Medicaid Fee Schedule without Mods 200801

PROC-CODE DESC MAC BEG END
K0822
POWER WHEELCHAIR, GROUP 2 STANDARD, SLING/SOLID SEAT/BACK,
PATIENT WEIGHT CAPACI $399.75 20071101 99999999
K0823
POWER WHEELCHAIR, GROUP 2 STANDARD, CAPTAINS CHAIR,
PATIENT WEIGHT CAPACITY UP T $402.37 20071101 99999999
K0824
POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SLING/SOLID
SEAT/BACK, PATIENT WEIGHT CAPA $484.27 20071101 99999999
K0825
POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, CAPTAINS CHAIR,
PATIENT WEIGHT CAPACITY 30 $443.32 20071101 99999999
K0826
POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, SLING/SOLID
SEAT/BACK, PATIENT WEIGHT $626.93 20071101 99999999
K0827
POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, CAPTAINS
CHAIR, PATIENT WEIGHT CAPACI $533.09 20071101 99999999
K0828
POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, SLING/SOLID
SEAT/BACK, PATIENT WEIGH $690.82 20071101 99999999
K0829
POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, CAPTAINS
CHAIR, PATIENT WEIGHT 601 P $634.37 20071101 99999999
K0830
POWER WHEELCHAIR, GROUP 2 STANDARD, SEAT ELEVATOR,
SLING/SOLID SEAT/BACK, PATIEN $442.59 20061115 99999999
K0831
POWER WHEELCHAIR, GROUP 2 STANDARD, SEAT ELEVATOR,
CAPTAINS CHAIR, PATIENT WEIGH $442.59 20061115 99999999
K0835
POWER WHEELCHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION,
SLING/SOLID SEAT/BACK, $405.74 20071101 99999999
K0836
POWER WHEELCHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION,
CAPTAINS CHAIR, PATIENT $420.75 20071101 99999999
K0837
POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SINGLE POWER
OPTION, SLING/SOLID SEAT/BACK $484.27 20071101 99999999
K0838
POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SINGLE POWER
OPTION, CAPTAINS CHAIR, PATIE $433.23 20071101 99999999
K0839
POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, SINGLE POWER
OPTION SLING/SOLID SEAT/ $626.93 20071101 99999999
K0840
POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, SINGLE POWER
OPTION, SLING/SOLID SEA $807.36 20071101 99999999
K0841
POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER
OPTION, SLING/SOLID SEAT/BACK $431.86 20071101 99999999
K0842
POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER
OPTION, CAPTAINS CHAIR, PATIE $431.86 20071101 99999999
K0843
POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, MULTIPLE POWER
OPTION, SLING/SOLID SEAT/BA $519.96 20071101 99999999
K0848
POWER WHEELCHAIR, GROUP 3 STANDARD, SLING/SOLID SEAT/BACK,
PATIENT WEIGHT CAPACI $528.44 20071101 99999999
K0849
POWER WHEELCHAIR, GROUP 3 STANDARD, CAPTAINS CHAIR,
PATIENT WEIGHT CAPACITY UP T $508.07 20071101 99999999
K0850
POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SLING/SOLID
SEAT/BACK, PATIENT WEIGHT CAPA $521.03 20071101 99999999
K0851
POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, CAPTAINS CHAIR,
PATIENT WEIGHT CAPACITY 30 $500.96 20071101 99999999
K0852
POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, SLING/SOLID
SEAT/BACK, PATIENT WEIGHT $708.26 20071101 99999999
K0853
POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS
CHAIR, PATIENT WEIGHT CAPACI $727.56 20071101 99999999
K0854
POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, SLING/SOLID
SEAT/BACK, PATIENT WEIGH $963.86 20071101 99999999
K0855
POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, CAPTAINS
CHAIR, PATIENT WEIGHT CAPAC $910.51 20071101 99999999
K0856
POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION,
SLING/SOLID SEAT/BACK, $567.23 20071101 99999999
K0857
POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION,
CAPTAINS CHAIR, PATIENT $578.60 20071101 99999999
Hawaii Medicaid Fee Schedule without Mods 01/2008 47