Sorted By Description (pdf) - HFS

Durable Medical Equipment
Equipment and Prostheses ONLY - Listed Alphabetically
HCPCS Description COS
E0705
L8618
L8629
L8617
E0911
E0912
E0940
E0910
L8330
L8320
L8310
L8300
E0245
A4604
L7499
L6641
L3995
L6642
L6687
L6690
L6688
L6672
L6676
L6675
L6670
L6632
L6635
L6637
L6628
L6629
L6691
Prior
Purch.
Appr. LTC PartB Price
Updated as of: 8/21/2012
Rent MaxQty/Days
TRANSFER DEVICE, ANY TYPE, EACH 41 N N Y 40.86 0.00 1. / 365.
TRANSMITTING CABLE FOR USE WITH COCHLEAR IMPLANT DEVICE 41 N N N 19.34 0.00 2. / 30.
TRANSMITTING COIL AND CABLE INTEGRATED FOR USE W/ COCH IMPLT 41 N N Y 148.58 0.00 1. / 120.
TRANSMITTING COIL FOR USE WITH COCHLEAR IMPLANT DEVICE, REPL 41 N N N 67.69 0.00 1. / 120.
TRAPEZE BAR, HEAVY DUTY, PATIENT WT > 250 LBS, ATTACH TO BED 41 B N Y 455.94 45.59 N / A
TRAPEZE BAR, HEAVY DUTY, PATIENT WT > 250 LBS, FREE STANDING 41 B N Y 1,046.97 104.69 N / A
TRAPEZE BAR;FREE STANDING,COMPLETE SET 41 N N Y 148.69 0.00 1. / 1095.
TRAPEZE BARS;ATTACHED TO BED 41 B N Y 164.02 16.40 N / A
TRUSS; ADDITION TO STANDARD PAD, SCROTAL PAD 41 N N Y 34.19 0.00 1. / 180.
TRUSS; ADDITION TO STANDARD PAD, WATER PAD 41 N N Y 42.96 0.00 1. / 180.
TRUSS; DOUBLE W/STANDARD PAD 41 N N Y 103.52 0.00 1. / 180.
TRUSS; SINGLE W/ STANDARD PAD 41 N N Y 58.42 0.00 1. / 180.
TUB STOOL OR BENCH 41 N N N 37.94 0.00 1. / 365.
TUBING W/ INTEGRATED HEATING ELEMENT USE WITH CPAP DEVICE 41 N N Y 55.30 0.00 1. / 180.
UE PROSTHESIS; NOT OTHERWISE SPECIFIED 41 B Y N 0.00 0.00 N / A
UE; ADDITION, EXCURSION AMPLIFIER, PULLEY TYPE 41 N Y Y 136.59 0.00 1. / 365.
UE; ADDITION, SOCK, FRACTURE OR EQUAL, EACH 41 N N Y 25.99 0.00 2. / 180.
UE; ADDITN, EXCURSION AMPLIFIER, LEVER TYPE 41 N Y Y 200.83 0.00 1. / 365.
UE; ADDITN, FRAME TYPE SOCKET, BELOW ELBOW/WRIST DISART 41 N Y Y 399.55 0.00 1. / 365.
UE; ADDITN, FRAME TYPE SOCKET, INTERSCAPULAR-THORACIC 41 Y Y Y 620.50 0.00 N / A
UE; ADDITN, FRAME TYPE SOCKET, SHOULDER DESART 41 N Y Y 442.20 0.00 1. / 365.
UE; ADDITN, HARNESS, CHEST OR SHOULDER, SADDLE TYPE 41 N Y Y 152.45 0.00 1. / 365.
UE; ADDITN, HARNESS, FIGURE "8" DUAL CABLE DESIGN 41 N Y Y 87.02 0.00 1. / 365.
UE; ADDITN, HARNESS, FIGURE "8", SINGLE CABLE DESIGN 41 N Y Y 83.18 0.00 1. / 365.
UE; ADDITN, HOOK TO HAND, CABLE ADAPTOR 41 N Y Y 33.22 0.00 1. / 365.
UE; ADDITN, LATEX SUSPENSION SLEEVE, EACH 41 N Y Y 45.08 0.00 1. / 180.
UE; ADDITN, LIFT ASSIST FOR ELBOW 41 N Y Y 143.88 0.00 1. / 365.
UE; ADDITN, NUDGE CONTROL ELBOW LOCK 41 N Y Y 281.67 0.00 1. / 365.
UE; ADDITN, QUICK DISCONNECT HOOK ADAPTER 41 N Y Y 396.55 0.00 1. / 365.
UE; ADDITN, QUICK DISCONNECT LAMINATION COLLAR 41 N Y Y 135.12 0.00 1. / 365.
UE; ADDITN, REMOVABLE INSERT, EACH 41 N Y Y 244.91 0.00 1. / 365.
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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