Sorted By Description (pdf) - HFS

Durable Medical Equipment
Equipment and Prostheses ONLY - Listed Alphabetically
HCPCS Description COS
E0580
E0570
E0575
E0574
E2402
E0460
E0765
E0745
L4386
S9211
A7028
E0485
E0486
L8042
L3225
L3224
L3590
L3580
L3520
L3595
L3540
L3530
L3560
L3550
L3570
L3202
L3201
L3206
L3204
L3207
L3649
Prior
Purch.
Appr. LTC PartB Price
Updated as of: 8/21/2012
Rent MaxQty/Days
NEBULIZER GLASS-AUTO PLASTICUSE W/REGULATOR 41 N N Y 122.60 0.00 1. / 365.
NEBULIZER W/ COMPRESSOR 41 N N Y 94.01 0.00 1. / 1825.
NEBULIZER; ULTRASONIC, LARGE VOLUME 41 B N Y 821.21 82.12 N / A
NEBULIZER;ULTRASONIC SMALL VOLUME 41 Y N Y 366.33 0.00 N / A
NEG. PRESS WOUND THERAPY, PUMP ELECTRICAL, STATIONARY OR POR 41 R Y N 0.00 0.00 N / A
NEGATIVE PRESSURE VENTILATOR, PORT OR STAT. 41 R N Y 0.00 670.93 N / A
NERVE STIMULATOR W/REPLACEABLE BATTERIES FOR NAUSEA/VOMITING 41 Y N Y 80.80 0.00 N / A
NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT 41 Y N Y 699.68 0.00 N / A
NON-PNEUMATIC WALKING SPLINT WITH OR WITHOUT JOINTS PREFABR 41 N N Y 116.75 0.00 1. / 365.
NURSING SERVICES AND EQUIP/SUP FOR GESTIONAL HYPERTENSION PR 41 R Y N 0.00 109.38 30. / 30.
ORAL CUSHION FOR COMBINATION ORAL/NASAL CPAP MASK REPLACEMEN 41 N N Y 45.31 0.00 2. / 365.
ORAL DEVICE/APPL USED TO REDUCE AIRWAY COLL, PRE. FAB 41 Y N N 0.00 0.00 N / A
ORAL DEVICE/APPLIANCE USED TO REDUCE AIRWAY COLL, ADJ/NON C 41 Y N N 0.00 0.00 N / A
ORBITAL PROTHESIS, BY NONPHYSICIAN 41 Y Y Y 2,785.70 0.00 N / A
ORTHO FOOTWEAR, MAN'S SHOE, OXFORD, USED AS PART OF BRACE 41 N Y Y 48.93 0.00 2. / 365.
ORTHO FOOTWEAR, WOMAN SHOE, OXFORD, USED AS PART OF BRACE 41 N Y Y 44.81 0.00 2. / 365.
ORTHO SHOE ADDITION; CONVERT FIRM COUNTER TO SOFT COUNTER 41 N Y N 36.61 0.00 3. / 365.
ORTHO SHOE ADDITION; CONVERT INSTEP-VELCRO CLOSURE 41 N Y N 35.81 0.00 2. / 365.
ORTHO SHOE ADDITION; INSOLE, FELT COVERED W/ LEATHER 41 N Y N 21.80 0.00 3. / 365.
ORTHO SHOE ADDITION; MARCH BAR 41 N Y N 28.77 0.00 3. / 365.
ORTHO SHOE ADDITION; SOLE, FULL 41 N Y Y 34.88 0.00 3. / 365.
ORTHO SHOE ADDITION; SOLE, HALF 41 N Y Y 21.80 0.00 3. / 365.
ORTHO SHOE ADDITION; TOE TAP HORSESHOE 41 N Y N 10.98 0.00 3. / 365.
ORTHO SHOE ADDITION; TOE TAP STANDARD 41 N Y N 6.10 0.00 3. / 365.
ORTHO SHOE ADDITION;SPECIAL EXT. TO INSTEP(LEATHER W/EYELET) 41 N Y N 58.41 0.00 3. / 365.
ORTHOPEDIC SHOE, OXFORD W/SUPINATOR OR PRONATOR, CHILD 41 N Y N 54.38 0.00 2. / 150.
ORTHOPEDIC SHOE, OXFORD W/SUPINATOR OR PRONATOR, INFANT 41 N Y N 44.12 0.00 2. / 90.
ORTHOPEDIC SHOE; HIGHTOP W/SUPINATOR OR PRONATOR, CHILD 41 N Y N 54.46 0.00 2. / 150.
ORTHOPEDIC SHOE; HIGHTOP W/SUPINATOR OR PRONATOR, INFANT 41 N Y N 47.21 0.00 2. / 90.
ORTHOPEDIC SHOE; HIGHTOP W/SUPINATOR OR PRONATOR, JUNIOR 41 N Y N 70.86 0.00 2. / 150.
ORTHOPEDIC SHOE; MOD, ADD, TRANSFER NOT OTHERWISE SPECIFIED 41 Y Y Y 0.00 0.00 N / A
NOTE: For "w" definition, refer to Wheelchair Pricing Schedule. For
"nr", the 2.7% reduction doesn't apply to this code.
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