fee schedule 2009 new - DE Medical Assistance Program

J9355 6 TRASTUZUMAB INJECTION 0.00
J9357 5 VALRUBICIN INJECTION 0.00
J9360 6 VINBLASTINE SULFATE INJ 0.00
J9370 6 VINCRISTINE SULFATE 1 MG INJ 0.00
J9375 6 VINCRISTINE SULFATE 2 MG INJ 0.00
J9380 5 VINCRISTINE SULFATE 5 MG INJ 0.00
J9390 6 VINORELBINE TARTRATE INJ 0.00
J9395 6 INJECTION, FULVESTRANT 0.00
J9600 5 PORFIMER SODIUM INJECTION 0.00
J9999 5 CHEMOTHERAPY DRUG 0.00
K0001 3 STANDARD WHEELCHAIR 532.70
K0002 5 STND HEMI (LOW SEAT) WHLCHR 0.00
K0003 3 LIGHTWEIGHT WHEELCHAIR 0.00
K0004 3 HIGH STRENGTH LTWT WHLCHR 1.00
K0005 3 ULTRALIGHTWEIGHT WHEELCHAIR 1,839.61
K0006 5 HEAVY DUTY WHEELCHAIR 0.00
K0007 5 EXTRA HEAVY DUTY WHEELCHAIR 0.00
K0008 9 CSTM MANUAL WHEELCHAIR/BASE 0.00
K0009 5 OTHER MANUAL WHEELCHAIR/BASE 0.00
K0010 5 STND WT FRAME POWER WHLCHR 0.00
K0011 5 STND WT PWR WHLCHR W CONTROL 0.00
K0012 5 LTWT PORTBL POWER WHLCHR 0.00
K0013 9 CUSTOM POWER WHLCHR BASE 0.00
K0014 5 OTHER POWER WHLCHR BASE 0.00
K0015 3 DETACH NON-ADJUS HGHT ARMRST 180.80
K0016 O DETACH ADJUST ARMRST CMPLETE 0.00
K0017 3 DETACH ADJUST ARMREST BASE 50.85
K0018 3 DETACH ADJUST ARMRST UPPER 28.41
K0019 3 ARM PAD EACH 14.58
K0020 3 FIXED ADJUST ARMREST PAIR 46.23
K0021 O ANTI-TIPPING DEVICE EACH 0.00
K0022 O REINFORCED BACK UPHOLSTERY 0.00
K0023 O PLANR BACK INSRT FOAM W/STRP 0.00
K0024 O PLNR BACK INSRT FOAM W/HRDWR 0.00
K0025 O HOOK-ON HEADREST EXTENSION 0.00
K0026 O BACK UPHOLST LGTWT WHLCHR 0.00
K0027 O BACK UPHOLST OTHER WHLCHR 0.00
K0028 O MANUAL FULLY RECLINING BACK 0.00
K0029 O REINFORCED SEAT UPHOLSTERY 0.00
K0030 O SOLID PLNR SEAT SNGL DNSFOAM 0.00
K0031 O SAFETY BELT/PELVIC STRAP 0.00
K0032 O SEAT UPHOLS LGTWT WHLCHR 0.00
K0033 O SEAT UPHOLSTERY OTHER WHLCHR 0.00
K0034 O HEEL LOOP EACH 0.00
K0035 O HEEL LOOP WITH ANKLE STRAP 0.00
K0036 O TOE LOOP EACH 0.00
K0037 3 HIGH MOUNT FLIP-UP FOOTREST 47.93
K0038 3 LEG STRAP EACH 24.14
K0039 3 LEG STRAP H STYLE EACH 53.61
K0040 3 ADJUSTABLE ANGLE FOOTPLATE 74.30