DME MAC JURISDICTION C - CGS

Supplier Documentation Chapter 3E0196 Gel pressure mattressE0197 Air pressure pad for mattress, standard mattress length and widthE0198 Water pressure pad for mattress, standard mattress length and widthE0199 Dry pressure pad for mattress, standard mattress length and widthE0277 Powered pressure-reducing air mattressE0371 Non-powered advanced pressure reducing overlay for mattress, standard mattress length andwidthE0372 Powered air overlay for mattress, standard mattress length and widthE0373 Non-powered pressure mattressSeat Lift MechanismE0172 Seat lift mechanism placed over or on top of toilet, any typeE0627 Seat lift mechanism incorporated into a combination lift-chair mechanismE0628 Separate seat lift mechanism for use with patient owned furniture-electricE0629 Separate seat lift mechanism for use with patient owned furniture-non-electricTranscutaneous Electrical Nerve Stimulator (TENS)E0720 TENS, two-lead, localized stimulationE0730 TENS, four-lead, larger area/multiple nerve stimulationE0731 Form fitting conductive garment for delivery of TENS or NMES (with conductive fibersseparated from the patient's skin by layers of fabric)Power Mobility DevicesK0800 Power operated vehicle, group 1 standard, patient weight capacity up to and including 300poundsK0801 Power operated vehicle, group 1 heavy duty, patient weight capacity, 301 to 450 poundsK0802 Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 poundsK0806 Power operated vehicle, group 2 standard, patient weight capacity up to and including 300poundsK0807 Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 poundsK0808 Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 poundsK0812 Power operated vehicle, not otherwise classifiedK0813 Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weightcapacity up to and including 300 poundsK0814 Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to andincluding 300 poundsK0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity upto and including 300 poundsK0816 Power wheelchair, group 1 standard, captains chair, patient weight capacity up to andincluding 300 poundsK0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weightcapacity up to and including 300 poundsK0821 Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to andincluding 300 poundsK0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to andincluding 300 poundsK0823 Power wheelchair, group 2 standard, captains chair, patient weight capacity up to andincluding 300 poundsK0824 Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301to 450poundsK0825 Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 451 to 600poundsK0826 Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to600 poundsK0827 Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to600 poundsDME MAC Jurisdiction C Supplier Manual Page 4