Sorted By Description (pdf) - HFS

Durable Medical Equipment
Equipment and Prostheses ONLY - Listed Alphabetically
HCPCS Description COS
L5000
L6010
L6000
L6020
E0630
E0621
E0300
E0480
L0980
E0202
L4350
E0665
E0660
E0655
E0666
E0669
E0668
E0667
E0672
E0671
E0673
E0650
E0652
E0651
L4370
L5410
E0190
E2621 w
E2614 w
E2620 w
E2613 w
Prior
Purch.
Appr. LTC PartB Price
Updated as of: 8/21/2012
Rent MaxQty/Days
PARTIAL FOOT, SHOE INSERT W/LONGITUDINAL ARCH, TOE FILLER 41 N Y Y 224.17 0.00 1. / 365.
PARTIAL HAND, LITTLE AND/OR RING FINGER REMAINING 41 Y Y Y 1,365.65 0.00 N / A
PARTIAL HAND, THUMB REMAINING 41 Y Y Y 1,227.18 0.00 N / A
PARTIAL HAND; NO FINGER REMAINING 41 Y Y Y 1,273.25 0.00 N / A
PATIENT LIFT:HYDRAULIC OR MECHANIC,INC SEAT,SLING,STRAP,PADS 41 B N Y 851.23 85.12 N / A
PATIENT LIFT;SLING OR SEAT,CANVAS OR NYLON-REPLACEMENT 41 N N Y 51.07 0.00 1. / 365.
PEDIATRIC CRIB, HOSP GRADE, FULLY ENCLOSED 41 Y N Y 0.00 0.00 N / A
PERCUSSOR-ELECTRIC OR PNEUMATIC 41 B N Y 384.50 38.44 N / A
PERONEAL STRAPS,PAIR 41 N N Y 11.89 0.00 2. / 365.
PHOTOTHERAPY (BILIRUBIN) LIGHT W/PHOTOMETER 41 R N Y 0.00 54.61 N / A
PNEUMATIC ANKLE CONTROL SPLINT (E.G. AIRCAST) PREFABRICATED 41 N N Y 30.98 0.00 1. / 365.
PNEUMATIC APPLIANCE; NON SEGMENTAL FOR COMPRESS,FULL ARM 41 N N Y 119.50 0.00 1. / 365.
PNEUMATIC APPLIANCE; NON SEGMENTAL FOR COMPRESS,FULL LEG 41 N N Y 128.85 0.00 1. / 365.
PNEUMATIC APPLIANCE; NON SEGMENTAL FOR COMPRESS,HALF ARM 41 N N Y 94.15 0.00 1. / 365.
PNEUMATIC APPLIANCE; NON SEGMENTAL FOR COMPRESS,HALF LEG 41 N N Y 126.30 0.00 1. / 365.
PNEUMATIC APPLIANCE; SEGMENTAL FOR COMPRESS., HALF LEG 41 N N Y 151.84 0.00 1. / 365.
PNEUMATIC APPLIANCE;SEGMENTAL FOR COMPRESS, FULL ARM 41 N N Y 224.34 0.00 1. / 365.
PNEUMATIC APPLIANCE;SEGMENTAL FOR COMPRESS.,FULL LEG 41 N N Y 210.36 0.00 1. / 365.
PNEUMATIC APPLIANCE;SEGMENTAL,GRADIENT PRESSURE,FULL ARM 41 N N Y 171.49 0.00 1. / 365.
PNEUMATIC APPLIANCE;SEGMENTAL,GRADIENT PRESSURE,FULL LEG 41 N N Y 171.49 0.00 1. / 365.
PNEUMATIC APPLIANCE;SEGMENTAL,GRADIENT PRESSURE,HALF LEG 41 N N Y 171.49 0.00 1. / 365.
PNEUMATIC COMPRESSOR(LYMPHEDEMA)NON-SEGMENTAL 41 B N Y 610.23 61.02 N / A
PNEUMATIC COMPRESSOR(LYMPHEDEMA)SEGMENTAL W/CALIBRATE PRESS 41 B N Y 1,731.68 173.16 N / A
PNEUMATIC COMPRESSOR(LYMPHEDEMA)SEGMENTAL WO CALIBRATE PRESS 41 B N Y 723.31 72.32 N / A
PNEUMATIC FULL LEG SPLINT (E.G. AIRCAST), PREFABRICATED 41 N N Y 100.86 0.00 1. / 365.
POS SUR APP INT RD FA BL KN CC 41 Y Y Y 121.64 0.00 1. / 365.
POSITIONING CUSHION/PILLOW/WEDGE, ANY SHAPE OR SIZE 41 N N N 23.26 0.00 1. / 365.
POSITIONING W/C BACK CUSH PLAN/LATE SUPPORT 22 OR>ANY HT HDW 41 Y N N 0.00 0.00 N / A
POSITIONING W/C BACK CUSH WT 22 INS OR > ANY HT INC ANY HDW 41 Y N N 0.00 0.00 N / A
POSITIONING W/C BACK CUSH,PLANBACK W/LATE SUPP WT