In accordance with Indiana Administrative Code (IAC), the IHCP reimburses long-term care (LTC) facilities at a per diem rate that includes services and products furnished by the facility for the usual care and treatment of patients. LTC facilities include:
  • Provider specialties 030 and 032 – Nursing facilities (NFs)

  • Provider specialty 031 – Intermediate care facilities for individuals with intellectual disabilities (ICFs/IID), including community residential facilities for the developmentally disabled (CRFs/DD)

The LTC per diem rate covers room and board, nursing care, and all other services listed in 405 IAC 5-13-3 (for ICFs/IID) and 405 IAC 5-31-4 (for NFs), including the following:
  • The cost of all medical and nonmedical supplies and equipment, which includes those items generally required to assure adequate medical care and personal hygiene of patients

  • Durable medical equipment (DME) and associated repair costs, routinely required for the care of patients

Because these items are covered in the per diem rate, they should not be billed to Medicaid by the facility, an outside pharmacy or any other provider.

LTC DME Per Diem Table Instructions:
  • The LTC DME Per Diem Table provides a list of DME and medical and nonmedical supply Healthcare Common Procedure Coding System (HCPCS) codes for items that are included in the LTC facility per diem rate.

  • Codes listed on the LTC DME Per Diem Table that are billed separately for LTC facility members will be denied with explanation of benefits (EOB) 2034 - Medical and nonmedical supplies and routine DME items are covered in the per diem rate paid to the long term care facility and may not be billed separately to the IHCP.

  • The HCPCS codes listed within the LTC DME Per Diem Table are subject to change based on annual and quarterly HCPCS review processes and IHCP policy changes.

  • Providers should check this website regularly for changes to the LTC DME Per Diem Table.
LTC DME Per Diem Table
Report Date: 3/29/2024 4:59 AM

Procedure
Code
Description Effective
Date
End
Date
A2001 Innovamatrix ac, per square centimeter 01/01/2022 Open
A2002 Mirragen advanced wound matrix, per square centimeter 01/01/2022 Open
A2003 Bio-connekt wound matrix, per square centimeter 01/01/2022 01/01/2022
A2004 Xcellistem, 1 mg 01/01/2022 Open
A2005 Microlyte matrix, per square centimeter 01/01/2022 Open
A2006 Novosorb synpath dermal matrix, per square centimeter 01/01/2022 Open
A2007 Restrata, per square centimeter 01/01/2022 Open
A2008 Theragenesis, per square centimeter 01/01/2022 Open
A2009 Symphony, per square centimeter 01/01/2022 Open
A2010 Apis, per square centimeter 01/01/2022 Open
A2011 Supra sdrm, per square centimeter 04/01/2022 Open
A2012 Suprathel, per square centimeter 04/01/2022 Open
A2013 Innovamatrix fs, per square centimeter 04/01/2022 Open
A2014 Omeza collagen matrix, per 100 mg 10/01/2022 Open
A2015 Phoenix wound matrix, per square centimeter 10/01/2022 Open
A2016 Permeaderm b, per square centimeter 10/01/2022 Open
A2017 Permeaderm glove, each 10/01/2022 Open
A2018 Permeaderm c, per square centimeter 10/01/2022 Open
A2022 Innovaburn or innovamatrix xl, per square centimeter 10/01/2023 Open
A2023 Innovamatrix pd, 1 mg 10/01/2023 Open
A2024 Resolve matrix, per square centimeter 10/01/2023 Open
A2025 Miro3d, per cubic centimeter 10/01/2023 Open
A4100 Skin substitute, fda cleared as a device, not otherwise specified 04/01/2022 Open
A4206 Syringe with needle, sterile, 1 cc or less, each 01/01/2000 Open
A4207 Syringe with needle, sterile 2 cc, each 01/01/2000 Open
A4208 Syringe with needle, sterile 3 cc, each 01/01/2000 Open
A4209 Syringe with needle, sterile 5 cc or greater, each 01/01/2000 Open
A4210 Needle-free injection device, each 01/01/2000 Open
A4211 Supplies for self-administered injections 01/01/2000 Open
A4212 Non-coring needle or stylet with or without catheter 01/01/2000 Open
A4213 Syringe, sterile, 20 cc or greater, each 01/01/2000 Open
A4215 Needle, sterile, any size, each 01/01/2000 Open
A4217 Sterile water/saline, 500 ml 01/01/2004 Open
A4220 Refill kit for implantable infusion pump 01/01/2000 Open
A4221 Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) 01/01/2000 Open
A4222 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) 01/01/2000 Open
A4223 Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) 01/01/2005 Open
A4226 Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week 01/01/2020 Open
A4230 Infusion set for external insulin pump, non needle cannula type 01/01/2000 Open
A4231 Infusion set for external insulin pump, needle type 01/01/2000 Open
A4232 Syringe with needle for external insulin pump, sterile, 3 cc 01/01/2000 Open
A4233 Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each 01/01/2006 Open
A4234 Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each 01/01/2006 Open
A4235 Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each 01/01/2006 Open
A4236 Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each 01/01/2006 Open
A4244 Alcohol or peroxide, per pint 01/01/2000 Open
A4245 Alcohol wipes, per box 01/01/2000 Open
A4246 Betadine or phisohex solution, per pint 01/01/2000 Open
A4247 Betadine or iodine swabs/wipes, per box 01/01/2000 Open
A4248 Chlorhexidine containing antiseptic, 1 ml 01/01/2004 Open
A4250 Urine test or reagent strips or tablets (100 tablets or strips) 01/01/2000 Open
A4252 Blood ketone test or reagent strip, each 01/01/2000 Open
A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips 01/01/2000 Open
A4255 Platforms for home blood glucose monitor, 50 per box 01/01/2000 Open
A4256 Normal, low and high calibrator solution / chips 01/01/2000 Open
A4257 Replacement lens shield cartridge for use with laser skin piercing device, each 01/01/2002 Open
A4258 Spring-powered device for lancet, each 01/01/2000 Open
A4259 Lancets, per box of 100 01/01/2000 Open
A4265 Paraffin, per pound 01/01/2000 Open
A4267 Contraceptive supply, condom, male, each 01/01/2003 Open
A4268 Contraceptive supply, condom, female, each 01/01/2003 Open
A4269 Contraceptive supply, spermicide (e.g., foam, gel), each 01/01/2003 Open
A4280 Adhesive skin support attachment for use with external breast prosthesis, each 01/01/2000 Open
A4281 Tubing for breast pump, replacement 01/01/2003 Open
A4282 Adapter for breast pump, replacement 01/01/2003 Open
A4283 Cap for breast pump bottle, replacement 01/01/2003 Open
A4284 Breast shield and splash protector for use with breast pump, replacement 01/01/2003 Open
A4285 Polycarbonate bottle for use with breast pump, replacement 01/01/2003 Open
A4286 Locking ring for breast pump, replacement 01/01/2003 Open
A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour 01/01/2000 Open
A4306 Disposable drug delivery system, flow rate of less than 50 ml per hour 01/01/2000 Open
A4310 Insertion tray without drainage bag and without catheter (accessories only) 01/01/2000 Open
A4311 Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) 01/01/2000 Open
A4312 Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone 01/01/2000 Open
A4313 Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation 01/01/2000 Open
A4314 Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) 01/01/2000 Open
A4315 Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone 01/01/2000 Open
A4316 Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation 01/01/2000 Open
A4319 STERILE WATER IRRIGATION SOLUTION, 1000 ML 01/01/2002 12/31/2003
A4320 Irrigation tray with bulb or piston syringe, any purpose 01/01/2000 Open
A4321 Therapeutic agent for urinary catheter irrigation 01/01/2000 Open
A4322 Irrigation syringe, bulb or piston, each 01/01/2000 Open
A4324 MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH 01/01/2001 12/31/2004
A4325 MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH 01/01/2001 12/31/2004
A4326 Male external catheter with integral collection chamber, any type, each 01/01/2000 Open
A4327 Female external urinary collection device; meatal cup, each 01/01/2000 Open
A4328 Female external urinary collection device; pouch, each 01/01/2000 Open
A4330 Perianal fecal collection pouch with adhesive, each 01/01/2000 Open
A4331 Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each 01/01/2001 Open
A4332 Lubricant, individual sterile packet, each 01/01/2005 Open
A4333 Urinary catheter anchoring device, adhesive skin attachment, each 01/01/2001 Open
A4334 Urinary catheter anchoring device, leg strap, each 01/01/2001 Open
A4335 Incontinence supply; miscellaneous 01/01/2000 Open
A4338 Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each 01/01/2000 Open
A4340 Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each 01/01/2000 Open
A4341 Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each 04/01/2023 Open
A4342 Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each 04/01/2023 Open
A4344 Indwelling catheter, foley type, two-way, all silicone or polyurethane, each 01/01/2000 Open
A4346 Indwelling catheter; foley type, three way for continuous irrigation, each 01/01/2000 Open
A4349 Male external catheter, with or without adhesive, disposable, each 01/01/2000 Open
A4351 Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each 01/01/2000 Open
A4352 Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each 01/01/2000 Open
A4353 Intermittent urinary catheter, with insertion supplies 01/01/2000 Open
A4354 Insertion tray with drainage bag but without catheter 01/01/2000 Open
A4355 Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each 01/01/2000 Open
A4356 External urethral clamp or compression device (not to be used for catheter clamp), each 01/01/2000 Open
A4357 Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each 01/01/2000 Open
A4358 Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each 01/01/2000 Open
A4360 Disposable external urethral clamp or compression device, with pad and/or pouch, each 01/01/2010 Open
A4361 Ostomy faceplate, each 01/01/2000 Open
A4362 Skin barrier; solid, 4 x 4 or equivalent; each 01/01/2000 Open
A4363 Ostomy clamp, any type, replacement only, each 01/01/2000 Open
A4364 Adhesive, liquid or equal, any type, per oz 01/01/2000 Open
A4365 ADHESIVE REMOVER WIPES, ANY TYPE, PER 50 01/01/2000 12/31/2009
A4366 Ostomy vent, any type, each 01/01/2000 Open
A4367 Ostomy belt, each 01/01/2000 Open
A4368 Ostomy filter, any type, each 01/01/2000 Open
A4369 Ostomy skin barrier, liquid (spray, brush, etc.), per oz 01/01/2000 Open
A4371 Ostomy skin barrier, powder, per oz 01/01/2000 Open
A4372 Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each 01/01/2000 Open
A4373 Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each 01/01/2000 Open
A4375 Ostomy pouch, drainable, with faceplate attached, plastic, each 01/01/2000 Open
A4376 Ostomy pouch, drainable, with faceplate attached, rubber, each 01/01/2000 Open
A4377 Ostomy pouch, drainable, for use on faceplate, plastic, each 01/01/2000 Open
A4378 Ostomy pouch, drainable, for use on faceplate, rubber, each 01/01/2000 Open
A4379 Ostomy pouch, urinary, with faceplate attached, plastic, each 01/01/2000 Open
A4380 Ostomy pouch, urinary, with faceplate attached, rubber, each 01/01/2000 Open
A4381 Ostomy pouch, urinary, for use on faceplate, plastic, each 01/01/2000 Open
A4382 Ostomy pouch, urinary, for use on faceplate, heavy plastic, each 01/01/2000 Open
A4383 Ostomy pouch, urinary, for use on faceplate, rubber, each 01/01/2000 Open
A4384 Ostomy faceplate equivalent, silicone ring, each 01/01/2000 Open
A4385 Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each 01/01/2000 Open
A4387 Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each 01/01/2000 Open
A4388 Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each 01/01/2000 Open
A4389 Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each 01/01/2000 Open
A4390 Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each 01/01/2000 Open
A4391 Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each 01/01/2000 Open
A4392 Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each 01/01/2000 Open
A4393 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each 01/01/2000 Open
A4394 Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce 01/01/2000 Open
A4395 Ostomy deodorant for use in ostomy pouch, solid, per tablet 01/01/2000 Open
A4396 Ostomy belt with peristomal hernia support 01/01/2001 Open
A4397 Irrigation supply; sleeve, each 01/01/2000 12/31/2021
A4398 Ostomy irrigation supply; bag, each 01/01/2000 Open
A4399 Ostomy irrigation supply; cone/catheter, with or without brush 01/01/2000 Open
A4400 Ostomy irrigation set 01/01/2000 Open
A4402 Lubricant, per ounce 01/01/2000 Open
A4404 Ostomy ring, each 01/01/2000 Open
A4405 Ostomy skin barrier, non-pectin based, paste, per ounce 01/01/2003 Open
A4406 Ostomy skin barrier, pectin-based, paste, per ounce 01/01/2003 Open
A4407 Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each 01/01/2003 Open
A4408 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each 01/01/2003 Open
A4409 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each 01/01/2003 Open
A4410 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each 01/01/2003 Open
A4412 Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each 01/01/2006 Open
A4413 Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each 01/01/2003 Open
A4414 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each 01/01/2003 Open
A4415 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each 01/01/2003 Open
A4416 Ostomy pouch, closed, with barrier attached, with filter (1 piece), each 01/01/2004 Open
A4417 Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each 01/01/2004 Open
A4418 Ostomy pouch, closed; without barrier attached, with filter (1 piece), each 01/01/2004 Open
A4419 Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each 01/01/2004 Open
A4420 Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each 01/01/2004 Open
A4421 Ostomy supply; miscellaneous 01/01/2000 Open
A4422 Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each 01/01/2003 Open
A4423 Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each 01/01/2004 Open
A4424 Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each 01/01/2004 Open
A4425 Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each 01/01/2004 Open
A4426 Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each 01/01/2004 Open
A4427 Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each 01/01/2004 Open
A4428 Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each 01/01/2004 Open
A4429 Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each 01/01/2004 Open
A4431 Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each 01/01/2004 Open
A4432 Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each 01/01/2004 Open
A4433 Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each 01/01/2004 Open
A4434 Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each 01/01/2004 Open
A4435 Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each 01/01/2013 Open
A4436 Irrigation supply; sleeve, reusable, per month 01/01/2022 Open
A4437 Irrigation supply; sleeve, disposable, per month 01/01/2022 Open
A4450 Tape, non-waterproof, per 18 square inches 01/01/2000 Open
A4452 Tape, waterproof, per 18 square inches 01/01/2003 Open
A4453 Rectal catheter for use with the manual pump-operated enema system, replacement only 10/01/2021 Open
A4455 Adhesive remover or solvent (for tape, cement or other adhesive), per ounce 01/01/2000 Open
A4456 Adhesive remover, wipes, any type, each 01/01/2010 Open
A4457 Enema tube, with or without adapter, any type, replacement only, each 01/01/2024 Open
A4458 Enema bag with tubing, reusable 01/01/2003 Open
A4461 Surgical dressing holder, non-reusable, each 01/01/2007 Open
A4463 Surgical dressing holder, reusable, each 01/01/2007 Open
A4464 JOINT SUPPORTIVE DEVICE/GARMENT, ELASTIC OR EQUAL, EACH 01/01/2001 12/31/2003
A4467 Belt, strap, sleeve, garment, or covering, any type 01/01/2017 Open
A4481 Tracheostoma filter, any type, any size, each 01/01/2000 Open
A4483 Moisture exchanger, disposable, for use with invasive mechanical ventilation 01/01/2000 Open
A4490 Surgical stockings above knee length, each 01/01/2000 Open
A4495 Surgical stockings thigh length, each 01/01/2000 Open
A4500 Surgical stockings below knee length, each 01/01/2000 Open
A4510 Surgical stockings full length, each 01/01/2000 Open
A4550 Surgical trays 01/01/2000 07/31/2012
A4555 Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only 01/01/2000 Open
A4556 Electrodes, (e.g., apnea monitor), per pair 01/01/2000 Open
A4557 Lead wires, (e.g., apnea monitor), per pair 01/01/2000 Open
A4558 Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz 01/01/2000 Open
A4561 Pessary, reusable, rubber, any type 01/01/2001 Open
A4562 Pessary, reusable, non rubber, any type 01/01/2001 Open
A4565 Slings 01/01/2000 Open
A4570 Splint 01/01/2000 Open
A4595 Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) 01/01/2003 Open
A4604 Tubing with integrated heating element for use with positive airway pressure device 01/01/2006 Open
A4605 Tracheal suction catheter, closed system, each 01/01/2005 Open
A4606 Oxygen probe for use with oximeter device, replacement 01/01/2003 Open
A4608 Transtracheal oxygen catheter, each 01/01/2001 Open
A4611 Battery, heavy duty; replacement for patient owned ventilator 01/01/2000 Open
A4612 Battery cables; replacement for patient-owned ventilator 01/01/2000 Open
A4613 Battery charger; replacement for patient-owned ventilator 01/01/2000 Open
A4614 Peak expiratory flow rate meter, hand held 01/01/2000 Open
A4615 Cannula, nasal 01/01/2000 Open
A4616 Tubing (oxygen), per foot 01/01/2000 Open
A4617 Mouth piece 01/01/2000 Open
A4618 Breathing circuits 01/01/2000 Open
A4619 Face tent 01/01/2000 Open
A4620 Variable concentration mask 01/01/2000 Open
A4623 Tracheostomy, inner cannula 01/01/2000 Open
A4624 Tracheal suction catheter, any type other than closed system, each 01/01/2000 Open
A4625 Tracheostomy care kit for new tracheostomy 01/01/2000 Open
A4626 Tracheostomy cleaning brush, each 01/01/2000 Open
A4627 Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler 01/01/2000 Open
A4628 Oral and/or oropharyngeal suction catheter, each 01/01/2000 Open
A4629 Tracheostomy care kit for established tracheostomy 01/01/2000 Open
A4630 Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient 01/01/1900 Open
A4631 REPLACEMENT, BATTERIES FOR MEDICALLY NECESSARY ELECTRONIC WHEEL CHAIR OWNED BY PATIENT 01/01/1900 12/31/2003
A4633 Replacement bulb/lamp for ultraviolet light therapy system, each 01/01/2003 Open
A4634 Replacement bulb for therapeutic light box, tabletop model 01/01/2003 Open
A4635 Underarm pad, crutch, replacement, each 01/01/2000 Open
A4636 Replacement, handgrip, cane, crutch, or walker, each 01/01/2000 Open
A4637 Replacement, tip, cane, crutch, walker, each. 01/01/2000 Open
A4638 Replacement battery for patient-owned ear pulse generator, each 01/01/2004 Open
A4639 Replacement pad for infrared heating pad system, each 01/01/2003 Open
A4640 Replacement pad for use with medically necessary alternating pressure pad owned by patient 01/01/2000 Open
A4641 Radiopharmaceutical, diagnostic, not otherwise classified 01/01/2000 Open
A4648 Tissue marker, implantable, any type, each 01/01/2000 Open
A4653 Peritoneal dialysis catheter anchoring device, belt, each 01/01/2003 12/31/2022
A4657 Syringe, with or without needle, each 01/01/2002 Open
A4660 Sphygmomanometer/blood pressure apparatus with cuff and stethoscope 01/01/1900 Open
A4663 Blood pressure cuff only 01/01/1900 Open
A4670 Automatic blood pressure monitor 01/01/1900 Open
A4671 Disposable cycler set used with cycler dialysis machine, each 01/01/2004 Open
A4672 Drainage extension line, sterile, for dialysis, each 01/01/2004 Open
A4673 Extension line with easy lock connectors, used with dialysis 01/01/2004 Open
A4674 Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz 01/01/2004 Open
A4712 WATER, STERILE, FOR INJECTION, PER 10 ML 01/01/2003 12/31/2003
A4714 Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon 10/01/2003 12/31/2022
A4728 Dialysate solution, non-dextrose containing, 500 ml 01/01/2004 Open
A4927 Gloves, non-sterile, per 100 01/01/1900 Open
A4928 Surgical mask, per 20 01/01/2002 Open
A4930 Gloves, sterile, per pair 01/01/2003 Open
A5051 Ostomy pouch, closed; with barrier attached (1 piece), each 01/01/2000 Open
A5052 Ostomy pouch, closed; without barrier attached (1 piece), each 01/01/2000 Open
A5053 Ostomy pouch, closed; for use on faceplate, each 01/01/2000 Open
A5054 Ostomy pouch, closed; for use on barrier with flange (2 piece), each 01/01/2000 Open
A5055 Stoma cap 01/01/2000 Open
A5056 Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each 01/01/2012 Open
A5057 Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each 01/01/2012 Open
A5061 Ostomy pouch, drainable; with barrier attached, (1 piece), each 01/01/2000 Open
A5062 Ostomy pouch, drainable; without barrier attached (1 piece), each 01/01/2000 Open
A5063 Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each 01/01/2000 Open
A5071 Ostomy pouch, urinary; with barrier attached (1 piece), each 01/01/2000 Open
A5072 Ostomy pouch, urinary; without barrier attached (1 piece), each 01/01/2000 Open
A5073 Ostomy pouch, urinary; for use on barrier with flange (2 piece), each 01/01/2000 Open
A5081 Stoma plug or seal, any type 01/01/2000 Open
A5082 Continent device; catheter for continent stoma 01/01/2000 Open
A5093 Ostomy accessory; convex insert 01/01/2000 Open
A5102 Bedside drainage bottle with or without tubing, rigid or expandable, each 01/01/2000 Open
A5105 Urinary suspensory with leg bag, with or without tube, each 01/01/2000 Open
A5112 Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each 01/01/2000 Open
A5113 Leg strap; latex, replacement only, per set 01/01/2000 Open
A5114 Leg strap; foam or fabric, replacement only, per set 01/01/2000 Open
A5120 Skin barrier, wipes or swabs, each 01/01/2006 Open
A5121 Skin barrier; solid, 6 x 6 or equivalent, each 01/01/2000 Open
A5122 Skin barrier; solid, 8 x 8 or equivalent, each 01/01/2000 Open
A5126 Adhesive or non-adhesive; disk or foam pad 01/01/2000 Open
A5131 Appliance cleaner, incontinence and ostomy appliances, per 16 oz. 01/01/2000 Open
A5200 Percutaneous catheter/tube anchoring device, adhesive skin attachment 01/01/2000 Open
A6000 Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card 01/01/2002 Open
A6010 Collagen based wound filler, dry form, sterile, per gram of collagen 01/01/2002 Open
A6011 Collagen based wound filler, gel/paste, per gram of collagen 01/01/2003 Open
A6020 COLLAGEN BASED WOUND DRESSING, EACH DRESSING 01/01/2000 12/31/2000
A6021 Collagen dressing, sterile, size 16 sq. in. or less, each 01/01/2001 Open
A6022 Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each 01/01/2001 Open
A6023 Collagen dressing, sterile, size more than 48 sq. in., each 01/01/2001 Open
A6024 Collagen dressing wound filler, sterile, per 6 inches 01/01/2001 Open
A6025 Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each 01/01/2000 Open
A6154 Wound pouch, each 01/01/2000 Open
A6196 Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing 01/01/2000 Open
A6197 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing 01/01/2000 Open
A6198 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing 01/01/2000 Open
A6199 Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches 01/01/2000 Open
A6200 COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING 01/01/2000 12/31/2009
A6201 COMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING 01/01/2000 12/31/2009
A6202 COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING 01/01/2000 12/31/2009
A6203 Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing 01/01/2000 Open
A6204 Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6205 Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6206 Contact layer, sterile, 16 sq. in. or less, each dressing 01/01/2000 Open
A6207 Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing 01/01/2000 Open
A6208 Contact layer, sterile, more than 48 sq. in., each dressing 01/01/2000 Open
A6209 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6210 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6211 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6212 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing 01/01/2000 Open
A6213 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6214 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6215 Foam dressing, wound filler, sterile, per gram 01/01/2000 Open
A6216 Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6217 Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6218 Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6219 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing 01/01/2000 Open
A6220 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6221 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6222 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6223 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6224 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6228 Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6229 Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6230 Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6231 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing 01/01/2001 Open
A6232 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing 01/01/2001 Open
A6233 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing 01/01/2001 Open
A6234 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6235 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6236 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6237 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing 01/01/2000 Open
A6238 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6239 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6240 Hydrocolloid dressing, wound filler, paste, sterile, per ounce 01/01/2000 Open
A6241 Hydrocolloid dressing, wound filler, dry form, sterile, per gram 01/01/2000 Open
A6242 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6243 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6244 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6245 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing 01/01/2000 Open
A6246 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6247 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6248 Hydrogel dressing, wound filler, gel, per fluid ounce 01/01/2000 Open
A6250 Skin sealants, protectants, moisturizers, ointments, any type, any size 01/01/2000 Open
A6251 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6252 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6253 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6254 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing 01/01/2000 Open
A6255 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6256 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing 01/01/2000 Open
A6257 Transparent film, sterile, 16 sq. in. or less, each dressing 01/01/2000 Open
A6258 Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing 01/01/2000 Open
A6259 Transparent film, sterile, more than 48 sq. in., each dressing 01/01/2000 Open
A6260 Wound cleansers, any type, any size 01/01/2000 Open
A6261 Wound filler, gel/paste, per fluid ounce, not otherwise specified 01/01/2000 Open
A6262 Wound filler, dry form, per gram, not otherwise specified 01/01/2000 Open
A6266 Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard 01/01/2000 Open
A6402 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2000 Open
A6403 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6404 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing 01/01/2000 Open
A6407 Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard 01/01/2004 Open
A6410 Eye pad, sterile, each 01/01/2003 Open
A6411 Eye pad, non-sterile, each 01/01/2003 Open
A6412 Eye patch, occlusive, each 01/01/2003 Open
A6441 Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6442 Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard 01/01/2004 Open
A6443 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6444 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard 01/01/2004 Open
A6445 Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard 01/01/2004 Open
A6446 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6447 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard 01/01/2004 Open
A6448 Light compression bandage, elastic, knitted/woven, width less than three inches, per yard 01/01/2004 Open
A6449 Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6450 Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard 01/01/2004 Open
A6451 Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6452 High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6453 Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard 01/01/2004 Open
A6454 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6455 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard 01/01/2004 Open
A6456 Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Open
A6457 Tubular dressing with or without elastic, any width, per linear yard 01/01/2006 Open
A6460 Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing 01/01/2019 Open
A6461 Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing 01/01/2019 Open
A6520 Gradient compression garment, glove, padded, for nighttime use, each 01/01/2024 Open
A6521 Gradient compression garment, glove, padded, for nighttime use, custom, each 01/01/2024 Open
A6522 Gradient compression garment, arm, padded, for nighttime use, each 01/01/2024 Open
A6523 Gradient compression garment, arm, padded, for nighttime use, custom, each 01/01/2024 Open
A6524 Gradient compression garment, lower leg and foot, padded, for nighttime use, each 01/01/2024 Open
A6525 Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each 01/01/2024 Open
A6526 Gradient compression garment, full leg and foot, padded, for nighttime use, each 01/01/2024 Open
A6527 Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each 01/01/2024 Open
A6528 Gradient compression garment, bra, for nighttime use, each 01/01/2024 Open
A6529 Gradient compression garment, bra, for nighttime use, custom, each 01/01/2024 Open
A6552 Gradient compression stocking, below knee, 30-40 mmhg, each 01/01/2024 Open
A6553 Gradient compression stocking, below knee, 30-40 mmhg, custom, each 01/01/2024 Open
A6554 Gradient compression stocking, below knee, 40 mmhg or greater, each 01/01/2024 Open
A6555 Gradient compression stocking, below knee, 40 mmhg or greater, custom, each 01/01/2024 Open
A6556 Gradient compression stocking, thigh length, 18-30 mmhg, custom, each 01/01/2024 Open
A6557 Gradient compression stocking, thigh length, 30-40 mmhg, custom, each 01/01/2024 Open
A6558 Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each 01/01/2024 Open
A6559 Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each 01/01/2024 Open
A6560 Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each 01/01/2024 Open
A6561 Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each 01/01/2024 Open
A6562 Gradient compression stocking, waist length, 18-30 mmhg, custom, each 01/01/2024 Open
A6563 Gradient compression stocking, waist length, 30-40 mmhg, custom, each 01/01/2024 Open
A6564 Gradient compression stocking, waist length, 40 mmhg or greater, custom, each 01/01/2024 Open
A6565 Gradient compression gauntlet, custom, each 01/01/2024 Open
A6566 Gradient compression garment, neck/head, each 01/01/2024 Open
A6567 Gradient compression garment, neck/head, custom, each 01/01/2024 Open
A6568 Gradient compression garment, torso and shoulder, each 01/01/2024 Open
A6569 Gradient compression garment, torso/shoulder, custom, each 01/01/2024 Open
A6570 Gradient compression garment, genital region, each 01/01/2024 Open
A6571 Gradient compression garment, genital region, custom, each 01/01/2024 Open
A6572 Gradient compression garment, toe caps, each 01/01/2024 Open
A6573 Gradient compression garment, toe caps, custom, each 01/01/2024 Open
A6574 Gradient compression arm sleeve and glove combination, custom, each 01/01/2024 Open
A6575 Gradient compression arm sleeve and glove combination, each 01/01/2024 Open
A6576 Gradient compression arm sleeve, custom, medium weight, each 01/01/2024 Open
A6577 Gradient compression arm sleeve, custom, heavy weight, each 01/01/2024 Open
A6578 Gradient compression arm sleeve, each 01/01/2024 Open
A6579 Gradient compression glove, custom, medium weight, each 01/01/2024 Open
A6580 Gradient compression glove, custom, heavy weight, each 01/01/2024 Open
A6581 Gradient compression glove, each 01/01/2024 Open
A6582 Gradient compression gauntlet, each 01/01/2024 Open
A6583 Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each 01/01/2024 Open
A6584 Gradient compression wrap with adjustable straps, not otherwise specified 01/01/2024 Open
A6585 Gradient pressure wrap with adjustable straps, above knee, each 01/01/2024 Open
A6586 Gradient pressure wrap with adjustable straps, full leg, each 01/01/2024 Open
A6587 Gradient pressure wrap with adjustable straps, foot, each 01/01/2024 Open
A6588 Gradient pressure wrap with adjustable straps, arm, each 01/01/2024 Open
A6589 Gradient pressure wrap with adjustable straps, bra, each 01/01/2024 Open
A6590 External urinary catheters; disposable, with wicking material, for use with suction pump, per month 04/01/2023 Open
A6591 External urinary catheter; non-disposable, for use with suction pump, per month 04/01/2023 Open
A6593 Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specified 01/01/2024 Open
A6594 Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each 01/01/2024 Open
A6595 Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each 01/01/2024 Open
A6596 Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each 01/01/2024 Open
A6597 Gradient compression bandage roll, elastic long stretch, linear yard, any width, each 01/01/2024 Open
A6598 Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each 01/01/2024 Open
A6599 Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each 01/01/2024 Open
A6600 Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each 01/01/2024 Open
A6601 Gradient compression bandaging supply, high density foam pad, any size or shape, each 01/01/2024 Open
A6602 Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each 01/01/2024 Open
A6603 Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each 01/01/2024 Open
A6604 Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each 01/01/2024 Open
A6605 Gradient compression bandaging supply, padded foam, per linear yard, any width, each 01/01/2024 Open
A6606 Gradient compression bandaging supply, padded textile, per linear yard, any width, each 01/01/2024 Open
A6607 Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each 01/01/2024 Open
A6608 Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each 01/01/2024 Open
A6609 Gradient compression bandaging supply, not otherwise specified 01/01/2024 Open
A6610 Gradient compression stocking, below knee, 18-30 mmhg, custom, each 01/01/2024 Open
A7000 Canister, disposable, used with suction pump, each 01/01/2000 Open
A7001 Canister, non-disposable, used with suction pump, each 01/01/2000 Open
A7002 Tubing, used with suction pump, each 01/01/2000 Open
A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable 01/01/2000 Open
A7004 Small volume nonfiltered pneumatic nebulizer, disposable 01/01/2000 Open
A7005 Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable 01/01/2000 Open
A7006 Administration set, with small volume filtered pneumatic nebulizer 01/01/2000 Open
A7007 Large volume nebulizer, disposable, unfilled, used with aerosol compressor 01/01/2000 Open
A7008 Large volume nebulizer, disposable, prefilled, used with aerosol compressor 01/01/2000 Open
A7009 Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer 01/01/2000 Open
A7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 feet 01/01/2000 Open
A7011 Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet 01/01/2000 12/31/2015
A7012 Water collection device, used with large volume nebulizer 01/01/2000 Open
A7013 Filter, disposable, used with aerosol compressor or ultrasonic generator 01/01/2000 Open
A7014 Filter, nondisposable, used with aerosol compressor or ultrasonic generator 01/01/2000 Open
A7015 Aerosol mask, used with dme nebulizer 01/01/2000 Open
A7016 Dome and mouthpiece, used with small volume ultrasonic nebulizer 01/01/2000 Open
A7017 Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen 01/01/2000 Open
A7018 Water, distilled, used with large volume nebulizer, 1000 ml 10/01/2003 Open
A7020 Interface for cough stimulating device, includes all components, replacement only 01/01/2011 Open
A7025 High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each 01/01/2003 Open
A7026 High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each 01/01/2003 Open
A7030 Full face mask used with positive airway pressure device, each 01/01/2003 Open
A7031 Face mask interface, replacement for full face mask, each 01/01/2003 Open
A7032 Cushion for use on nasal mask interface, replacement only, each 01/01/2003 Open
A7033 Pillow for use on nasal cannula type interface, replacement only, pair 01/01/2003 Open
A7034 Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap 01/01/2003 Open
A7035 Headgear used with positive airway pressure device 01/01/2003 Open
A7036 Chinstrap used with positive airway pressure device 01/01/2003 Open
A7037 Tubing used with positive airway pressure device 01/01/2003 Open
A7038 Filter, disposable, used with positive airway pressure device 01/01/2003 Open
A7039 Filter, non disposable, used with positive airway pressure device 01/01/2003 Open
A7040 One way chest drain valve 01/01/2005 Open
A7041 Water seal drainage container and tubing for use with implanted chest tube 01/01/2005 Open
A7043 Vacuum drainage bottle and tubing for use with implanted catheter 01/01/2003 12/31/2014
A7044 Oral interface used with positive airway pressure device, each 01/01/2003 Open
A7045 Exhalation port with or without swivel used with accessories for positive airway devices, replacement only 01/01/2005 Open
A7046 Water chamber for humidifier, used with positive airway pressure device, replacement, each 01/01/2004 Open
A7047 Oral interface used with respiratory suction pump, each 01/01/2014 Open
A7501 Tracheostoma valve, including diaphragm, each 01/01/2001 Open
A7502 Replacement diaphragm/faceplate for tracheostoma valve, each 01/01/2001 Open
A7503 Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each 01/01/2001 Open
A7504 Filter for use in a tracheostoma heat and moisture exchange system, each 01/01/2001 Open
A7505 Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each 01/01/2001 Open
A7506 Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each 01/01/2001 Open
A7507 Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each 01/01/2001 Open
A7508 Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each 01/01/2001 Open
A7509 Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each 01/01/2001 Open
A7520 Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each 01/01/2004 Open
A7521 Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each 01/01/2004 Open
A7522 Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each 01/01/2004 Open
A7523 Tracheostomy shower protector, each 01/01/2004 Open
A7524 Tracheostoma stent/stud/button, each 01/01/2004 Open
A7525 Tracheostomy mask, each 01/01/2004 Open
A7526 Tracheostomy tube collar/holder, each 01/01/2004 Open
A7527 Tracheostomy/laryngectomy tube plug/stop, each 01/01/2005 Open
A9273 Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type 01/01/2011 Open
A9286 Hygienic item or device, disposable or non-disposable, any type, each 01/01/2017 Open
B4034 Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape 01/01/2000 Open
B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape 01/01/2000 Open
B4036 Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape 01/01/2000 Open
B4081 Nasogastric tubing with stylet 01/01/2000 Open
B4082 Nasogastric tubing without stylet 01/01/2000 Open
B4083 Stomach tube - levine type 01/01/2000 Open
B4100 Food thickener, administered orally, per ounce 06/12/2003 Open
B4102 Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit 01/01/2005 Open
B4103 Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit 01/01/2005 Open
B4148 Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape 10/01/2023 Open
B4149 Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4150 Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2000 Open
B4152 Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2000 Open
B4153 Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2000 Open
B4154 Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2000 Open
B4155 Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2000 Open
B4157 Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4158 Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4159 Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4160 Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4161 Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4162 Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit 01/01/2005 Open
B4220 Parenteral nutrition supply kit; premix, per day 01/01/2000 Open
B4222 Parenteral nutrition supply kit; home mix, per day 01/01/2000 Open
B4224 Parenteral nutrition administration kit, per day 01/01/2000 Open
B9000 Enteral nutrition infusion pump - without alarm 01/01/2000 12/31/2016
B9002 Enteral nutrition infusion pump, any type 01/01/2000 Open
B9004 Parenteral nutrition infusion pump, portable 01/01/2000 Open
B9006 Parenteral nutrition infusion pump, stationary 01/01/2000 Open
B9998 Noc for enteral supplies 01/01/2000 Open
B9999 Noc for parenteral supplies 01/01/2000 Open
E0100 Cane, includes canes of all materials, adjustable or fixed, with tip 01/01/2000 Open
E0105 Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips 01/01/2000 Open
E0110 Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips 01/01/2000 Open
E0111 Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips 01/01/2000 Open
E0112 Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips 01/01/2000 Open
E0113 Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip 01/01/2000 Open
E0114 Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips 01/01/2000 Open
E0116 Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each 01/01/2000 Open
E0117 Crutch, underarm, articulating, spring assisted, each 01/01/2003 Open
E0130 Walker, rigid (pickup), adjustable or fixed height 01/01/2000 Open
E0135 Walker, folding (pickup), adjustable or fixed height 01/01/2000 Open
E0140 Walker, with trunk support, adjustable or fixed height, any type 01/01/2000 Open
E0141 Walker, rigid, wheeled, adjustable or fixed height 01/01/2000 Open
E0143 Walker, folding, wheeled, adjustable or fixed height 01/01/2000 Open
E0144 Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat 01/01/2000 Open
E0147 Walker, heavy duty, multiple braking system, variable wheel resistance 01/01/2000 Open
E0148 Walker, heavy duty, without wheels, rigid or folding, any type, each 01/01/2001 Open
E0149 Walker, heavy duty, wheeled, rigid or folding, any type 01/01/2004 Open
E0153 Platform attachment, forearm crutch, each 01/01/2000 Open
E0154 Platform attachment, walker, each 01/01/2000 Open
E0155 Wheel attachment, rigid pick-up walker, per pair 01/01/2000 Open
E0156 Seat attachment, walker 01/01/2000 Open
E0157 Crutch attachment, walker, each 01/01/2000 Open
E0158 Leg extensions for walker, per set of four (4) 01/01/2000 Open
E0159 Brake attachment for wheeled walker, replacement, each 01/01/1997 Open
E0160 Sitz type bath or equipment, portable, used with or without commode 01/01/2000 Open
E0161 Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s 01/01/2000 Open
E0162 Sitz bath chair 01/01/2000 Open
E0163 Commode chair, mobile or stationary, with fixed arms 01/01/2000 Open
E0165 Commode chair, mobile or stationary, with detachable arms 01/01/2000 Open
E0167 Pail or pan for use with commode chair, replacement only 01/01/2000 Open
E0168 Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each 01/01/2001 Open
E0170 Commode chair with integrated seat lift mechanism, electric, any type 01/01/2006 Open
E0171 Commode chair with integrated seat lift mechanism, non-electric, any type 01/01/2006 Open
E0172 Seat lift mechanism placed over or on top of toilet, any type 01/01/2006 Open
E0175 Foot rest, for use with commode chair, each 01/01/2000 Open
E0181 Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty 01/01/2000 Open
E0182 Pump for alternating pressure pad, for replacement only 01/01/2000 Open
E0183 Powered pressure reducing underlay/pad, alternating, with pump, includes heavy duty 10/01/2022 Open
E0184 Dry pressure mattress 01/01/2000 Open
E0185 Gel or gel-like pressure pad for mattress, standard mattress length and width 01/01/2000 Open
E0186 Air pressure mattress 01/01/2000 Open
E0187 Water pressure mattress 01/01/2000 Open
E0188 Synthetic sheepskin pad 01/01/2000 Open
E0189 Lambswool sheepskin pad, any size 01/01/2000 Open
E0191 Heel or elbow protector, each 01/01/2000 Open
E0192 LOW PRESSURE AND POSITIONING EQUALIZATION PAD, FOR WHEELCHAIR 01/01/1900 12/31/2004
E0193 Powered air flotation bed (low air loss therapy) 01/01/1900 Open
E0196 Gel pressure mattress 01/01/2000 Open
E0197 Air pressure pad for mattress, standard mattress length and width 01/01/2000 Open
E0198 Water pressure pad for mattress, standard mattress length and width 01/01/2000 Open
E0199 Dry pressure pad for mattress, standard mattress length and width 01/01/2000 Open
E0200 Heat lamp, without stand (table model), includes bulb, or infrared element 01/01/2000 Open
E0202 Phototherapy (bilirubin) light with photometer 01/01/2000 Open
E0203 Therapeutic lightbox, minimum 10,000 lux, table top model 01/01/2003 Open
E0205 Heat lamp, with stand, includes bulb, or infrared element 01/01/2000 Open
E0210 Electric heat pad, standard 01/01/2000 Open
E0215 Electric heat pad, moist 01/01/2000 Open
E0217 Water circulating heat pad with pump 01/01/2000 Open
E0218 Fluid circulating cold pad with pump, any type 01/01/2000 Open
E0220 HOT WATER BOTTLE 01/01/2000 12/31/2010
E0221 Infrared heating pad system 01/01/2002 Open
E0225 Hydrocollator unit, includes pads 01/01/2000 Open
E0230 ICE CAP OR COLLAR 01/01/2000 12/31/2010
E0231 Non-contact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover 01/01/2002 Open
E0232 Warming card for use with the non contact wound warming device and non contact wound warming wound cover 01/01/2002 Open
E0235 Paraffin bath unit, portable (see medical supply code a4265 for paraffin) 01/01/2000 Open
E0236 Pump for water circulating pad 01/01/2000 Open
E0238 NON-ELECTRIC HEAT PAD, MOIST 01/01/2000 12/31/2010
E0239 Hydrocollator unit, portable 01/01/2000 Open
E0240 Bath/shower chair, with or without wheels, any size 01/01/2004 Open
E0241 Bath tub wall rail, each 01/01/2000 Open
E0242 Bath tub rail, floor base 01/01/2000 Open
E0243 Toilet rail, each 01/01/2000 Open
E0244 Raised toilet seat 01/01/2000 Open
E0245 Tub stool or bench 01/01/2000 Open
E0246 Transfer tub rail attachment 01/01/2000 Open
E0247 Transfer bench for tub or toilet with or without commode opening 01/01/2004 Open
E0248 Transfer bench, heavy duty, for tub or toilet with or without commode opening 01/01/2004 Open
E0249 Pad for water circulating heat unit, for replacement only 01/01/2000 Open
E0250 Hospital bed, fixed height, with any type side rails, with mattress 01/01/2000 Open
E0251 Hospital bed, fixed height, with any type side rails, without mattress 01/01/2000 Open
E0255 Hospital bed, variable height, hi-lo, with any type side rails, with mattress 01/01/2000 Open
E0256 Hospital bed, variable height, hi-lo, with any type side rails, without mattress 01/01/2000 Open
E0260 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress 01/01/2000 Open
E0261 Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress 01/01/2000 Open
E0265 Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress 01/01/2000 Open
E0266 Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress 01/01/2000 Open
E0270 Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress 01/01/2000 Open
E0271 Mattress, innerspring 01/01/2000 Open
E0272 Mattress, foam rubber 01/01/2000 Open
E0273 Bed board 01/01/2000 Open
E0274 Over-bed table 01/01/2000 Open
E0275 Bed pan, standard, metal or plastic 01/01/2000 Open
E0276 Bed pan, fracture, metal or plastic 01/01/2000 Open
E0277 Powered pressure-reducing air mattress 01/01/1900 Open
E0280 Bed cradle, any type 01/01/2000 Open
E0290 Hospital bed, fixed height, without side rails, with mattress 01/01/2000 Open
E0291 Hospital bed, fixed height, without side rails, without mattress 01/01/2000 Open
E0292 Hospital bed, variable height, hi-lo, without side rails, with mattress 01/01/2000 Open
E0293 Hospital bed, variable height, hi-lo, without side rails, without mattress 01/01/2000 Open
E0294 Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress 01/01/2000 Open
E0295 Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress 01/01/2000 Open
E0296 Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress 01/01/2000 Open
E0297 Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress 01/01/2000 Open
E0300 Pediatric crib, hospital grade, fully enclosed, with or without top enclosure 01/01/2004 Open
E0301 Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress 01/01/2004 Open
E0302 Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress 01/01/2004 Open
E0303 Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress 01/01/2004 Open
E0304 Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress 01/01/2004 Open
E0305 Bed side rails, half length 01/01/2000 Open
E0310 Bed side rails, full length 01/01/2000 Open
E0315 Bed accessory: board, table, or support device, any type 01/01/2000 Open
E0316 Safety enclosure frame/canopy for use with hospital bed, any type 01/01/2002 Open
E0325 Urinal; male, jug-type, any material 01/01/2000 Open
E0326 Urinal; female, jug-type, any material 01/01/2000 Open
E0350 Control unit for electronic bowel irrigation/evacuation system 01/01/2000 Open
E0352 Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system 01/01/2000 Open
E0370 Air pressure elevator for heel 01/01/2000 Open
E0371 Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width 01/01/2000 Open
E0372 Powered air overlay for mattress, standard mattress length and width 01/01/1998 Open
E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing 01/01/2000 Open
E0425 Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing 01/01/2000 Open
E0430 Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing 01/01/2000 Open
E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing 01/01/2000 Open
E0433 Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge 01/01/2010 Open
E0434 Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing 01/01/2000 Open
E0435 Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor 01/01/2000 Open
E0439 Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing 01/01/2000 Open
E0440 Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing 01/01/2000 Open
E0441 Stationary oxygen contents, gaseous, 1 month's supply = 1 unit 01/01/2000 Open
E0442 Stationary oxygen contents, liquid, 1 month's supply = 1 unit 01/01/2000 Open
E0443 Portable oxygen contents, gaseous, 1 month's supply = 1 unit 01/01/2000 Open
E0444 Portable oxygen contents, liquid, 1 month's supply = 1 unit 01/01/2000 Open
E0445 Oximeter device for measuring blood oxygen levels non-invasively 01/01/2003 Open
E0450 Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) 01/01/2000 12/31/2015
E0453 THERAPEUTIC VENTILATOR; SUITABLE FOR USE 12 HOURS OR LESS PER DAY 01/01/2000 01/01/2000
E0455 Oxygen tent, excluding croup or pediatric tents 01/01/2000 Open
E0457 Chest shell (cuirass) 01/01/2000 Open
E0459 Chest wrap 01/01/2000 Open
E0460 Negative pressure ventilator; portable or stationary 01/01/2000 12/31/2015
E0461 Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask) 01/01/2000 12/31/2015
E0462 Rocking bed with or without side rails 01/01/2000 Open
E0463 Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) 01/01/2005 12/31/2015
E0464 Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask) 01/01/2005 12/31/2015
E0470 Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 01/01/2004 Open
E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 01/01/2004 Open
E0472 Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device) 01/01/2004 Open
E0480 Percussor, electric or pneumatic, home model 01/01/2000 Open
E0482 Cough stimulating device, alternating positive and negative airway pressure 01/01/2002 Open
E0483 High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each 01/01/2003 Open
E0484 Oscillatory positive expiratory pressure device, non-electric, any type, each 01/01/2003 Open
E0485 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment 01/01/2006 Open
E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment 01/01/2006 Open
E0500 Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source 01/01/2000 Open
E0550 Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery 01/01/2000 Open
E0555 Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter 01/01/2000 Open
E0560 Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery 01/01/2000 Open
E0561 Humidifier, non-heated, used with positive airway pressure device 01/01/2004 Open
E0562 Humidifier, heated, used with positive airway pressure device 01/01/2004 Open
E0565 Compressor, air power source for equipment which is not self-contained or cylinder driven 01/01/2000 Open
E0570 Nebulizer, with compressor 01/01/2000 Open
E0571 Aerosol compressor, battery powered, for use with small volume nebulizer 01/01/2001 12/31/2011
E0572 Aerosol compressor, adjustable pressure, light duty for intermittent use 01/01/2001 Open
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer 01/01/2003 Open
E0575 Nebulizer, ultrasonic, large volume 01/01/2000 Open
E0580 Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter 01/01/2000 Open
E0585 Nebulizer, with compressor and heater 01/01/2000 Open
E0600 Respiratory suction pump, home model, portable or stationary, electric 01/01/2000 Open
E0601 Continuous positive airway pressure (cpap) device 01/01/2000 Open
E0602 Breast pump, manual, any type 01/01/2000 Open
E0603 Breast pump, electric (ac and/or dc), any type 03/26/2003 Open
E0604 Breast pump, hospital grade, electric (ac and / or dc), any type 01/01/2002 Open
E0605 Vaporizer, room type 01/01/2000 Open
E0606 Postural drainage board 01/01/2000 Open
E0607 Home blood glucose monitor 01/01/2000 Open
E0610 Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) 01/01/2000 Open
E0615 Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems 01/01/2000 Open
E0618 Apnea monitor, without recording feature 01/01/2003 Open
E0619 Apnea monitor, with recording feature 01/01/2003 Open
E0620 Skin piercing device for collection of capillary blood, laser, each 01/01/2000 Open
E0621 Sling or seat, patient lift, canvas or nylon 01/01/2000 Open
E0625 Patient lift, bathroom or toilet, not otherwise classified 01/01/2000 Open
E0627 Seat lift mechanism, electric, any type 01/01/1900 Open
E0628 Separate seat lift mechanism for use with patient owned furniture-electric 01/01/1900 12/31/2016
E0629 Seat lift mechanism, non-electric, any type 01/01/1900 Open
E0630 Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) 01/01/2000 Open
E0635 Patient lift, electric with seat or sling 01/01/2000 Open
E0636 Multipositional patient support system, with integrated lift, patient accessible controls 01/01/2003 Open
E0637 Combination sit to stand frame/table system, any size including pediatric, with seat lift feature, with or without wheels 01/01/2004 Open
E0638 Standing frame/table system, one position (e.g., upright, supine or prone stander), any size including pediatric, with or without wheels 01/01/2004 Open
E0639 Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories 01/01/2005 Open
E0640 Patient lift, fixed system, includes all components/accessories 01/01/2005 Open
E0641 Standing frame/table system, multi-position (e.g., three-way stander), any size including pediatric, with or without wheels 01/01/2006 Open
E0650 Pneumatic compressor, non-segmental home model 01/01/2000 Open
E0651 Pneumatic compressor, segmental home model without calibrated gradient pressure 01/01/2000 Open
E0652 Pneumatic compressor, segmental home model with calibrated gradient pressure 01/01/2000 Open
E0655 Non-segmental pneumatic appliance for use with pneumatic compressor, half arm 01/01/2000 Open
E0656 Segmental pneumatic appliance for use with pneumatic compressor, trunk 01/01/2009 Open
E0657 Segmental pneumatic appliance for use with pneumatic compressor, chest 01/01/2009 Open
E0660 Non-segmental pneumatic appliance for use with pneumatic compressor, full leg 01/01/2000 Open
E0665 Non-segmental pneumatic appliance for use with pneumatic compressor, full arm 01/01/2000 Open
E0666 Non-segmental pneumatic appliance for use with pneumatic compressor, half leg 01/01/2000 Open
E0667 Segmental pneumatic appliance for use with pneumatic compressor, full leg 01/01/2000 Open
E0668 Segmental pneumatic appliance for use with pneumatic compressor, full arm 01/01/2000 Open
E0669 Segmental pneumatic appliance for use with pneumatic compressor, half leg 01/01/2000 Open
E0670 Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk 01/01/2013 Open
E0671 Segmental gradient pressure pneumatic appliance, full leg 01/01/2000 Open
E0672 Segmental gradient pressure pneumatic appliance, full arm 01/01/2000 Open
E0673 Segmental gradient pressure pneumatic appliance, half leg 01/01/2000 Open
E0675 Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) 01/01/2004 Open
E0677 Non-pneumatic sequential compression garment, trunk 04/01/2023 Open
E0678 Non-pneumatic sequential compression garment, full leg 01/01/2024 Open
E0679 Non-pneumatic sequential compression garment, half leg 01/01/2024 Open
E0680 Non-pneumatic compression controller with sequential calibrated gradient pressure 01/01/2024 Open
E0681 Non-pneumatic compression controller without calibrated gradient pressure 01/01/2024 Open
E0682 Non-pneumatic sequential compression garment, full arm 01/01/2024 Open
E0691 Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square feet or less 01/01/2003 Open
E0692 Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 4 foot panel 01/01/2003 Open
E0693 Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, 6 foot panel 01/01/2003 Open
E0694 Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes bulbs/lamps, timer and eye protection 01/01/2003 Open
E0700 Safety equipment, device or accessory, any type 01/01/2000 Open
E0705 Transfer device, any type, each 01/01/2006 Open
E0710 Restraints, any type (body, chest, wrist or ankle) 01/01/2000 Open
E0776 Iv pole 01/01/2000 Open
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater 01/01/2000 Open
E0780 Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours 01/01/2000 Open
E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient 01/01/2000 Open
E0784 External ambulatory infusion pump, insulin 01/01/2000 Open
E0787 External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing 01/01/2020 Open
E0791 Parenteral infusion pump, stationary, single or multi-channel 01/01/2000 Open
E0830 Ambulatory traction device, all types, each 01/01/2001 Open
E0840 Traction frame, attached to headboard, cervical traction 01/01/2000 Open
E0849 Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible 01/01/2005 Open
E0850 Traction stand, free standing, cervical traction 01/01/2000 Open
E0855 Cervical traction equipment not requiring additional stand or frame 01/01/2000 Open
E0860 Traction equipment, overdoor, cervical 01/01/2000 Open
E0870 Traction frame, attached to footboard, extremity traction, (e.g., buck's) 01/01/2000 Open
E0880 Traction stand, free standing, extremity traction 01/01/2000 Open
E0890 Traction frame, attached to footboard, pelvic traction 01/01/2000 Open
E0900 Traction stand, free standing, pelvic traction, (e.g., buck's) 01/01/2000 Open
E0910 Trapeze bars, a/k/a patient helper, attached to bed, with grab bar 01/01/2000 Open
E0920 Fracture frame, attached to bed, includes weights 01/01/2000 Open
E0930 Fracture frame, free standing, includes weights 01/01/2000 Open
E0935 Continuous passive motion exercise device for use on knee only 01/01/2000 Open
E0940 Trapeze bar, free standing, complete with grab bar 01/01/2000 Open
E0941 Gravity assisted traction device, any type 01/01/2000 Open
E0942 Cervical head harness/halter 01/01/2000 Open
E0944 Pelvic belt/harness/boot 01/01/2000 Open
E0945 Extremity belt/harness 01/01/2000 Open
E0946 Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster) 01/01/2000 Open
E0947 Fracture frame, attachments for complex pelvic traction 01/01/2000 Open
E0948 Fracture frame, attachments for complex cervical traction 01/01/2000 Open
E0950 Wheelchair accessory, tray, each 01/01/2000 Open
E0951 Heel loop/holder, any type, with or without ankle strap, each 01/01/1900 Open
E0952 Toe loop/holder, any type, each 01/01/1900 Open
E0953 Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each 01/01/2018 Open
E0954 Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot 01/01/2018 Open
E0955 Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each 01/01/2004 Open
E0956 Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each 01/01/2004 Open
E0957 Wheelchair accessory, medial thigh support, any type, including fixed mounting hardware, each 01/01/2004 Open
E0958 Manual wheelchair accessory, one-arm drive attachment, each 01/01/1900 Open
E0959 Manual wheelchair accessory, adapter for amputee, each 01/01/1900 Open
E0960 Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware 01/01/2004 Open
E0961 Manual wheelchair accessory, wheel lock brake extension (handle), each 01/01/1900 Open
E0962 1" CUSHION, FOR WHEELCHAIR 01/01/1900 12/31/2004
E0964 3" CUSHION, FOR WHEELCHAIR 01/01/1900 12/31/2004
E0965 4" CUSHION, FOR WHEELCHAIR 01/01/1900 12/31/2004
E0966 Manual wheelchair accessory, headrest extension, each 01/01/1900 Open
E0967 Manual wheelchair accessory, hand rim with projections, any type, replacement only, each 01/01/1900 Open
E0968 Commode seat, wheelchair 01/01/2000 Open
E0969 Narrowing device, wheelchair 01/01/1900 Open
E0970 No. 2 footplates, except for elevating leg rest 01/01/1900 Open
E0971 Manual wheelchair accessory, anti-tipping device, each 01/01/1900 Open
E0973 Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each 01/01/1900 Open
E0974 Manual wheelchair accessory, anti-rollback device, each 01/01/1900 Open
E0975 REINFORCED SEAT UPHOLSTERY, WHEELCHAIR 01/01/1900 12/31/2003
E0976 REINFORCED BACK, WHEELCHAIR, UPHOLSTERY OR OTHER MATERIAL 01/01/1900 12/31/2003
E0978 Wheelchair accessory, positioning belt/safety belt/pelvic strap, each 01/01/1900 Open
E0979 BELT, SAFETY WITH VELCRO CLOSURE, WHEELCHAIR 01/01/1900 Open
E0980 Safety vest, wheelchair 01/01/2000 Open
E0981 Wheelchair accessory, seat upholstery, replacement only, each 01/01/1900 Open
E0982 Wheelchair accessory, back upholstery, replacement only, each 01/01/2004 Open
E0983 Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control 01/01/2004 Open
E0984 Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control 01/01/2004 Open
E0985 Wheelchair accessory, seat lift mechanism 01/01/2004 Open
E0986 Manual wheelchair accessory, push-rim activated power assist system 01/01/2004 Open
E0988 Manual wheelchair accessory, lever-activated, wheel drive, pair 01/01/2012 Open
E0990 Wheelchair accessory, elevating leg rest, complete assembly, each 01/01/1900 Open
E0991 UPHOLSTERY SEAT 01/01/1900 12/31/2003
E0992 Manual wheelchair accessory, solid seat insert 01/01/1900 Open
E0993 BACK, UPHOLSTERY 01/01/1900 12/31/2003
E0994 Arm rest, each 01/01/1900 Open
E0995 Wheelchair accessory, calf rest/pad, replacement only, each 01/01/1900 Open
E1011 Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) 01/01/2003 Open
E1012 Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each 08/25/2017 Open
E1014 Reclining back, addition to pediatric size wheelchair 01/01/2003 Open
E1015 Shock absorber for manual wheelchair, each 01/01/2003 Open
E1016 Shock absorber for power wheelchair, each 01/01/2003 Open
E1017 Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each 01/01/2003 Open
E1018 Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each 01/01/2003 Open
E1020 Residual limb support system for wheelchair, any type 01/01/2003 Open
E1028 Wheelchair accessory, manual swingaway, retractable or removable mounting hardware for joystick, other control interface or positioning accessory 01/01/2004 Open
E1029 Wheelchair accessory, ventilator tray, fixed 01/01/2004 Open
E1030 Wheelchair accessory, ventilator tray, gimbaled 01/01/2000 Open
E1031 Rollabout chair, any and all types with casters 5" or greater 01/01/2000 Open
E1035 Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs 01/01/2000 Open
E1036 Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity greater than 300 lbs 01/01/2000 Open
E1037 Transport chair, pediatric size 01/01/2003 Open
E1038 Transport chair, adult size, patient weight capacity up to and including 300 pounds 01/01/2003 Open
E1039 Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds 01/01/2005 Open
E1130 Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests 01/01/2000 Open
E1140 Wheelchair, detachable arms, desk or full length, swing away detachable footrests 01/01/2000 Open
E1150 Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests 01/01/2000 Open
E1160 Wheelchair, fixed full length arms, swing away detachable elevating legrests 01/01/2000 Open
E1225 Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each 09/01/2008 Open
E1226 Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each 09/01/2008 Open
E1227 Special height arms for wheelchair 09/01/2008 Open
E1228 Special back height for wheelchair 09/01/2008 Open
E1229 Wheelchair, pediatric size, not otherwise specified 01/01/2005 Open
E1231 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system 01/01/2003 Open
E1232 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system 01/01/2003 Open
E1233 Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system 01/01/2003 Open
E1234 Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system 01/01/2003 Open
E1235 Wheelchair, pediatric size, rigid, adjustable, with seating system 01/01/2003 Open
E1236 Wheelchair, pediatric size, folding, adjustable, with seating system 01/01/2003 Open
E1237 Wheelchair, pediatric size, rigid, adjustable, without seating system 01/01/2003 Open
E1238 Wheelchair, pediatric size, folding, adjustable, without seating system 01/01/2003 Open
E1239 Power wheelchair, pediatric size, not otherwise specified 01/01/2005 08/31/2008
E1310 Whirlpool, non-portable (built-in type) 01/01/2000 Open
E1352 Oxygen accessory, flow regulator capable of positive inspiratory pressure 01/01/2000 12/31/2013
E1352 Oxygen accessory, flow regulator capable of positive inspiratory pressure 08/25/2017 Open
E1353 Regulator 01/01/2000 Open
E1354 Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each 01/01/2000 Open
E1355 Stand/rack 01/01/2000 Open
E1356 Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each 01/01/2000 Open
E1357 Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each 01/01/2009 Open
E1358 Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each 01/01/2009 Open
E1372 Immersion external heater for nebulizer 01/01/2000 Open
E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate 01/01/2000 Open
E1391 Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each 01/01/2000 Open
E1392 Portable oxygen concentrator, rental 01/01/2000 Open
E1400 OXYGEN CONCENTRATOR, MANUFACTURER SPECIFIED MAXIMUM FLOW RATE DOES NOT EXCEED 2 LITERS PER MINUTE, AT 85 PERCENT OR GREATER CONCENTRATION. 01/01/2000 01/01/2000
E1401 OXYGEN CONCENTRATOR, MANUFACTURER SPECIFIED MAXIMUM FLOW RATE GREATER THAN 2 LITERS PER MINUTE, DOES NOT EXCEED 3 LITERS PER MINUTE, AT 85 PERCENT OR GREATER CONCENTRATION 01/01/2000 01/01/2000
E1402 OXYGEN CONCENTRATOR, MANUFACTURER SPECIFIED MAXIMUM FLOW RATE GREATER THAN 3 LITERS PER MINUTE, DOES NOT EXCEED 4 LITERS PER MINUTE, AT 85 PERCENT OR GREATER CONCENTRATION 01/01/2000 01/01/2000
E1403 OXYGEN CONCENTRATOR, MANUFACTURER SPECIFIED MAXIMUM FLOW RATE GREATER THAN 4 LITERS PER MINUTE, DOES NOT EXCEED 5 LITERS PER MINUTE, AT 85 PERCENT OR GREATER CONCENTRATION 01/01/2000 01/01/2000
E1404 OXYGEN CONCENTRATOR, MANUFACTURER SPECIFIED MAXIMUM FLOW RATE GREATER THAN 5 LITERS PER MINUTE, AT 85 PERCENT OR GREATER CONCENTRATION 01/01/2000 01/01/2000
E1405 Oxygen and water vapor enriching system with heated delivery 01/01/2000 Open
E1406 Oxygen and water vapor enriching system without heated delivery 01/01/2000 Open
E1610 Reverse osmosis water purification system, for hemodialysis 10/01/2003 12/31/2022
E1615 Deionizer water purification system, for hemodialysis 10/01/2003 12/31/2022
E1625 Water softening system, for hemodialysis 10/01/2003 12/31/2022
E1629 Tablo hemodialysis system for the billable dialysis service 01/01/2022 12/31/2022
E1634 Peritoneal dialysis clamps, each 01/01/2004 12/31/2022
E1700 Jaw motion rehabilitation system 01/01/2000 Open
E1701 Replacement cushions for jaw motion rehabilitation system, pkg. of 6 01/01/2000 Open
E1702 Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200 01/01/2000 Open
E1802 Dynamic adjustable forearm pronation/supination device, includes soft interface material 01/01/2003 Open
E2100 Blood glucose monitor with integrated voice synthesizer 01/01/2002 Open
E2101 Blood glucose monitor with integrated lancing/blood sample 01/01/2002 Open
E2102 Adjunctive, non-implanted continuous glucose monitor or receiver 04/01/2022 Open
E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver 01/01/2023 Open
E2202 Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches 09/01/2008 Open
E2203 Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches 09/01/2008 Open
E2204 Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches 09/01/2008 Open
E2205 Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each 01/01/2005 Open
E2206 Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each 09/01/2008 Open
E2209 Accessory, arm trough, with or without hand support, each 01/01/2006 Open
E2210 Wheelchair accessory, bearings, any type, replacement only, each 09/01/2008 Open
E2211 Manual wheelchair accessory, pneumatic propulsion tire, any size, each 01/01/2006 Open
E2212 Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each 09/01/2008 Open
E2213 Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each 01/01/2006 Open
E2214 Manual wheelchair accessory, pneumatic caster tire, any size, each 01/01/2006 Open
E2215 Manual wheelchair accessory, tube for pneumatic caster tire, any size, each 09/01/2008 Open
E2216 Manual wheelchair accessory, foam filled propulsion tire, any size, each 09/01/2008 Open
E2217 Manual wheelchair accessory, foam filled caster tire, any size, each 09/01/2008 Open
E2218 Manual wheelchair accessory, foam propulsion tire, any size, each 09/01/2008 Open
E2219 Manual wheelchair accessory, foam caster tire, any size, each 01/01/2006 Open
E2220 Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each 01/01/2006 Open
E2221 Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each 09/01/2008 Open
E2222 Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each 09/01/2008 Open
E2223 MANUAL WHEELCHAIR ACCESSORY, VALVE, ANY TYPE, REPLACEMENT ONLY, EACH 09/01/2008 12/31/2009
E2224 Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each 01/01/2006 Open
E2225 Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each 09/01/2008 Open
E2226 Manual wheelchair accessory, caster fork, any size, replacement only, each 09/01/2008 Open
E2228 Manual wheelchair accessory, wheel braking system and lock, complete, each 01/01/2017 Open
E2230 Manual wheelchair accessory, manual standing system 01/01/2009 Open
E2231 Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware 01/01/2009 Open
E2291 Back, planar, for pediatric size wheelchair including fixed attaching hardware 09/01/2008 Open
E2292 Seat, planar, for pediatric size wheelchair including fixed attaching hardware 09/01/2008 Open
E2293 Back, contoured, for pediatric size wheelchair including fixed attaching hardware 09/01/2008 Open
E2294 Seat, contoured, for pediatric size wheelchair including fixed attaching hardware 09/01/2008 Open
E2295 Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features 01/01/2009 Open
E2398 Wheelchair accessory, dynamic positioning hardware for back 01/01/2020 Open
E2601 General use wheelchair seat cushion, width less than 22 inches, any depth 01/01/2005 Open
E2602 General use wheelchair seat cushion, width 22 inches or greater, any depth 01/01/2005 Open
E2603 Skin protection wheelchair seat cushion, width less than 22 inches, any depth 09/01/2008 Open
E2604 Skin protection wheelchair seat cushion, width 22 inches or greater, any depth 09/01/2008 Open
E2605 Positioning wheelchair seat cushion, width less than 22 inches, any depth 09/01/2008 Open
E2606 Positioning wheelchair seat cushion, width 22 inches or greater, any depth 09/01/2008 Open
E2607 Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth 09/01/2008 Open
E2608 Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth 09/01/2008 Open
E2609 Custom fabricated wheelchair seat cushion, any size 09/01/2008 05/13/2010
E2611 General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware 01/01/2005 Open
E2612 General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware 01/01/2005 Open
E2613 Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware 09/01/2008 Open
E2614 Positioning wheelchair back cushion, posterior, width 22 inches or greater, any height, including any type mounting hardware 09/01/2008 Open
E2615 Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware 09/01/2008 Open
E2616 Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware 09/01/2008 Open
E2618 WHEELCHAIR ACCESSORY, SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), FOR USE WITH MANUAL WHEELCHAIR OR LIGHTWEIGHT POWER WHEELCHAIR, INCLUDES ANY TYPE MOUNTING HARDWARE 09/01/2008 Open
E2619 Replacement cover for wheelchair seat cushion or back cushion, each 09/01/2008 Open
E2620 Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware 09/01/2008 Open
E2621 Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware 09/01/2008 Open
E2622 Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth 01/01/2011 Open
E2623 Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth 01/01/2011 Open
E2624 Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth 01/01/2011 Open
E2625 Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth 01/01/2011 Open
K0001 Standard wheelchair 11/01/2023 Open
K0009 Other manual wheelchair/base 11/01/2023 Open
K0015 Detachable, non-adjustable height armrest, replacement only, each 01/01/2017 Open
K0017 Detachable, adjustable height armrest, base, replacement only, each 11/01/2023 Open
K0018 Detachable, adjustable height armrest, upper portion, replacement only, each 11/01/2023 Open
K0019 Arm pad, replacement only, each 01/01/2017 Open
K0020 Fixed, adjustable height armrest, pair 11/01/2023 Open
K0037 High mount flip-up footrest, each 01/01/2017 Open
K0038 Leg strap, each 11/01/2023 Open
K0039 Leg strap, h style, each 11/01/2023 Open
K0040 Adjustable angle footplate, each 01/01/2004 Open
K0041 Large size footplate, each 11/01/2023 Open
K0042 Standard size footplate, replacement only, each 01/01/2017 Open
K0043 Footrest, lower extension tube, replacement only, each 01/01/2004 Open
K0044 Footrest, upper hanger bracket, replacement only, each 01/01/2004 Open
K0045 Footrest, complete assembly, replacement only, each 01/01/2004 Open
K0046 Elevating legrest, lower extension tube, replacement only, each 01/01/2017 Open
K0047 Elevating legrest, upper hanger bracket, replacement only, each 01/01/2017 Open
K0050 Ratchet assembly, replacement only 01/01/2017 Open
K0051 Cam release assembly, footrest or legrest, replacement only, each 01/01/2017 Open
K0052 Swingaway, detachable footrests, replacement only, each 01/01/2017 Open
K0053 Elevating footrests, articulating (telescoping), each 11/01/2023 Open
K0056 Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair 11/01/2023 Open
K0065 Spoke protectors, each 11/01/2023 Open
K0069 Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each 01/01/2017 Open
K0070 Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each 11/01/2023 Open
K0071 Front caster assembly, complete, with pneumatic tire, replacement only, each 11/01/2023 Open
K0072 Front caster assembly, complete, with semi-pneumatic tire, replacement only, each 11/01/2023 Open
K0073 Caster pin lock, each 11/01/2023 Open
K0077 Front caster assembly, complete, with solid tire, replacement only, each 01/01/2017 Open
K0105 Iv hanger, each 11/01/2023 Open
K0195 Elevating leg rests, pair (for use with capped rental wheelchair base) 11/01/2023 Open
K0268 HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 01/01/1900 12/31/2003
K0407 URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT 01/01/1996 12/31/2000
K0408 URINARY CATHETER ANCHORING DEVICE, LEG STRAP 01/01/1996 12/31/2000
K0409 STERILE WATER IRRIGATION SOLUTION, 1000 ML 01/01/1996 12/31/2000
K0410 MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH 01/01/1996 12/31/2000
K0411 MALE EXTERNAL CATHETER, WITH ADHESIVE STRIP, EACH 01/01/1996 12/31/2000
K0531 HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 05/19/2000 12/31/2003
K0552 Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each 01/01/2004 Open
K0601 Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each 11/11/2005 Open
K0602 Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each 11/11/2005 Open
K0603 Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each 11/11/2005 Open
K0604 Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each 11/11/2005 Open
K0608 Replacement garment for use with automated external defibrillator, each 01/01/2004 Open
K0733 Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) 07/01/2006 Open
K0734 SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES, ANY DEPTH 07/01/2006 12/31/2010
K0735 SKIN PROTECTION WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER, ANY DEPTH 07/01/2006 12/31/2010
K0736 SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH LESS THAN 22 INCHES, ANY DEPTH 07/01/2006 12/31/2010
K0737 SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSHION, ADJUSTABLE, WIDTH 22 INCHES OR GREATER, ANY DEPTH 07/01/2006 12/31/2010
K0738 Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing 10/01/2006 Open
K0800 Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0801 Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0802 Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds 10/01/2006 08/31/2008
K0806 Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds 10/01/2006 08/31/2008
K0807 Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds 10/01/2006 08/31/2008
K0808 Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds 10/01/2006 08/31/2008
K0812 Power operated vehicle, not otherwise classified 10/01/2006 08/31/2008
K0813 Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0814 Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0815 Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0816 Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0820 Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0821 Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0822 Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0823 Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0824 Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0825 Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0826 Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0827 Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0828 Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more 10/01/2006 Open
K0829 Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more 10/01/2006 Open
K0830 Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 08/31/2008
K0831 Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 08/31/2008
K0835 Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0836 Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0837 Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0838 Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0839 Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0840 Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more 10/01/2006 Open
K0841 Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0842 Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0843 Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0848 Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0849 Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0850 Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0851 Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0852 Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0853 Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0854 Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more 10/01/2006 Open
K0855 Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more 10/01/2006 Open
K0856 Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0857 Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0858 Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight 301 to 450 pounds 10/01/2006 Open
K0859 Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0860 Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0861 Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0862 Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0863 Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0864 Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more 10/01/2006 Open
K0868 Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0869 Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0870 Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0871 Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds 10/01/2006 Open
K0877 Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0878 Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0879 Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0880 Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds 10/01/2006 Open
K0884 Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0885 Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds 10/01/2006 Open
K0886 Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds 10/01/2006 Open
K0890 Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds 10/01/2006 Open
K0891 Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds 10/01/2006 Open
K0898 Power wheelchair, not otherwise classified 10/01/2006 Open
K0899 Power mobility device, not coded by dme pdac or does not meet criteria 10/01/2006 08/31/2008
K1024 Non-pneumatic compression controller with sequential calibrated gradient pressure 10/01/2021 12/31/2023
K1025 Non-pneumatic sequential compression garment, full arm 10/01/2021 12/31/2023
K1027 Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustment 10/01/2021 Open
K1031 Non-pneumatic compression controller without calibrated gradient pressure 04/01/2022 12/31/2023
K1032 Non-pneumatic sequential compression garment, full leg 04/01/2022 12/31/2023
K1033 Non-pneumatic sequential compression garment, half leg 04/01/2022 12/31/2023
S1030 Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code) 01/01/2002 Open
S1031 Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code) 01/01/2002 Open
S5165 Home modifications; per service 01/01/2004 Open
S8100 Holding chamber or spacer for use with an inhaler or nebulizer; without mask 01/01/2002 Open
S8101 Holding chamber or spacer for use with an inhaler or nebulizer; with mask 01/01/2002 Open
S8105 OXIMETER FOR MEASURING BLOOD OXYGEN LEVELS NONINVASIVELY 01/01/2001 12/31/2002
S8120 Oxygen contents, gaseous, 1 unit equals 1 cubic foot 01/01/2004 Open
S8121 Oxygen contents, liquid, 1 unit equals 1 pound 01/01/2004 Open
S8180 TRACHEOSTOMY SHOWER PROTECTOR 01/01/2002 12/31/2002
S8181 TRACHEOSTOMY TUBE HOLDER 01/01/2002 12/31/2002
S8182 HUMIDIFIER, HEATED, USED WITH VENTILATOR, NON-SERVO-CONTROLLED 01/01/2002 12/31/2002
S8183 HUMIDIFIER, HEATED, USED WITH VENTILATOR, DUAL SERVO-CONTROLLED WITH TEMPERATURE MONITORING 01/01/2002 12/31/2002
S8185 Flutter device 01/01/2002 Open
S8186 Swivel adapter 01/01/2002 Open
S8189 Tracheostomy supply, not otherwise classified 01/01/2002 Open
S8190 ELECTRONIC SPIROMETER (OR MICROSPIROMETER) 01/01/2002 03/31/2009
S8421 Gradient pressure aid (sleeve and glove combination), ready made 01/01/2002 Open
S8424 Gradient pressure aid (sleeve), ready made 01/01/2002 Open
S8427 Gradient pressure aid (glove), ready made 01/01/2002 Open
S8428 Gradient pressure aid (gauntlet), ready made 01/01/2002 Open
S8429 Gradient pressure exterior wrap 01/01/2002 Open
S8430 Padding for compression bandage, roll 01/01/2002 Open
S8431 Compression bandage, roll 01/01/2002 Open
S8490 Insulin syringes (100 syringes, any size) 01/01/2002 Open
T2029 Specialized medical equipment, not otherwise specified, waiver 01/01/2004 Open
T2039 Vehicle modifications, waiver; per service 01/01/2004 Open
T4521 Adult sized disposable incontinence product, brief/diaper, small, each 01/01/2005 Open
T4522 Adult sized disposable incontinence product, brief/diaper, medium, each 01/01/2005 Open
T4523 Adult sized disposable incontinence product, brief/diaper, large, each 01/01/2005 Open
T4524 Adult sized disposable incontinence product, brief/diaper, extra large, each 01/01/2005 Open
T4525 Adult sized disposable incontinence product, protective underwear/pull-on, small size, each 01/01/2005 Open
T4526 Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each 01/01/2005 Open
T4527 Adult sized disposable incontinence product, protective underwear/pull-on, large size, each 01/01/2005 Open
T4528 Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each 01/01/2005 Open
T4529 Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each 01/01/2005 Open
T4530 Pediatric sized disposable incontinence product, brief/diaper, large size, each 01/01/2005 Open
T4531 Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each 01/01/2005 Open
T4532 Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each 01/01/2005 Open
T4533 Youth sized disposable incontinence product, brief/diaper, each 01/01/2005 Open
T4534 Youth sized disposable incontinence product, protective underwear/pull-on, each 01/01/2005 Open
T4535 Disposable liner/shield/guard/pad/undergarment, for incontinence, each 01/01/2005 Open
T4536 Incontinence product, protective underwear/pull-on, reusable, any size, each 01/01/2005 Open
T4537 Incontinence product, protective underpad, reusable, bed size, each 01/01/2005 Open
T4539 Incontinence product, diaper/brief, reusable, any size, each 01/01/2005 Open
T4540 Incontinence product, protective underpad, reusable, chair size, each 01/01/2005 Open
T4541 Incontinence product, disposable underpad, large, each 01/01/2005 Open
T4542 Incontinence product, disposable underpad, small size, each 01/01/2005 Open
T4543 Adult sized disposable incontinence product, protective brief/diaper, above extra large, each 02/01/2008 Open
T4544 Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each 01/01/2014 Open