Sorted By Description (pdf) - HFS

Durable Medical Equipment
Equipment and Prostheses ONLY - Listed Alphabetically
HCPCS Description COS
E0994 w
E0961 w
E0995 w
E0990 w
E0966 w
E0969 w
E0978 w
E0980 w
E0973 w
L3906
L3908
L6380
L6055
L6050
L3808
L3931
COUNT 1349
Prior
Purch.
Appr. LTC PartB Price
Updated as of: 8/21/2012
Rent MaxQty/Days
WHLCHR ACC-ARMREST,EACH 41 Y N Y 0.00 0.00 N / A
WHLCHR ACC-BRAKE LOCK EXTENSION, EACH 41 Y N Y 0.00 0.00 N / A
WHLCHR ACC-CALF REST, PAD EACH 41 Y N Y 0.00 0.00 N / A
WHLCHR ACC-ELEV LEG REST, COMPLETE ASSE, EACH 41 Y N Y 0.00 0.00 N / A
WHLCHR ACC-HEADREST EXTENSION 41 Y N Y 0.00 0.00 N / A
WHLCHR ACC-NARROWING DEVICE 41 Y Y Y 0.00 0.00 N / A
WHLCHR ACC-SAFETY POSITIONING BELT/ PELVIC STRAP, EACH 41 Y N Y 0.00 0.00 N / A
WHLCHR ACC-SAFETY VEST 41 Y N Y 0.00 0.00 N / A
WHLCHR-ADJ HGT DETACH ARMS, COMPLETE ASSEMBLY, EACH 41 Y N Y 0.00 0.00 N / A
WHO; W/O JOINTS, INCLUDES SOFT INTERFACE, STRAPS, CUST FAB 41 Y Y Y 320.70 0.00 N / A
WHO; WRIST EXTENSION CONTROL COCK-UP, NON-MOLDED 41 N N Y 26.12 0.00 2. / 365.
WRIST DISART OR BELOW ELBOW IMMEDIATE POST-SURGICAL DRESSING 41 Y Y Y 986.72 0.00 N / A
WRIST DISART;MOLDED SOCKET W/EXPANDABLE INTERFACE,FLEX ELBOW 41 Y Y Y 2,209.09 0.00 N / A
WRIST DISART;MOLDED SOCKET,FLEXIBLE ELBOW HINGES,TRICEP PAD 41 Y Y Y 1,731.87 0.00 N / A
WRIST HAND FINGER ORTHOSIS,RIG WITHOUT JTS,INCL STRAP CUSFAB 41 Y Y Y 0.00 0.00 N / A
WRST HD/FING ORT,INC NON TOR JTS,BUCK,SPGS, ARE FAB INC F/A 41 N N Y 149.66 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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