Pt\\
\z~\ed \e.~u\\e ~ac.~
\\e\'\"5
·\o
~~ce
6oc.
All items on this list require a face to face examination
with patient's MD in order to be covered by Medicare
Appendix A
0
{...._
The DME list of Specified Covered Items are as follows, the original list was at 77 FR 44798:~d·,co'l'-e
HCPCS
Code
Description
E0185
Gel or gel-like pressure mattress pad
• E0188
I
Synthetic sheepskin pad
E0189
Lamb's wool sheepskin pad
E0194
Air fluidized bed
E0197
Air pressure pad lor mattress standard length and width
E0198
Water pressure pad lor mattress standard length and width
E0199
Dry pressure pad lor mattress standard length and width
E0250
Hospital bed fixed height with any type of side rails, mattress
-
--
--
'
, Hospital bed fixed height with any type side rails without mattress
E0251
f
Hospital bed variable height with any type side rails with mattress
Hospital bed variable height withany type side rails without mattress
6
; E0260
-
....,.,
...
-
...
·-
....
Hospital bed semi-electric (Head and foot adjustment) with any type side
rails with mattress
E0261
' Hospital bed semi-electric (head and foot adjustment) with any type side rails
without mattress
E0265
Hospital bed total electric (head, foot and height adjustments) with any type
side rails with mattress
E0266
Hospital bed total electric (head, foot and height adjustments) with any type
side rails without mattress
E0290
: E0291
E0292
1 Hospital
bed fixed height without rails with matlress
Hospital bed fixed height without rail without mattress
1 Hospital bed variable height without rail without mattress
E0293
Hospital bed variable height without rail with mattress
E0294
Hospital bed semi-electric (head and loot adjustment) without rail with
mattress
E0295
Hospital bed semi-electric (head and foot adjustment) without rail without
..
'
--'
i
'
Disclaimer
This article was p1epared as a service to the public and is no! intended to grant rights or impose obligations. This article may contain ref&em;es or !inks to s1atules,
regulaOOns, or olhor poJlcy materials. The inkmnalior orovidetl is only mteni.led to be a general summary. lt is nof intended to take 1he piare of eit!lor Uw written law
q regulations. We ern:;curage readers to review the specific sialutes regulahons and olf1er inlerpre!ive ma!eria!s for a full aid accurale stalement of their contents.
CPT only copyrighl2012 American tv1edical Associaliort
Page 4 of 11
MLN Matters® Number: MM8304
Related Change Request Number: 8304
'
HCPCS
Code
Description
' mattress
E0296
Hospital bed total electric (head, foot and height adjustments) without rail
with mattress
E0297
Hospital bed total electric (head, foot and height adjustments) without rail
, without mattress
E0300
E0301
Pediatric crib, hospital grade, fully enclosed
, Hospital bed Heavy Duty extra wide, with weight capacity 350-600 lbs with ~
any type of rail, without mattress
E0302
Hospital bed Heavy Duty extra wide, with weight capacity greater than 600
lbs with any type of rail, without mattress
E0303
Hospital bed Heavy Duty extra wide, with weight capacity 350-600 lbs with
any type of rail, with mattress
E0304
Hospital bed Heavy Duty extra wide, with weight capacity greater than 600
lbs with any type of rail, with mattress
E0424
Stationary compressed gas Oxygen System rental; Includes contents,
regulator, nebulizer, cannula or mask and tubing
E0431
Portable gaseous oxygen system rental includes portable container,
regulator, flowmeter, humidifier, cannula or mask, and tubing
E0433
Portable liquid oxygen system
'
E0434
• Portable liquid oxygen system, rental; Includes portable container, supply
! reservoir, humidifier, flowmeter, refill adaptor, content gauge, cannula or
mask, and tubing
E0439
Stationary liquid oxygen system rental, includes container, oontents,
regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0441
Oxygen contents, gaseous (1 months supply)
E0442
Oxygen contents, liquid (1 months supply)
E0443
Portable Oxygen oontents, gas (1 months supply)
E0444
Portable oxygen contents, liquid (1 months supply)
E0450
Volume control ventilator without pressure support used with invasive
interface
E0457
1 Chest shell
Disclaimer
This artlCle was prepared as a smvica to !he pub!k: and is nct intended to urant rights or impose ooligalions. This article may contain references or links to statutes.
reg;.~la!lons, or olller no!icy maleria\s. Ttle information provided is only intended to 00 a general summary. It is oot mte1ded to lake the place of either the written law
or regulations. We cqcoorage readers to review !he specific statuies, regulations ami olhor interpreiJvo materials for a full and accurate stalemenl oi !heir oonten!s.
CPT oniy copyrigh!2012 American Medical Associatimt
Page 5 of 11
MLN Matters® Number: MM8304
HCPCS
Code
E0459
E0460
1
E0461
E0462
Related Change Request Number: 8304 :
Description
Chest wrap
, Negative pressure ventilator portable or stationary
-
-
Volume control ventilator without pressure support node for a noninvasive
interface
Rocking bed with or without side rail
E0463
, Pressure support ventilator with volume control mode used lor invasive
surfaces
E0464
Pressure support vent with volume control mode used for noninvasive
surfaces
E0470
Respireiory Assist Device, bi-level pressure capability, without backup rate
used non-invasive interface
E0471
Respiratory Assist Device, bi-level pressure capability, with backup rate for
a non-invasive interface
E0472
E0480
E0482
E0483
· E0484
E0570
E05?5
E0580
E0585
E0601
E0607
E0627
E0628
E0629
I
Respiratory Assist Device, bi-level pressure capability, with backup rate for
invasive interface
Percussor electric/pneumatic home model
Cough stimulating device, alternating positive and negative airway pressure
High Frequency chest wall oscillation air pulse generator system
Oscillatory positive expiratory device, non-electric
Nebulizer with compressor
Nebulizer, ultrasonic, large volume
Nebulizer, durable, glass or autoclavable plastic, bottle type for use with
regulator or flowmeter
Nebulizer with compressor & heater
Continuous airway pressure device
~<
Home blood glucose monitor
--
Seat lift mechanism incorporated lift-chair
< -
Separate Seat lift mechanism for patient owned furniture electric
Separate seat lift mechanism for patient owned furniture non-electric
Disclaimer
This article was prepared as a se1vice to lhe _o;1Liic and is not in landed tc grant righ!s or impose obligations. This artJCJe may contain feferences or links to statl!les.
regulations, or o!her policy materials. The infrnmalioo provided is only intended lo be B general summary. It is not mtended to take the place of eilher the written law
Of reguleUons. We encourage readers to review !he specific statutes. reglllatiofls anrl other inierprelive materials Ia; a luil and BOOJrate statement of U1elr 0011~ents.
CPT only copyright 2012 Americar; Medicat Assor.lation.
Page 6 of 11
MI.:N Matters® Number: MM8304
Related Change Request Number: 8304
: HCPCS
Code
' escnpuon
'
I
ID ''
Multi positional patient support system with integrated lilt patient accessible '
'
'
controls
E0636
, E0650
Pneumatic compressor non-segmental home model
IEO~;i
Pneumatic compressor segmental home model without calibrated gradienr-' pressure
Pneumatic compressor segmental home model with calibrated gradient
pressure
E0652
i
' E0655
Non- segmental pneumatic appliance for use with pneumatic compressor on
half arm
E0656
. Non- segmental pneumatic appliance for use with pneumatic compressor on
trunk
E0657
Non- segmental pneumatic appliance for use with pneumatic compressor
. chest
-
-
I Non- segmental pneumatic appliance for use with pneumatic compressor on
E0660
! lull leg
E0665
Non- segmental pneumatic appliance lor use with pneumatic compressor on
full arm
E0666
, Non- segmental pneumatic appliance for use with pneumatic compressor on
i half leg
E0667
I leg
E0668
' Segmental pneumatic appliance for use with pneumatic compressor on full
arm
1
E0669
E0671
Segmental pneumatic appliance for use with pneumatic compressor on full-
, Segmental pneumatic appliance for use with pneumatic compressor on half
leg
! Segmental gradient pressure pneumatic appliance full leg
I
E0672
Segmental gradient pressure pneumatic appliance full arm
E6673
Segmental gradient pressure pneumatic appliance half leg
, E0675
I E0692
i
--
-
, Pneumatic compression device, high pressure, rapid inflation/deflation cycle,
: for arterial insufficiency
Ultraviolet light therapy system panel treatment 4 foot panel
Oisclmmer
This article was prepared as a service to ltJe public ana Is not L1tended lo grant rights or lmpose obligations. Tills article ;nay contain refmences or Jinks to statutes,
regulations, or othet policy ma!erlals. The infotmalioil provided is only Intended to be a general summary. !I !s not intended to lake !he place of ellllo; lhe written law
or regulations. We encourage readers to revie-o\' the specific s!alutes, rsgulatiooo and olher inletpretiiKl materials for a full and acc.trale stale men! ol their contents.
CPT only oopyrigh!2012 American MediCfll Association"
Page 7 of 11
MLN Matters® Number: MM8304
I HCPCS
Code
J
Related Change Request Number: 830ii ;
Desert ption
E0693
Ultraviolet light therapy system panel treatment6 foot panel
E0694
Ultraviolet multidirectional light therapy system in 6 foot cabinet
Transcutaneous electrical nerve stimulation, two lead, local stimulation
I E0720""
----
Transcutaneous electrical nerve stimulation, four or more leads, for multiple
nerve stimulation
i E0730
E0731
Form fitting conductive garment for delivery of TENS or NMES
E0740
Incontinence treatment system, Pelvic ftoor stimulator, monitor, sensor,
and/or trainer
E0744
: E0745
Neuromuscular stimulator for scoliosis
"
Neuromuscular stimulator electric shock unit
, Osteogenesis stimulator, electrical, non-invasive, other than spine
application.
E0747
E0748
Osteogenesis stimulator, electrical, non-invasive, spinal application
E0749
Osteogenesis stimulator, electrical, surgically implanted
E0760
Osteogenesis stimulator, low intensity ultrasound, non-invasive
E0762
1
, Transcutaneous electrical joint stimulation system including ali accessories
E0764
Functional neuromuscular stimulator, transcutaneous stimulations of
muscles of ambulation with computer controls
E0765
FDA approved nerve stimulator for treatment of nausea & vomiting
E0782
Infusion pumps, implantable, Non-programmable
~---~--
, E0783
'
Infusion pump, implantable, Programmable
E0784
External ambulatory Infusion pump
Implantable programmable infusion pump, replacement
E0786
'
E0840
· Tract frame attach to headboard, cervical traction
E0849
Traction equipment cervical, free-standing stand/frame, pneumatic, applying
traction force to other than mandible
E0850
Traction stand, free standing, cervical traction
E0855
Cervical traction equipment not requiring additional stand or frame
E0856
Cervical traction device, cervical collar with inflatable air bladder
'
Disclaimer
This arlicle was prepared as a se.O'Ioo to lhe ;r.tblic and is nol inlended to grant rights or irnpose obligations. This Miele may oonlair re1ere11::es ot links to statul.es,
regulations. or other policy materials. The inf01malior: provided is only inlended to be a .genera· summary. It is not intended to lake the place of aiU1er the wtillen taw
o; regulations, We encourage readers to review !he specific sla1u!es, regulations and other interpretive materials lor a ful! n:~d accurate slaie;nent of their COfi!Sil!s
CP1 only c~yrigfit 2012 American Medical Association.
Page 8 of 11
MLN Matters® Number:·MM8304
I
Related Change.Request Number: 8304
!
-~
HGPCS
Code
i Description
E0958
Manual wheelchair accessory, one-arm drive attachment
E0959
Manual wheelchair accessory-adapter for Amputee
E0960
Manual wheelchair accessory, shoulder harness/strap
E0961
i Manual wheelchair accessory wheel lock brake extension handle
E0966
' Manual wheelchair accessory, headrest extension
E0967
E0968
-
Manual wheelchair accessory, hand rim with projections
Commode seat, wheelchair
E0969
I Narrowing device wheelchair
E0971
' Manual wheelchair accessory anti-tipping device
--
-
-·-
E0973
Manual wheelchair accessory, adjustable height, detachable armrest
E0974
Manual wheelchair accessory anti-rollback device
E0978
Manual wheelchair accessory positioning belt/safety belt! pelvic strap
E0980
Manual wheelchair accessory safety vest
---
-~-'
------
E6981
Manual wheelchair accessory Seat upholstery, replacement only
E0982
Manual wheelchair accessory, back upholstery, replacement only
E0983
Manual wheelchair accessory power add on to convert manual wheelchair
motorized wheelchair, joystick control
E0984
i Manual wheelchair accessory power add on to convert manual wheelchair to
· motorized wheelchair, Tiller control
E0985
'E0986
E0990
: E0992
Wheelchair accessory, seat lift mechanism
--
' Manual wheelchair accessory, push activated power assist
Manual wheelchair accessory, elevating leg rest
Manual wheelchair accessory, elevating leg rest solid seat insert
Arm rest
E0994
~;
--------E1014 -- Reclining back, addition to pediatric size wheelchair
E1015
Shock absorber for manual wheelchair
E1020
Residual limb support system for wheelchair
E1028
to-
-
. Wheelchair accessory, manual swing
------
away, retractable or removable
--~
,_
Oisclaimet
This a:tK:ie was prepared as a SQ!Vlce to «1e public and is noi. intended lo grant rlghls or impose obtigatioos_ This article may oonl&in referooce;. or links to statutes,
regula lions, or other policy materials. The information provided is only Intended tc be a general sumnwry, It is not intended to lake !he ;:;iaoo of eit.her the wrilten law
or regulations. We a11coumge readers !o revlev; the specific slaNles. regulations and other interprt*ive mat+lfials for a M and accumte statement of their con!ents.
CPT only copyright 2012 American Medical Association.
Page 9 of 11
MIJN Matters® Number: MM8304
ICode
HCPCS
Related Change Request Number: 8304 ,
Description
mounting hardware for joystick, other control interface or positioning
accessory
E1029
E-t030
1
E1035
E1036
Patient transfer system
E1037
Transport chair, pediatric size
E1038
Transport chair, adult size up to 3001b
• Transport chair, adult size heavy duty >3001b
.
E1161
E1228
··~
Rollabout chair, any and all types with castors 5" or greater
Multi-positional patient transfer system with integrated seat operated by care
1 giver
I
E1227
-·-
, Wheelchair accessory, ventilator tray, gimbaled
E1031
E1039
--
Wheelchair accessory, ventilator tray
Manual Adult size wheelchair includes tilt in space
. Special height arm for wheelchair
'
Special back height for wheelchair
Wheelchair, pediatric size, tilt-in-space, folding, adjustable with seating
system
E1232
Wheelcnair, pediatric size, tilt-in-space, folding, adjustable without seating
E1233
1 system
'
i
E1234
Wheelchair, pediatric size, tilt-in-space, folding, adjustable without seating:
system
E1235
Wheelchair, pediatric size, rigid, adjustable, with seating system
E1236
Wheelchair, pediatric size, folding, adjustable, with seating system
E1237
Wheelchair, pediatric size, rigid, adjustable, without seating system
,._
E1238
E1296
1
'
-
Wheelchair, pediatric size, folding, adjustable, without seating system
··---1 Special sized wheelchair seat height
---,
I'
E1297
Special sized wheelchair seat depth by upholstery
E1298
Special sized wheelchair seat depth and/or width by construction
E1310
Whirlpool non-portable
E2502
Speech Generating Devices prerecord messages between 8 and 20 Minutes
----..
Disctaimer
This article was prepared as a service lo the pt~blic and is not intended to grant rights or impose obligations, This arlicla may coolain references or li11ksto statt~les.
regulations, or other policy- materials, The iflforrr.a!ion th"OVided is on!y intended to be a genera1 summary. It is not intenderi to take the p;ace ol either the: written lRw
01 regulations. We encowage readers to review lhe specific statutes, regJlfltioos and othor interprelive ma!eria:.S for a ful! and aGCUrate slatemcnt of U:eir contBnts.
CPT only copyright 2012 American Medical Assoclalio1.
Page 10 of 11
.?,Lj C:iJ
'
MLN Matters® Number: MMB304
HCPCS
Related Change Request Number: 8304 :
i
Code
Description
E2506
Speech Generating Devices prerecord messages over 40 minutes
E2508
Speech Generating Devices message through spelling, manual type
E2510
, Speech Generating Devices synthesized with multiple message methods
E2227
' Rigid pediatric wheelchair adjustable
K0001
K0002
Standard wheelchair
j Standard hemi (low seat) wheelchair
··-·
K0003 ]ghtweight wheelchair
K0004
, High strength ltwt wheelchair
K0005
Ultra Lightweight wheelchair
K0006
Heavy duty wheelchair
K0007
1 Extra heavy duty wheelchair
K0009
Other manual wheelchair/base
K0606
AED garment with electronic analysis
K0730
Controlled dose inhalation drug delivery system
··-
·-
Disclaimer
This a.iicle was prepared as a service to the public and is not intended to grant rights or 1m pose OOHgations. This ArUcle may contain refeHmces or ll'l<s to statutes.
regulations, or other policy materials. The information provided is o1liy intended loDe a general summary, It is Ji::lt intended lo take the place of eilher the wril!en !aw
or regu!alioos, We encourage readers to review the speci6c statutes, regulat<ms and other interprelivc materials for a full and accurate statement of their contents
CPT ooly copyright 2012 Amerlcan Medical Associaiion.
Page 11 of 11
© Copyright 2024 ExpyDoc
