Cane, includes canes of all materials, adjustable or fixed, with tip

Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips

Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips

Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips

Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips

Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip

Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips

Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each

Crutch, underarm, articulating, spring assisted, each

Crutch substitute, lower leg platform, with or without wheels, each

Walker, rigid (pickup), adjustable or fixed height

Walker, folding (pickup), adjustable or fixed height

Walker, with trunk support, adjustable or fixed height, any type

Walker, rigid, wheeled, adjustable or fixed height

Walker, folding, wheeled, adjustable or fixed height

Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat

Walker, heavy duty, multiple braking system, variable wheel resistance

Walker, heavy duty, without wheels, rigid or folding, any type, each

Walker, heavy duty, wheeled, rigid or folding, any type

Platform attachment, forearm crutch, each

Platform attachment, walker, each

Wheel attachment, rigid pick-up walker, per pair

Seat attachment, walker

Crutch attachment, walker, each

Leg extensions for walker, per set of four (4)

Brake attachment for wheeled walker, replacement, each

Sitz type bath or equipment, portable, used with or without commode

Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s

Sitz bath chair

Commode chair, mobile or stationary, with fixed arms

Commode chair, mobile or stationary, with detachable arms

Pail or pan for use with commode chair, replacement only

Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each

Commode chair with integrated seat lift mechanism, electric, any type

Commode chair with integrated seat lift mechanism, non-electric, any type

Seat lift mechanism placed over or on top of toilet, any type

Foot rest, for use with commode chair, each

Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty

Pump for alternating pressure pad, for replacement only

Powered pressure reducing underlay/pad, alternating, with pump, includes heavy duty

Dry pressure mattress

Gel or gel-like pressure pad for mattress, standard mattress length and width

Air pressure mattress

Water pressure mattress

Synthetic sheepskin pad

Lambswool sheepskin pad, any size

Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories

Heel or elbow protector, each

Powered air flotation bed (low air loss therapy)

Air fluidized bed

Gel pressure mattress

Air pressure pad for mattress, standard mattress length and width

Water pressure pad for mattress, standard mattress length and width

Dry pressure pad for mattress, standard mattress length and width

Heat lamp, without stand (table model), includes bulb, or infrared element

Phototherapy (bilirubin) light with photometer

Therapeutic lightbox, minimum 10,000 lux, table top model

Heat lamp, with stand, includes bulb, or infrared element

Electric heat pad, standard

Electric heat pad, moist

Water circulating heat pad with pump

Fluid circulating cold pad with pump, any type

Infrared heating pad system

Hydrocollator unit, includes pads

Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover

Warming card for use with the non contact wound warming device and non contact wound warming wound cover

Paraffin bath unit, portable (see medical supply code a4265 for paraffin)

Pump for water circulating pad

Hydrocollator unit, portable

Bath/shower chair, with or without wheels, any size

Bath tub wall rail, each

Bath tub rail, floor base

Toilet rail, each

Raised toilet seat

Tub stool or bench

Transfer tub rail attachment

Transfer bench for tub or toilet with or without commode opening

Transfer bench, heavy duty, for tub or toilet with or without commode opening

Pad for water circulating heat unit, for replacement only

Hospital bed, fixed height, with any type side rails, with mattress

Hospital bed, fixed height, with any type side rails, without mattress

Hospital bed, variable height, hi-lo, with any type side rails, with mattress

Hospital bed, variable height, hi-lo, with any type side rails, without mattress

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress

Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress

Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress

Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress

Mattress, innerspring

Mattress, foam rubber

Bed board

Over-bed table

Bed pan, standard, metal or plastic

Bed pan, fracture, metal or plastic

Powered pressure-reducing air mattress

Bed cradle, any type

Hospital bed, fixed height, without side rails, with mattress

Hospital bed, fixed height, without side rails, without mattress

Hospital bed, variable height, hi-lo, without side rails, with mattress

Hospital bed, variable height, hi-lo, without side rails, without mattress

Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress

Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress

Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress

Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress

Pediatric crib, hospital grade, fully enclosed, with or without top enclosure

Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress

Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress

Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress

Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress

Bed side rails, half length

Bed side rails, full length

Bed accessory: board, table, or support device, any type

Safety enclosure frame/canopy for use with hospital bed, any type

Urinal; male, jug-type, any material

Urinal; female, jug-type, any material

Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress

Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress

Control unit for electronic bowel irrigation/evacuation system

Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system

Air pressure elevator for heel

Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width

Powered air overlay for mattress, standard mattress length and width

Nonpowered advanced pressure reducing mattress

Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing

Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge

Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing

Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor

Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing

Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

Stationary oxygen contents, gaseous, 1 month’s supply = 1 unit

Stationary oxygen contents, liquid, 1 month’s supply = 1 unit

Portable oxygen contents, gaseous, 1 month’s supply = 1 unit

Portable oxygen contents, liquid, 1 month’s supply = 1 unit

Oximeter device for measuring blood oxygen levels non-invasively

Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories

Portable oxygen contents, liquid, 1 month’s supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm)

Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)

Terminated December 31, 2015.

Oxygen tent, excluding croup or pediatric tents

Chest shell (cuirass)

Chest wrap

Negative pressure ventilator; portable or stationary

Terminated December 31, 2015.

Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask)

Terminated December 31, 2015.

Rocking bed with or without side rails

Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)

Terminated December 31, 2015.

Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask)

Terminated December 31, 2015.

Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)

Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions

Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

Percussor, electric or pneumatic, home model

Intrapulmonary percussive ventilation system and related accessories

Cough stimulating device, alternating positive and negative airway pressure

High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each

Oscillatory positive expiratory pressure device, non-electric, any type, each

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment

Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

Spirometer, electronic, includes all accessories

Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source

Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery

Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter

Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery

Humidifier, non-heated, used with positive airway pressure device

Humidifier, heated, used with positive airway pressure device

Compressor, air power source for equipment which is not self-contained or cylinder driven

Nebulizer, with compressor

Aerosol compressor, adjustable pressure, light duty for intermittent use

Ultrasonic/electronic aerosol generator with small volume nebulizer

Nebulizer, ultrasonic, large volume

Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter

Nebulizer, with compressor and heater

Respiratory suction pump, home model, portable or stationary, electric

Continuous positive airway pressure (cpap) device

Breast pump, manual, any type

Breast pump, electric (ac and/or dc), any type

Breast pump, hospital grade, electric (ac and / or dc), any type

Vaporizer, room type

Postural drainage board

Home blood glucose monitor

Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)

Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems

Implantable cardiac event recorder with memory, activator and programmer

External defibrillator with integrated electrocardiogram analysis

Apnea monitor, without recording feature

Apnea monitor, with recording feature

Skin piercing device for collection of capillary blood, laser, each

Sling or seat, patient lift, canvas or nylon

Patient lift, bathroom or toilet, not otherwise classified

Seat lift mechanism, electric, any type

Separate seat lift mechanism for use with patient owned furniture-electric

Terminated December 31, 2016.

Seat lift mechanism, non-electric, any type

Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)

Patient lift, electric with seat or sling

Multipositional patient support system, with integrated lift, patient accessible controls

Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels

Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels

Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories

Patient lift, fixed system, includes all components/accessories

Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels

Standing frame/table system, mobile (dynamic stander), any size including pediatric

Pneumatic compressor, non-segmental home model

Pneumatic compressor, segmental home model without calibrated gradient pressure

Pneumatic compressor, segmental home model with calibrated gradient pressure

Non-segmental pneumatic appliance for use with pneumatic compressor, half arm

Segmental pneumatic appliance for use with pneumatic compressor, trunk

Segmental pneumatic appliance for use with pneumatic compressor, chest

Non-segmental pneumatic appliance for use with pneumatic compressor, full leg

Non-segmental pneumatic appliance for use with pneumatic compressor, full arm

Non-segmental pneumatic appliance for use with pneumatic compressor, half leg

Segmental pneumatic appliance for use with pneumatic compressor, full leg

Segmental pneumatic appliance for use with pneumatic compressor, full arm

Segmental pneumatic appliance for use with pneumatic compressor, half leg

Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk

Segmental gradient pressure pneumatic appliance, full leg

Segmental gradient pressure pneumatic appliance, full arm

Segmental gradient pressure pneumatic appliance, half leg

Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system)

Intermittent limb compression device (includes all accessories), not otherwise specified

Non-pneumatic sequential compression garment, trunk

Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less

Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel

Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel

Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection

Safety equipment, device or accessory, any type

Transfer device, any type, each

Restraints, any type (body, chest, wrist or ankle)

Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion

Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation

Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation

Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient’s skin by layers of fabric)

Non-implanted pelvic floor electrical stimulator, complete system

Neuromuscular stimulator for scoliosis

Neuromuscular stimulator, electronic shock unit

Electromyography (emg), biofeedback device

Osteogenesis stimulator, electrical, non-invasive, other than spinal applications

Osteogenesis stimulator, electrical, non-invasive, spinal applications

Osteogenesis stimulator, electrical, surgically implanted

Electronic salivary reflex stimulator (intra-oral/non-invasive)

Osteogenesis stimulator, low intensity ultrasound, non-invasive

Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device

Transcutaneous electrical joint stimulation device system, includes all accessories

Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program

Fda approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting

Electrical stimulation device used for cancer treatment, includes all accessories, any type

Electrical stimulation or electromagnetic wound treatment device, not otherwise classified

Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified

Iv pole

Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater

Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours

Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient

Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)

Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)

External ambulatory infusion pump, insulin

Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement

Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)

External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing

Parenteral infusion pump, stationary, single or multi-channel

Ambulatory traction device, all types, each

Traction frame, attached to headboard, cervical traction

Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible

Traction stand, free standing, cervical traction

Cervical traction equipment not requiring additional stand or frame

Cervical traction device, with inflatable air bladder(s)

Traction equipment, overdoor, cervical

Traction frame, attached to footboard, extremity traction, (e.g., buck’s)

Traction stand, free standing, extremity traction

Traction frame, attached to footboard, pelvic traction

Traction stand, free standing, pelvic traction, (e.g., buck’s)

Trapeze bars, a/k/a patient helper, attached to bed, with grab bar

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar

Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar

Fracture frame, attached to bed, includes weights

Fracture frame, free standing, includes weights

Continuous passive motion exercise device for use on knee only

Continuous passive motion exercise device for use other than knee

Trapeze bar, free standing, complete with grab bar

Gravity assisted traction device, any type

Cervical head harness/halter

Pelvic belt/harness/boot

Extremity belt/harness

Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)

Fracture frame, attachments for complex pelvic traction

Fracture frame, attachments for complex cervical traction

Wheelchair accessory, tray, each

Heel loop/holder, any type, with or without ankle strap, each

Toe loop/holder, any type, each

Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each

Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot

Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each

Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each

Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each

Manual wheelchair accessory, one-arm drive attachment, each

Manual wheelchair accessory, adapter for amputee, each

Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware

Manual wheelchair accessory, wheel lock brake extension (handle), each

Manual wheelchair accessory, headrest extension, each

Manual wheelchair accessory, hand rim with projections, any type, replacement only, each

Commode seat, wheelchair

Narrowing device, wheelchair

No. 2 footplates, except for elevating leg rest

Manual wheelchair accessory, anti-tipping device, each

Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each

Manual wheelchair accessory, anti-rollback device, each

Wheelchair accessory, positioning belt/safety belt/pelvic strap, each

Safety vest, wheelchair

Wheelchair accessory, seat upholstery, replacement only, each

Wheelchair accessory, back upholstery, replacement only, each

Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control

Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control

Wheelchair accessory, seat lift mechanism

Manual wheelchair accessory, push-rim activated power assist system

Manual wheelchair accessory, lever-activated, wheel drive, pair

Wheelchair accessory, elevating leg rest, complete assembly, each

Manual wheelchair accessory, solid seat insert

Arm rest, each

Wheelchair accessory, calf rest/pad, replacement only, each

Wheelchair accessory, power seating system, tilt only

Wheelchair accessory, power seating system, recline only, without shear reduction

Wheelchair accessory, power seating system, recline only, with mechanical shear reduction

Wheelchair accessory, power seatng system, recline only, with power shear reduction

Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction

Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction

Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction

Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each

Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair

Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)

Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each

Reclining back, addition to pediatric size wheelchair

Shock absorber for manual wheelchair, each

Shock absorber for power wheelchair, each

Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each

Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each

Residual limb support system for wheelchair, any type

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory

Wheelchair accessory, ventilator tray, fixed

Wheelchair accessory, ventilator tray, gimbaled

Rollabout chair, any and all types with casters 5″ or greater

Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs

Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs

Transport chair, pediatric size

Transport chair, adult size, patient weight capacity up to and including 300 pounds

Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds

Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests

Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests

Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest

Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest

Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests

Hemi-wheelchair, fixed full length arms, swing away detachable foot rests

Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests

High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests

High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests

High strength lightweight wheelchair, fixed length arms, swing away detachable footrest

High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests

Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests

Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests

Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests

Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest

Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests

Wheelchair, detachable arms, desk or full length, swing away detachable footrests

Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests

Wheelchair, fixed full length arms, swing away detachable elevating legrests

Manual adult size wheelchair, includes tilt in space

Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests

Amputee wheelchair, fixed full length arms, without footrests or legrest

Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest

Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests

Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests

Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests

Amputee wheelchair, fixed full length arms, swing away detachable footrest

Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification

Wheelchair with fixed arm, footrests

Wheelchair with fixed arm, elevating legrests

Wheelchair with detachable arms, footrests

Wheelchair with detachable arms, elevating legrests

Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each

Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each

Special height arms for wheelchair

Special back height for wheelchair

Wheelchair, pediatric size, not otherwise specified

Power operated vehicle (three or four wheel nonhighway) specify brand name and model number

Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system

Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system

Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system

Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system

Wheelchair, pediatric size, rigid, adjustable, with seating system

Wheelchair, pediatric size, folding, adjustable, with seating system

Wheelchair, pediatric size, rigid, adjustable, without seating system

Wheelchair, pediatric size, folding, adjustable, without seating system

Power wheelchair, pediatric size, not otherwise specified

Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest

Lightweight wheelchair, fixed full length arms, swing away detachable footrest

Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest

Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests

Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests

Heavy duty wheelchair, fixed full length arms, swing away detachable footrest

Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest

Heavy duty wheelchair, fixed full length arms, elevating legrest

Special wheelchair seat height from floor

Special wheelchair seat depth, by upholstery

Special wheelchair seat depth and/or width, by construction

Whirlpool, portable (overtub type)

Whirlpool, non-portable (built-in type)

Oxygen accessory, flow regulator capable of positive inspiratory pressure

Regulator

Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each

Stand/rack

Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each

Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each

Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each

Immersion external heater for nebulizer

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate

Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each

Portable oxygen concentrator, rental

Durable medical equipment, miscellaneous

Oxygen and water vapor enriching system with heated delivery

Oxygen and water vapor enriching system without heated delivery

Centrifuge, for dialysis

Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i.v. poles, pressure gauge, concentrate container

Heparin infusion pump for hemodialysis

Air bubble detector for hemodialysis, each, replacement

Pressure alarm for hemodialysis, each, replacement

Bath conductivity meter for hemodialysis, each

Blood leak detector for hemodialysis, each, replacement

Adjustable chair, for esrd patients

Transducer protectors/fluid barriers, for hemodialysis, any size, per 10

Unipuncture control system for hemodialysis

Hemodialysis machine

Automatic intermittent peritoneal dialysis system

Cycler dialysis machine for peritoneal dialysis

Delivery and/or installation charges for hemodialysis equipment

Reverse osmosis water purification system, for hemodialysis

Deionizer water purification system, for hemodialysis

Blood pump for hemodialysis, replacement

Water softening system, for hemodialysis

Tablo hemodialysis system for the billable dialysis service

Reciprocating peritoneal dialysis system

Wearable artificial kidney, each

Peritoneal dialysis clamps, each

Compact (portable) travel hemodialyzer system

Sorbent cartridges, for hemodialysis, per 10

Hemostats, each

Scale, each

Dialysis equipment, not otherwise specified

Jaw motion rehabilitation system

Replacement cushions for jaw motion rehabilitation system, pkg. of 6

Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200

Dynamic adjustable elbow extension/flexion device, includes soft interface material

Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

Dynamic adjustable forearm pronation/supination device, includes soft interface material

Dynamic adjustable wrist extension / flexion device, includes soft interface material

Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories

Dynamic adjustable knee extension / flexion device, includes soft interface material

Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

Dynamic knee, extension/flexion device with active resistance control

Dynamic adjustable ankle extension/flexion device, includes soft interface material

Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories

Static progressive stretch forearm pronation / supination device, with or without range of motion adjustment, includes all components and accessories

Replacement soft interface material, dynamic adjustable extension/flexion device

Replacement soft interface material/cuffs for bi-directional static progressive stretch device

Dynamic adjustable finger extension/flexion device, includes soft interface material

Dynamic adjustable toe extension/flexion device, includes soft interface material

Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories

Dynamic adjustable shoulder flexion / abduction / rotation device, includes soft interface material

Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories

Communication board, non-electronic augmentative or alternative communication device

Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software

Gastric suction pump, home model, portable or stationary, electric

Blood glucose monitor with integrated voice synthesizer

Blood glucose monitor with integrated lancing/blood sample

Adjunctive, non-implanted continuous glucose monitor or receiver

Non-adjunctive, non-implanted continuous glucose monitor or receiver

Pulse generator system for tympanic treatment of inner ear endolymphatic fluid

Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches

Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches

Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches

Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches

Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each

Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each

Wheelchair accessory, crutch and cane holder, each

Wheelchair accessory, cylinder tank carrier, each

Accessory, arm trough, with or without hand support, each

Wheelchair accessory, bearings, any type, replacement only, each

Manual wheelchair accessory, pneumatic propulsion tire, any size, each

Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each

Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each

Manual wheelchair accessory, pneumatic caster tire, any size, each

Manual wheelchair accessory, tube for pneumatic caster tire, any size, each

Manual wheelchair accessory, foam filled propulsion tire, any size, each

Manual wheelchair accessory, foam filled caster tire, any size, each

Manual wheelchair accessory, foam propulsion tire, any size, each

Manual wheelchair accessory, foam caster tire, any size, each

Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each

Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each

Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

Manual wheelchair accessory, caster fork, any size, replacement only, each

Manual wheelchair accessory, gear reduction drive wheel, each

Manual wheelchair accessory, wheel braking system and lock, complete, each

Manual wheelchair accessory, manual standing system

Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware

Back, planar, for pediatric size wheelchair including fixed attaching hardware

Seat, planar, for pediatric size wheelchair including fixed attaching hardware

Back, contoured, for pediatric size wheelchair including fixed attaching hardware

Seat, contoured, for pediatric size wheelchair including fixed attaching hardware

Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features

Wheelchair accessory, power seat elevation system, any type

Wheelchair accessory, power standing system, any type

Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware

Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware

Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware

Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each

Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware

Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware

Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated

Power wheelchair accessory, chin cup for chin control interface

Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware

Power wheelchair accessory, breath tube kit for sip and puff interface

Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware

Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware

Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware

Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware

Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware

Power wheelchair accessory, nonstandard seat frame width, 20-23 inches

Power wheelchair accessory, nonstandard seat frame width, 24-27 inches

Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches

Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches

Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface

Power wheelchair accessory, group 34 non-sealed lead acid battery, each

Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)

Power wheelchair accessory, 22nf non-sealed lead acid battery, each

Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)

Power wheelchair accessory, group 24 non-sealed lead acid battery, each

Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)

Power wheelchair accessory, u-1 non-sealed lead acid battery, each

Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)

Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each

Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each

Power wheelchair component, drive wheel motor, replacement only

Power wheelchair component, drive wheel gear box, replacement only

Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only

Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each

Power wheelchair accessory, group 27 non-sealed lead acid battery, each

Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware

Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only

Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only

Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only

Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue

Power wheelchair component, actuator, replacement only

Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each

Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each

Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each

Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each

Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each

Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each

Power wheelchair accessory, foam filled caster tire, any size, replacement only, each

Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each

Power wheelchair accessory, foam caster tire, any size, replacement only, each

Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each

Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each

Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each

Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each

Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each

Power wheelchair accessory, caster fork, any size, replacement only, each

Power wheelchair accessory, lithium-based battery, each

Wheelchair accessory, dynamic positioning hardware for back

Negative pressure wound therapy electrical pump, stationary or portable

Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time

Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time

Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time

Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time

Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device

Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access

Speech generating software program, for personal computer or personal digital assistant

Accessory for speech generating device, mounting system

Accessory for speech generating device, not otherwise classified

General use wheelchair seat cushion, width less than 22 inches, any depth

General use wheelchair seat cushion, width 22 inches or greater, any depth

Skin protection wheelchair seat cushion, width less than 22 inches, any depth

Skin protection wheelchair seat cushion, width 22 inches or greater, any depth

Positioning wheelchair seat cushion, width less than 22 inches, any depth

Positioning wheelchair seat cushion, width 22 inches or greater, any depth

Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth

Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth

Custom fabricated wheelchair seat cushion, any size

Wheelchair seat cushion, powered

General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware

General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware

Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware

Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware

Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware

Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware

Custom fabricated wheelchair back cushion, any size, including any type mounting hardware

Replacement cover for wheelchair seat cushion or back cushion, each

Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware

Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware

Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth

Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth

Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth

Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)

Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support

Wheelchair accessory, addition to mobile arm support, elevating proximal arm

Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control

Wheelchair accessory, addition to mobile arm support, supinator

Gait trainer, pediatric size, posterior support, includes all accessories and components

Gait trainer, pediatric size, upright support, includes all accessories and components

Gait trainer, pediatric size, anterior support, includes all accessories and components