 999

L2037 Knee ankle foot orthosis, full plastic, single upright,

with or without free motion knee, with or without

free motion an

0 - 999

L2038 Knee ankle foot orthosis, full plastic, with or without

free motion knee, multi-axis ankle, custom fabKnee

ankle foot or

0 - 999

L2040 Hkafo Torsion Bil Rot Straps 0 - 999

L2050 Hkafo Torsion Cable Hip Pelv 0 - 999

L2060 Hkafo Torsion Ball Bearing J 0 - 999

L2070 Hkafo Torsion Unilat Rot Str 0 - 999

L2080 Hkafo Unilat Torsion Cable 0 - 999

L2090 Hkafo Unilat Torsion Ball Br 0 - 999

L2106 Afo Tib Fx Cast Plaster Mold 0 - 999

L2108 Afo Tib Fx Cast Molded To Pt 0 - 999

L2112 Afo Tibial Fracture Soft 0 - 999

L2114 Afo Tib Fx Semi-Rigid 0 - 999

L2116 Afo Tibial Fracture Rigid 0 - 999

L2126 Kafo Fem Fx Cast Thermoplas 0 - 999

L2128 Kafo Fem Fx Cast Molded To P 0 - 999

L2132 Kafo Femoral Fx Cast Soft 0 - 999

L2134 Kafo Fem Fx Cast Semi-Rigid 0 - 999

L2136 Kafo Femoral Fx Cast Rigid 0 - 999

L2180 Plas Shoe Insert W Ank Joint 0 - 999

L2182 Drop Lock Knee 0 - 999

L2184 Limited Motion Knee Joint 0 - 999

L2186 Adj Motion Knee Jnt Lerman T 0 - 999

L2188 Quadrilateral Brim 0 - 999

L2190 Waist Belt 0 - 999

L2192 Pelvic Band & Belt Thigh Fla 0 - 999

L2200 Limited Ankle Motion Ea Jnt 0 - 999

L2210 Dorsiflexion Assist Each Joi 0 - 999

L2220 Dorsi & Plantar Flex Ass/Res 0 - 999

L2230 Split Flat Caliper Stirr & P 0 - 999

L2240 Round Caliper And Plate Atta 0 - 999

L2250 Foot Plate Molded Stirrup At 0 - 999

L2260 Reinforced Solid Stirrup 0 - 999

L2265 Long Tongue Stirrup 0 - 999

L2270 Varus/Valgus Strap Padded/Li 0 - 999

L2275 Plastic Mod Low Ext Pad/Line 0 - 999

L2280 Molded Inner Boot 0 - 999

L2300 Abduction Bar Jointed Adjust 0 - 999

L2310 Abduction Bar-Straight 0 - 999

L2320 Non-Molded Lacer 0 - 999

L2330 Lacer Molded To Patient Mode 0 - 999

L2335 Anterior Swing Band 0 - 999

L2340 Pre-Tibial Shell Molded To P 0 - 999

L2350 Prosthetic Type Socket Molde 0 - 999

L2360 Extended Steel Shank 0 - 999

L2370 Patten Bottom 0 - 999

L2375 Torsion Ank & Half Solid Sti 0 - 999

L2380 Torsion Straight Knee Joint 0 - 999

L2385 Straight Knee Joint Heavy Du 0 - 999

L2390 Offset Knee Joint Each 0 - 999

L2395 Offset Knee Joint Heavy Duty 0 - 999

L2397 Suspension Sleeve Lower Ext 0 - 999

L2405 Addition to knee joint, drop lock, each 0 - 999

L2415 Knee Joint Cam Lock Each Joi 0 - 999

L2425 Knee Disc/Dial Lock/Adj Flex 0 - 999

L2430 Knee Jnt Ratchet Lock Ea Jnt 0 - 999

L2492 Knee Lift Loop Drop Lock Rin 0 - 999

L2500 Thi/Glut/Ischia Wgt Bearing 0 - 999

L2510 Th/Wght Bear Quad-Lat Brim M 0 - 999

L2520 Th/Wght Bear Quad-Lat Brim C 0 - 999

L2525 Th/Wght Bear Nar M-L Brim Mo 0 - 999

L2526 Th/Wght Bear Nar M-L Brim Cu 0 - 999

L2530 Thigh/Wght Bear Lacer Non-Mo 0 - 999

L2540 Thigh/Wght Bear Lacer Molded 0 - 999

L2550 Thigh/Wght Bear High Roll Cu 0 - 999

L2570 Hip Clevis Type 2 Posit Jnt 0 - 999

L2580 Pelvic Control Pelvic Sling 0 - 999

L2600 Hip Clevis/Thrust Bearing Fr 0 - 999

L2610 Hip Clevis/Thrust Bearing Lo 0 - 999

L2620 Pelvic Control Hip Heavy Dut 0 - 999

L2622 Hip Joint Adjustable Flexion 0 - 999

L2624 Hip Adj Flex Ext Abduct Cont 0 - 999

L2627 Plastic Mold Recipro Hip & C 0 - 999

L2628 Metal Frame Recipro Hip & Ca 0 - 999

L2630 Pelvic Control Band & Belt U 0 - 999

L2640 Pelvic Control Band & Belt B 0 - 999

L2650 Pelv & Thor Control Gluteal 0 - 999

L2660 Thoracic Control Thoracic Ba 0 - 999

L2670 Thorac Cont Paraspinal Uprig 0 - 999

L2680 Thorac Cont Lat Support Upri 0 - 999

L2750 Plating Chrome/Nickel Pr Bar 0 - 999

L2755 Carbon Graphite Lamination 0 - 999

L2760 Extension Per Extension Per 0 - 999

L2768 Orthotic side bar disconnect device, per bar 0 - 999

L2780 Non-Corrosive Finish 0 - 999

L2785 Drop Lock Retainer Each 0 - 999

L2795 Knee Control Full Kneecap 0 - 999

L2800 Knee Cap Medial Or Lateral P 0 - 999

L2810 Knee Control Condylar Pad 0 - 999

L2820 Soft Interface Below Knee Se 0 - 999

L2830 Soft Interface Above Knee Se 0 - 999

L2840 Tibial Length Sock Fx Or Equ 0 - 999

L2850 Femoral Lgth Sock Fx Or Equa 0 - 999

L2999 Lower Extremity Orthosis Nos 0 - 999

L3000 Ft Insert Ucb Berkeley Shell 0 - 999

L3001 Foot Insert Remov Molded Spe 0 - 999

L3002 Foot Insert Plastazote Or Eq 0 - 999

L3010 Foot Longitudinal Arch Suppo 0 - 999

L3020 Foot Longitud/Metatarsal Sup 0 - 999

L3030 Foot Arch Support Remov Prem 0 - 999

L3040 Ft Arch Suprt Premold Longit 0 - 999

L3050 Foot Arch Supp Premold Metat 0 - 999

L3060 Foot Arch Supp Longitud/Meta 0 - 999

L3070 Arch Suprt Att To Sho Longit 0 - 999

L3080 Arch Supp Att To Shoe Metata 0 - 999

L3100 Hallus-valgus night dynamic splint, prefabricated, off-

the-shelf

0 - 999

L3140 Abduction Rotation Bar Shoe 0 - 999

L3150 Abduct Rotation Bar W/O Shoe 0 - 999

L3170 Foot, plastic, silicone or equal, heel stabilizer,

prafabricated, off-the-shelf, each

0 - 999

L3201 Oxford W Supinat/Pronat Inf 0 - 20

L3202 Oxford W/ Supinat/Pronator C 0 - 20

L3203 Oxford W/ Supinator/Pronator 0 - 20

L3204 Hightop W/ Supp/Pronator Inf 0 - 20

L3206 Hightop W/ Supp/Pronator Chi 0 - 20

L3207 Hightop W/ Supp/Pronator Jun 0 - 20

L3208 Surgical Boot Each Infant 0 - 20

L3209 Surgical Boot Each Child 0 - 20

L3211 Surgical Boot Each Junior 0 - 20

L3215 Orthopedic footwear, ladies shoe, oxford, each 0 - 999

L3216 Orthopedic footwear, ladies shoe, depth inlay, each 0 - 999

L3217 Orthopedic footwear, ladies shoe, hightop, depth

inlay, each

0 - 999

L3219 Orthopedic footwear, mens shoe, oxford, each 0 - 999

L3221 Orthopedic footwear, mens shoe, depth inlay, each 0 - 999

L3222 Orthopedic footwear, mens shoe, hightop, depth

inlay, each

0 - 999

L3230 Orthopedic footwear, custom shoe, depth inlay, each 0 - 999

L3251 Shoe Molded To Pt Silicone S 0 - 999

L3253 Shoe Molded Plastazote Cust 0 - 999

L3254 Orth Foot Non-Stndard Size/W 0 - 999

L3255 Orth Foot Non-Standard Size/ 0 - 999

L3257 Orth Foot Add Charge Split S 0 - 999

L3300 Sho Lift Taper To Metatarsal 0 - 999

L3310 Shoe Lift Elev Heel/Sole Neo 0 - 999

L3320 Shoe Lift Elev Heel/Sole Cor 0 - 999

L3330 Lifts Elevation Metal Extens 0 - 999

L3332 Shoe Lifts Tapered To One-Ha 0 - 999

L3334 Shoe Lifts Elevation Heel /I 0 - 999

L3340 Shoe Wedge Sach 0 - 999

L3350 Shoe Heel Wedge 0 - 999

L3360 Shoe Sole Wedge Outside Sole 0 - 999

L3370 Shoe Sole Wedge Between Sole 0 - 999

L3380 Shoe Clubfoot Wedge 0 - 999

L3390 Shoe Outflare Wedge 0 - 999

L3400 Shoe Metatarsal Bar Wedge Ro 0 - 999

L3410 Shoe Metatarsal Bar Between 0 - 999

L3420 Full Sole/Heel Wedge Btween 0 - 999

L3430 Sho Heel Count Plast Reinfor 0 - 999

L3440 Heel Leather Reinforced 0 - 999

L3450 Shoe Heel Sach Cushion Type 0 - 999

L3460 Shoe Heel New Rubber Standar 0 - 999

L3465 Shoe Heel Thomas With Wedge 0 - 999

L3470 Shoe Heel Thomas Extend To B 0 - 999

L3480 Shoe Heel Pad & Depress For 0 - 999

L3570 O Shoe Add Instep Extension 0 - 999

L3580 O Shoe Add Instep Velcro Clo 0 - 999

L3590 O Shoe Convert To Sof Counte 0 - 999

L3595 Ortho Shoe Add March Bar 0 - 999

L3600 Transfer of an orthosis from one shoe to another,

caliper plate, existing

0 - 999


caliper plate, new

0 - 999


solid stirrup, existing

0 - 999


solid stirrup, new

0 - 999


Dennis Browne splint (Riveton), both shoes

0 - 999

L3649 Orthopedic Shoe Modifica Nos 0 - 999

L3650 Shoulder orthosis, figure of eight design abduction

restrainer, prefabricated, off-the-shelf

0 - 999

L3660 Shoulder orthosis, figure of eight design abduction

restrainer, canvas and webbing, prefabricated, off-

the-shelf

0 - 999

L3670 Shoulder orthosis, acromio/clavicular (canvas and

webbing type), prefabricated, off-the-shelf

0 - 999

L3675 Shoulder orthosis, vest type abduction restrainer,

canvas webbing type or equal, prefabricated, off-the-

shelf

0 - 999

L3677 Shoulder orthosis, shoulder joint design, without

joints, may include soft interface, straps,




0 - 999

L3710 Elbow orthosis, elastic with metal joints,


0 - 999

L3720 Forearm/Arm Cuffs Free Motio 0 - 999

L3730 Forearm/Arm Cuffs Ext/Flex A 0 - 999

L3740 Cuffs Adj Lock W/ Active Con 0 - 999

L3760 Elbow orthosis (eo), with adjustable position locking

joint(s), prefabricated, item that has been trimmed,

bent, molded, assembled, or otherwise customized

to fit a specific patient by an individual with expertise

0 - 999

L3761 Elbow orthosis (EO), with adjustable position locking

joint(s), prefabricated, off-the-shelf

0 - 999

L3762 Elbow orthosis, rigid, without joints, includes soft

interface material, prefabricated, off-the-shelf

0 - 999

L3763 EWHO, rigid, without joints, may include soft

interface, straps, custom fabricated, includes fitting

and adjustment

0 - 999

L3764 EWHO, includes one or more nontorsion joints,

elastic bands, turnbuckles, may include soft

interface, straps, custom fab

0 - 999

L3808 WRIST HAND FINGER ORTHOSIS, RIGID WITHOUT

JOINTS, MAY INCLUDE SOFT INTERFACE

0 - 999

L3900 Hinge Extension/Flex Wrist/F 0 - 999

L3901 Hinge Ext/Flex Wrist Finger 0 - 999

L3904 Whfo Electric Custom Fitted 0 - 999

L3906 WHO, without joints, may include soft interface,

straps, custom fabricated, includes fitting and

adjustment

0 - 999

L3908 Wrist hand orthosis, wrist extension control cock-up,

non molded, prefabricated, off-the-shelf

0 - 999

L3912 Hand finger orthosis (hfo), flexion glove with elastic

finger control, prefabricated, off-the-shelf

0 - 999

L3923 Hand finger orthosis, without joints, may include soft

interface, straps, prefabricated item that has been



with expertise

0 - 999

L3925 Finger orthosis, proximal interphalangeal (pip)/distal

interphalangeal (dip), non torsion joint/spring,

extension/flexion, may include soft interface

material, prefabricated, off-the-shelf

0 - 999

L3929 Hand finger orthosis, includes one or more

nontorsion joint(s), turnbuckles, elastic

bands/springs, may include soft interface material,

straps, prefabricated item that has been trimmed,

bent, molded, assembled, or otherwise customized

to fit a specific patient by an individual with expertise

0 - 999

L3931 Wrist hand finger orthosis, includes one or more

nontorsion joint(s),

0 - 999

L3960 Sewho Airplan Desig Abdu Pos 0 - 999

L3962 Sewho Erbs Palsey Design Abd 0 - 999

L3980 Upp Ext Fx Orthosis Humeral 0 - 999

L3982 Upper Ext Fx Orthosis Rad/Ul 0 - 999

L3984 Upper Ext Fx Orthosis Wrist 0 - 999

L3995 Sock Fracture Or Equal Each 0 - 999

L3999 Upper Limb Orthosis Nos 0 - 999

L4000 Repl Girdle Milwaukee Orth 0 - 999

L4010 Replace Trilateral Socket Br 0 - 999

L4020 Replace Quadlat Socket Brim 0 - 999

L4030 Replace Socket Brim Cust Fit 0 - 999

L4040 Replace Molded Thigh Lacer 0 - 999

L4045 Replace Non-Molded Thigh Lac 0 - 999

L4050 Replace Molded Calf Lacer 0 - 999

L4055 Replace Non-Molded Calf Lace 0 - 999

L4060 Replace High Roll Cuff 0 - 999

L4070 Replace Prox & Dist Upright 0 - 999

L4080 Repl Met Band Kafo-Afo Prox 0 - 999

L4090 Repl Met Band Kafo-Afo Calf/ 0 - 999

L4100 Repl Leath Cuff Kafo Prox Th 0 - 999

L4110 Repl Leath Cuff Kafo-Afo Cal 0 - 999

L4130 Replace Pretibial Shell 0 - 999

L4205 Ortho Dvc Repair Per 15 Min 0 - 999

L4210 Orth Dev Repair/Repl Minor P 0 - 999

L4350 Ankle control orthosis, stirrup style, rigid, includes

any type interface (e.g., pneumatic, gel),


0 - 999

L4360 Walking boot, pneumatic and/or vacuum, with or

without joints, with or without interface material,




0 - 999

L4370 Pneumatic full leg splint, prefabricated, off-the-shelf 0 - 999

L4386 Walking boot, non-pneumatic, with or without joints,

with or without interface material, prefabricated




0 - 999

L4392 Replace Afo Soft Interface 0 - 999

L4394 Replace Foot Drop Spint 0 - 999

L4396 Static or dynamic ankle foot orthosis, including soft

interface material, adjustable for fit, for positioning,

may be used for minimal ambulation, prefabricated




0 - 999

L4398 Foot drop splint, recumbent positioning device,


0 - 999

L5000 Sho Insert W Arch Toe Filler 0 - 999

L5010 Mold Socket Ank Hgt W/ Toe F 0 - 999

L5020 Tibial Tubercle Hgt W/ Toe F 0 - 999

L5050 Ank Symes Mold Sckt Sach Ft 0 - 999

L5060 Symes Met Fr Leath Socket Ar 0 - 999

L5100 Molded Socket Shin Sach Foot 0 - 999

L5105 Plast Socket Jts/Thgh Lacer 0 - 999

L5150 Mold Sckt Ext Knee Shin Sach 0 - 999

L5160 Mold Socket Bent Knee Shin S 0 - 999

L5200 Kne Sing Axis Fric Shin Sach 0 - 999

L5210 No Knee/Ankle Joints W/ Ft B 0 - 999

L5220 No Knee Joint With Artic Ali 0 - 999

L5230 Fem Focal Defic Constant Fri 0 - 999

L5250 Hip Canad Sing Axi Cons Fric 0 - 999

L5280 Hemipelvect Canad Sing Axis 0 - 999

L5301 Below knee, molded socket, shin, SACH foot,

endoskeletal system

0 - 999

L5312 Knee disarticulation (or through knee), molded

socket, single axis knee, pylon, SACH foot,

endoskeletal system

0 - 999

L5321 Above knee, molded socket, open end, SACH foot,

endoskeletal system, single axis knee

0 - 999

L5331 Hip disarticulation, Canadian type, molded socket,

endoskeletal system, hip joint, single axis knee, SACH

foot

0 - 999

L5341 Hemipelvectomy, Canadian type, molded socket,

endoskeletal system, hip joint, single axis knee, SACH

foot

0 - 999

L5400 Postop Dress & 1 Cast Chg Bk 0 - 999

L5410 Postop Dsg Bk Ea Add Cast Ch 0 - 999

L5420 Postop Dsg & 1 Cast Chg Ak/D 0 - 999

L5430 Postop Dsg Ak Ea Add Cast Ch 0 - 999

L5450 Postop App Non-Wgt Bear Dsg 0 - 999

L5460 Postop App Non-Wgt Bear Dsg 0 - 999

L5530 Prep Bk Ptb Thermopls Molded 0 - 999

L5535 Preparatory, below knee PTB type socket,

nonalignable system, no cover, SACH foot,

prefabricated, adjustable open end socket

0 - 999

L5540 Prep Bk Ptb Laminated Socket 0 - 999

L5560 Prep Ak Ischial Plast Molded 0 - 999

L5580 Prep Ak Ischial Thermo Mold 0 - 999

L5585 Prep Ak Ischial Open End 0 - 999

L5590 Prep Ak Ischial Laminated 0 - 999

L5595 Hip Disartic Sach Thermopls 0 - 999

L5600 Hip Disart Sach Laminat Mold 0 - 999

L5610 Above Knee Hydracadence 0 - 999

L5611 Ak 4 Bar Link W/Fric Swing 0 - 999

L5613 Ak 4 Bar Ling W/Hydraul Swig 0 - 999

L5616 Ak Univ Multiplex Sys Frict 0 - 999

L5617 Ak/Bk Self-Aligning Unit Ea 0 - 999

L5618 Test Socket Symes 0 - 999

L5620 Test Socket Below Knee 0 - 999

L5622 Test Socket Knee Disarticula 0 - 999

L5624 Test Socket Above Knee 0 - 999

L5626 Test Socket Hip Disarticulat 0 - 999

L5628 Test Socket Hemipelvectomy 0 - 999

L5629 Below Knee Acrylic Socket 0 - 999

L5630 Syme Typ Expandabl Wall Sckt 0 - 999

L5631 Ak/Knee Disartic Acrylic Soc 0 - 999

L5632 Symes Type Ptb Brim Design S 0 - 999

L5634 Symes Type Poster Opening So 0 - 999

L5636 Symes Type Medial Opening So 0 - 999

L5637 Below Knee Total Contact 0 - 999

L5638 Below Knee Leather Socket 0 - 999

L5639 Below Knee Wood Socket 0 - 999

L5640 Knee Disarticulat Leather So 0 - 999

L5642 Above Knee Leather Socket 0 - 999

L5643 Hip Flex Inner Socket Ext Fr 0 - 999

L5644 Above Knee Wood Socket 0 - 999

L5645 Ak Flexibl Inner Socket Ext 0 - 999

L5646 Below Knee Air Cushion Socke 0 - 999

L5647 Below Knee Suction Socket 0 - 999

L5648 Above Knee Air Cushion Socke 0 - 999

L5649 Isch Containmt/Narrow M-L So 0 - 999

L5650 Tot Contact Ak/Knee Disart S 0 - 999

L5651 Ak Flex Inner Socket Ext Fra 0 - 999

L5652 Suction Susp Ak/Knee Disart 0 - 999

L5653 Knee Disart Expand Wall Sock 0 - 999

L5654 Socket Insert Symes 0 - 999

L5655 Socket Insert Below Knee 0 - 999

L5656 Socket Insert Knee Articulat 0 - 999

L5658 Socket Insert Above Knee 0 - 999

L5661 Multi-Durometer Symes 0 - 999

L5665 Multi-Durometer Below Knee 0 - 999

L5666 Below Knee Cuff Suspension 0 - 999

L5668 Socket Insert W/O Lock Lower 0 - 999

L5670 Bk Molded Supracondylar Susp 0 - 999

L5671 Addition lower extremity, below knee/above knee

suspension locking mechanism (shuttle, lanyard or

equal), includes socke

0 - 999

L5672 Bk Removable Medial Brim Sus 0 - 999

L5673 Addition to lower extremity, below knee/above

knee, custom fabricated

0 - 999

L5676 Bk Knee Joints Single Axis P 0 - 999

L5677 Bk Knee Joints Polycentric P 0 - 999

L5678 Bk Joint Covers Pair 0 - 999


knee, custom fabricated

0 - 999

L5680 Bk Thigh Lacer Non-Molded 0 - 999


knee, custom fabricated socket insert

0 - 999

L5682 Bk Thigh Lacer Glut/Ischia M 0 - 999

L5684 Bk Fork Strap 0 - 999

L5685 Below knee sus/seal sleeve 0 - 999

L5686 Bk Back Check 0 - 999

L5688 Bk Waist Belt Webbing 0 - 999

L5690 Bk Waist Belt Padded And Lin 0 - 999

L5692 Ak Pelvic Control Belt Light 0 - 999

L5694 Ak Pelvic Control Belt Pad/L 0 - 999

L5695 Ak Sleeve Susp Neoprene/Equa 0 - 999

L5696 Ak/Knee Disartic Pelvic Join 0 - 999

L5697 Ak/Knee Disartic Pelvic Band 0 - 999

L5698 Ak/Knee Disartic Silesian Ba 0 - 999

L5699 Shoulder Harness 0 - 999

L5700 Replace Socket Below Knee 0 - 999

L5701 Replace Socket Above Knee 0 - 999

L5702 Replace Socket Hip 0 - 999

L5704 Custom Shape Covr Below Knee 0 - 999

L5705 Custm Shape Cover Above Knee 0 - 999

L5706 Custm Shape Cvr Knee Disart 0 - 999

L5707 Custm Shape Cover Hip Disart 0 - 999

L5710 Kne-Shin Exo Sng Axi Mnl Loc 0 - 999

L5711 Knee-Shin Exo Mnl Lock Ultra 0 - 999

L5712 Knee-Shin Exo Frict Swg & St 0 - 999

L5714 Knee-Shin Exo Variable Frict 0 - 999

L5716 Knee-Shin Exo Mech Stance Ph 0 - 999

L5718 Knee-Shin Exo Frct Swg & Sta 0 - 999

L5722 Knee-Shin Pneum Swg Frct Exo 0 - 999

L5724 Knee-Shin Exo Fluid Swing Ph 0 - 999

L5726 Knee-Shin Ext Jnts Fld Swg E 0 - 999

L5728 Knee-Shin Fluid Swg & Stance 0 - 999

L5780 Knee-Shin Pneum/Hydra Pneum 0 - 999

L5785 Exoskeletal Bk Ultralt Mater 0 - 999

L5790 Exoskeletal Ak Ultra-Light M 0 - 999

L5795 Exoskel Hip Ultra-Light Mate 0 - 999

L5810 Endoskel Knee-Shin Mnl Lock 0 - 999

L5811 Endo Knee-Shin Mnl Lck Ultra 0 - 999

L5812 Endo Knee-Shin Frct Swg & St 0 - 999

L5814 Endo Knee-Shin Hydral Swg Ph 0 - 999

L5816 Endo Knee-Shin Polyc Mch Sta 0 - 999

L5818 Endo Knee-Shin Frct Swg & St 0 - 999

L5822 Endo Knee-Shin Pneum Swg Frc 0 - 999

L5824 Endo Knee-Shin Fluid Swing P 0 - 999

L5828 Endo Knee-Shin Fluid Swg/Sta 0 - 999

L5830 Endo Knee-Shin Pneum/Swg Pha 0 - 999

L5840 Multi-Axial Knee/Shin System 0 - 999

L5845 Knee-Shin Sys Stance Flexion 0 - 999

L5850 Endo Ak/Hip Knee Extens Assi 0 - 999

L5855 Mech Hip Extension Assist 0 - 999

L5910 Endo Below Knee Alignable Sy 0 - 999

L5920 Endo Ak/Hip Alignable System 0 - 999

L5940 Endo Bk Ultra-Light Material 0 - 999

L5950 Endo Ak Ultra-Light Material 0 - 999

L5960 Endo Hip Ultra-Light Materia 0 - 999

L5962 Below Knee Flex Cover System 0 - 999

L5964 Above Knee Flex Cover System 0 - 999

L5966 Hip Flexible Cover System 0 - 999

L5968 Multiaxial Ankle W Dorsiflex 0 - 999

L5970 Foot External Keel Sach Foot 0 - 999

L5972 All lower extremity prostheses, foot, flexible keel 0 - 999

L5974 Foot Single Axis Ankle/Foot 0 - 999

L5975 Combo Ankle/Foot Prosthesis 0 - 999

L5976 Energy Storing Foot 0 - 999

L5978 Ft Prosth Multiaxial Ankl/Ft 0 - 999

L5979 Multi-Axial Ankle/Ft Prosth 0 - 999

L5980 Flex Foot System 0 - 999

L5981 Flex-Walk Sys Low Ext Prosth 0 - 999

L5982 Exoskeletal Axial Rotation U 0 - 999

L5984 Endoskeletal Axial Rotation 0 - 999

L5985 Lwr Ext Dynamic Prosth Pylon 0 - 999

L5986 Multi-Axial Rotation Unit 0 - 999

L5987 Shank Ft W Vert Load Pylon 0 - 999

L5988 Vertical Shock Reducing Pylo 0 - 999

L5990 Addition to lower extremity prosthesis, user

adjustable heel height

0 - 999

L5999 Lower Extremity Prosthes Nos 0 - 999

L6000 Partial hand, thumb remaining 0 - 999

L6010 Partial hand, little and/or ring finger remaining 0 - 999

L6020 Partial hand, no finger remaining 0 - 999

L6050 Wrst Mld Sck Flx Hng Tri Pad 0 - 999

L6055 Wrst Mold Sock W/Exp Interfa 0 - 999

L6100 Elb Mold Sock Flex Hinge Pad 0 - 999

L6110 Elbow Mold Sock Suspension T 0 - 999

L6120 Elbow Mold Doub Splt Soc Ste 0 - 999

L6130 Elbow Stump Activated Lock H 0 - 999

L6200 Elbow Mold Outsid Lock Hinge 0 - 999

L6205 Elbow Molded W/ Expand Inter 0 - 999

L6250 Elbow Inter Loc Elbow Forarm 0 - 999

L6300 Shlder Disart Int Lock Elbow 0 - 999

L6310 Shoulder Passive Restor Comp 0 - 999

L6320 Shoulder Passive Restor Cap 0 - 999

L6350 Thoracic Intern Lock Elbow 0 - 999

L6360 Thoracic Passive Restor Comp 0 - 999

L6370 Thoracic Passive Restor Cap 0 - 999

L6380 Postop Dsg Cast Chg Wrst/Elb 0 - 999

L6382 Postop Dsg Cast Chg Elb Dis/ 0 - 999

L6384 Postop Dsg Cast Chg Shlder/T 0 - 999

L6386 Postop Ea Cast Chg & Realign 0 - 999

L6388 Postop Applicat Rigid Dsg On 0 - 999

L6400 Below Elbow Prosth Tiss Shap 0 - 999

L6450 Elb Disart Prosth Tiss Shap 0 - 999

L6500 Above Elbow Prosth Tiss Shap 0 - 999

L6550 Shldr Disar Prosth Tiss Shap 0 - 999

L6570 Scap Thorac Prosth Tiss Shap 0 - 999

L6580 Wrist/Elbow Bowden Cable Mol 0 - 999

L6582 Wrist/Elbow Bowden Cbl Dir F 0 - 999

L6584 Elbow Fair Lead Cable Molded 0 - 999

L6586 Elbow Fair Lead Cable Dir Fo 0 - 999

L6588 Shdr Fair Lead Cable Molded 0 - 999

L6590 Shdr Fair Lead Cable Direct 0 - 999

L6600 Polycentric Hinge Pair 0 - 999

L6605 Single Pivot Hinge Pair 0 - 999

L6610 Flexible Metal Hinge Pair 0 - 999

L6615 Disconnect Locking Wrist Uni 0 - 999

L6616 Disconnect Insert Locking Wr 0 - 999

L6620 Flexion-Friction Wrist Unit 0 - 999

L6624 UPPER EXTREMITY ADDITION, FLEXION/EXTENSION

AND ROTATION WRIST UNIT

0 - 999

L6625 Rotation Wrst W/ Cable Lock 0 - 999

L6628 Quick Disconn Hook Adapter O 0 - 999

L6629 Lamination Collar W/ Couplin 0 - 999

L6630 Stainless Steel Any Wrist 0 - 999

L6632 Latex Suspension Sleeve Each 0 - 999

L6635 Lift Assist For Elbow 0 - 999

L6637 Nudge Control Elbow Lock 0 - 999

L6640 Shoulder Abduction Joint Pai 0 - 999

L6641 Excursion Amplifier Pulley T 0 - 999

L6642 Excursion Amplifier Lever Ty 0 - 999

L6645 Shoulder Flexion-Abduction J 0 - 999

L6650 Shoulder Universal Joint 0 - 999

L6655 Standard Control Cable Extra 0 - 999

L6660 Heavy Duty Control Cable 0 - 999

L6665 Teflon Or Equal Cable Lining 0 - 999

L6670 Hook To Hand Cable Adapter 0 - 999

L6672 Harness Chest/Shlder Saddle 0 - 999

L6675 Harness Figure Of 8 Sing Con 0 - 999

L6676 Harness Figure Of 8 Dual Con 0 - 999

L6680 Test Sock Wrist Disart/Bel E 0 - 999

L6682 Test Sock Elbw Disart/Above 0 - 999

L6684 Test Socket Shldr Disart/Tho 0 - 999

L6686 Suction Socket 0 - 999

L6687 Frame Typ Socket Bel Elbow/W 0 - 999

L6688 Frame Typ Sock Above Elb/Dis 0 - 999

L6689 Frame Typ Socket Shoulder Di 0 - 999

L6690 Frame Typ Sock Interscap-Tho 0 - 999

L6691 Removable Insert Each 0 - 999

L6692 Silicone Gel Insert Or Equal 0 - 999

L6693 Lockingelbow Forearm Cntrbal 0 - 999

L6703 TERMINAL DEVICE, PASSIVE HAND/MITT, ANY

MATERIAL, ANY SIZE

0 - 999

L6706 TERMINAL DEVICE, HOOK, MECHANICAL,

VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE,

0 - 999

L6707 TERMINAL DEVICE, HOOK, MECHANICAL,

VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE,

0 - 999

L6708 TERMINAL DEVICE, HAND, MECHANICAL,

VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE

0 - 999

L6709 TERMINAL DEVICE, HAND, MECHANICAL,

VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE

0 - 999

L6805 ADDITION TO TERMINAL DEVICE, MODIFIER WRIST

UNIT

0 - 999

L6810 ADDITION TO TERMINAL DEVICE, PRECISION PINCH

DEVICE

0 - 999

L6881 AUTOMATIC GRASP FEATURE, ADDITION TO UPPER

LIMB ELECTRIC PROSTHETIC TERMINAL

0 - 999

L6882 Microprocessor control feature, addition to upper

limb prosthesis terminal device

0 - 999

L6890 Production Glove 0 - 999

L6900 Hand Restorat Thumb/1 Finger 0 - 999

L6905 Hand Restoration Multiple Fi 0 - 999

L6910 Hand Restoration No Fingers 0 - 999

L6915 Hand Restoration Replacmnt G 0 - 999

L6920 Wrist Disarticul Switch Ctrl 0 - 999

L6925 Wrist Disart Myoelectronic C 0 - 999

L6930 Below Elbow Switch Control 0 - 999

L6935 Below Elbow Myoelectronic Ct 0 - 999

L6940 Elbow Disarticulation Switch 0 - 999

L6945 Elbow Disart Myoelectronic C 0 - 999

L6950 Above Elbow Switch Control 0 - 999

L6955 Above Elbow Myoelectronic Ct 0 - 999

L6960 Shldr Disartic Switch Contro 0 - 999

L6965 Shldr Disartic Myoelectronic 0 - 999

L6970 Interscapular-Thor Switch Ct 0 - 999

L6975 Interscap-Thor Myoelectronic 0 - 999

L7007 ELECTRIC HAND, SWITCH OR MYOELECTRIC

CONTROLLED, ADULT

0 - 999

L7008 ELECTRIC HAND, SWITCH OR MYOELECTRIC,

CONTROLLED, PEDIATRIC

0 - 999

L7009 ELECTRIC HOOK, SWITCH OR MYOELECTRIC

CONTROLLED, ADULT

0 - 999

L7040 PREHENSILE ACTUATOR, SWITCH CONTROLLED 0 - 999

L7045 ELECTRIC HOOK, SWITCH OR MYOELECTRIC

ONTROLLED, PEDIATRIC

0 - 999

L7170 Electronic Elbow Hosmer Swit 0 - 999

L7185 Electron Elbow Adolescent Sw 0 - 999

L7186 Electron Elbow Child Switch 0 - 999

L7360 Six volt battery, each 0 - 999

L7362 Battery charger, six volt, each 0 - 999

L7364 Twelve volt battery, each 0 - 999

L7366 Battery charger, twelve volt, each 0 - 999

L7499 Upper Extremity Prosthes Nos 0 - 999

L7520 Repair Prosthesis Per 15 Min 0 - 999

L7900 NU Male vacuum erection system 0 - 999

L8000 Breast prosthesis, mastectomy bra, without

integrated breast prosthesis form, any size, any type

0 - 999

L8001 Breast prosthesis, mastectomy bra, with integrated

breast prosthesis form, unilateral, any size, any type

0 - 999

L8002 Breast prosthesis, mastectomy bra, with integrated

breast prosthesis form, bilateral, any size, any type

0 - 999

L8010 Mastectomy Sleeve 0 - 999

L8015 Ext Breastprosthesis Garment 0 - 999

L8020 Mastectomy Form 0 - 999

L8030 Breast Prosthesis, Silicone Or Equal, Without Integral

Adhesive

0 - 999

L8300 Truss Single W/ Standard Pad 0 - 999

L8310 Truss Double W/ Standard Pad 0 - 999

L8400 Sheath Below Knee 0 - 999

L8410 Sheath Above Knee 0 - 999

L8415 Sheath Upper Limb 0 - 999

L8417 Pros Sheath/Sock W Gel Cushn 0 - 999

L8420 Prosthetic Sock Multi Ply Bk 0 - 999

L8430 Prosthetic Sock Multi Ply Ak 0 - 999

L8435 Pros Sock Multi Ply Upper Lm 0 - 999

L8440 Shrinker Below Knee 0 - 999

L8460 Shrinker Above Knee 0 - 999

L8465 Shrinker Upper Limb 0 - 999

L8470 Pros Sock Single Ply Bk 0 - 999

L8480 Pros Sock Single Ply Ak 0 - 999

L8485 Pros Sock Single Ply Upper L 0 - 999

L8499 Unlisted procedure for miscellaneous prosthetic

services

0 - 999

L8500 ARTIFICIAL LARYNX 0 - 999

L8500 NU ARTIFICIAL LARYNX 0 - 999

L8501 TRACHEOSTOMY SPEAKING VALVE 0 - 999

L8501 NU TRACHEOSTOMY SPEAKING VALVE 0 - 999

L8505 NU ARTIFICIAL LARYNX, ACCESSORY 0 - 999

L8507 Tracheo-esophageal voice prosthesis, patient

inserted, any type, each

0 - 999

Q4074 Iloprost, Inhalation Solution, Fda-Approved Final

Product, Non-Compounded, Administered Through

Dme, Unit Dose Form, Up

0 - 999

S1040 CRANIAL REMOLDING ORTHOSIS, PEDIATRIC, RIGID,

WITH SOFT INTERFACE MATERIAL,

0 - 20

S5560 Insulin delivery device, reusable pen; 1.5 ml size 0 - 999

S5561 Insulin delivery device, reusable pen; 3 ml size 0 - 999

S8490 Insulin syringes (100 syringes, any size) 0 - 999

T4521 NU ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT,

BRIEF/DIAPER, SMALL, EACH

0 - 999

T4521* ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT,

BRIEF/DIAPER, SMALL, EACH

4 - 20


BRIEF/DIAPER, MEDIUM, EACH

0 - 999


BRIEF/DIAPER, MEDIUM, EACH

4 - 20


BRIEF/DIAPER, LARGE, EACH

0 - 999


BRIEF/DIAPER, LARGE, EACH

4 - 20


BRIEF/DIAPER, EXTRA LARGE, EACH

0 - 999


BRIEF/DIAPER, EXTRA LARGE, EACH

4 - 20


PROTECTIVE UNDERWEAR/PULL-ON, SMALL SIZE,

EACH

0 - 999


PROTECTIVE UNDERWEAR/PULL-ON, SMALL SIZE,

EACH

4 - 20


PROTECTIVE UNDERWEAR/PULL-ON, MEDIUM SIZE,

EACH

0 - 999


PROTECTIVE UNDERWEAR/PULL-ON, MEDIUM SIZE,

EACH

4 - 20


PROTECTIVE UNDERWEAR/PULL-ON, LARGE SIZE,

EACH

0 - 999


PROTECTIVE UNDERWEAR/PULL-ON, LARGE SIZE,

EACH

4 - 20


PROTECTIVE UNDERWEAR/PULL-ON, EXTRA LARGE

SIZE, EACH

0 - 999


PROTECTIVE UNDERWEAR/PULL-ON, EXTRA LARGE

SIZE, EACH

4 - 20

T4529 NU PEDIATRIC SIZED DISPOSABLE INCONTINENCE

PRODUCT, BRIEF/DIAPER, SMALL/MEDIUM SIZE,

EACH

0 - 999

T4529* PEDIATRIC SIZED DISPOSABLE INCONTINENCE

PRODUCT, BRIEF/DIAPER, SMALL/MEDIUM SIZE,

EACH

4 - 20


PRODUCT, BRIEF/DIAPER, LARGE SIZE, EACH

0 - 999


PRODUCT, BRIEF/DIAPER, LARGE SIZE, EACH

4 - 20


PRODUCT, PROTECTIVE UNDERWEAR/PULL- ON,

SMALL/MEDIUM SIZE, EACH

0 - 999


PRODUCT, PROTECTIVE UNDERWEAR/PULL- ON,

SMALL/MEDIUM SIZE, EACH

4 - 20


PRODUCT, PROTECTIVE UNDERWEAR/PULL-ON,

LARGE SIZE, EACH

0 - 999



LARGE SIZE, EACH

4 - 20

T4533 NU YOUTH SIZED DISPOSABLE INCONTINENCE

PRODUCT, BRIEF/DIAPER, EACH

0 - 999

T4533* YOUTH SIZED DISPOSABLE INCONTINENCE

PRODUCT, BRIEF/DIAPER, EACH

4 - 20

T4534 NU YOUTH SIZED DISPOSABLE INCONTINENCE


EACH

0 - 999

T4534* YOUTH SIZED DISPOSABLE INCONTINENCE


EACH

4 - 20

T4535 NU DISPOSABLE LINER/SHIELD/GUARD/PAD/

UNDERGARMENT, FOR INCONTINENCE, EACH

0 - 999

T4535* DISPOSABLE LINER/SHIELD/GUARD/PAD/

UNDERGARMENT, FOR INCONTINENCE, EACH

4 - 20


PROTECTIVE BRIEF/DIAPER, ABOVE EXTRA LARGE,

EACH

0 - 999


PROTECTIVE BRIEF/DIAPER, ABOVE EXTRA LARGE,

EACH

4 - 20


PROTECTIVE UNDERWEAR/PULL-ON, ABOVE EXTRA

LARGE, EACH

0 - 999


PROTECTIVE UNDERWEAR/PULL-ON, ABOVE EXTRA

LARGE, EACH

4 - 20

V2623 Plastic Eye Prosth Custom 0 - 999

V2624 Polishing Artifical Eye 0 - 999

V2625 Enlargemnt Of Eye Prosthesis 0 - 999

V2626 Reduction Of Eye Prosthesis 0 - 999

V2627 Scleral Cover Shell 0 - 999

V2628 Fabrication & Fitting 0 - 999

V5336 Repair Communication Device 0 - 999

SFLPEC-2525-21 March 2021

999 94761 NU MEASURE BLOOD OXYGEN LEVEL 0

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