dme codes that require authorization · b4154 enteral formula,nutritionally complete,for special...

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A4210 NEEDLE-FREE INJECT-A4210 AA4421 OSTOMY SUPPLY,MISC.-A4421 AA4435 1PC OST PCH DRAIN HIGH OUTPUT AA4456 ADHESIVE REMOVER, WIPES AA4466 GARMENT, BELT, SLEEVE OR OTHER COVERING, ELASTIC OR SIMILAR STRETCHABLE AA4614 PEAK EXPIRATORY FLOW RATE METER, HAND HELD AA4615 CANNULA,NASAL-A4615 AA4619 FACE TENT AA4620 VARIABLE CONCENTRATION MASK AA4649 SURGICAL SUPPLY, MISCELLANEOUS AA5083 CONTINENT DEVICE, STOMA ABSORPTIVE COVER FOR CONTINENT STOMA AA6010 COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE PER GRAM OF COLLAGEN AA6412 EYE PATCH, OCCLUSIVE, EACH AA6501 COMPRESS BURN GARMENT,BODYSUIT HEAD TO FOOT CUSTOM FABRIC AA6502 COMPRESSION BRN GARMNT, CHIN STRAP, CUSTOM FABRICATED AA6503 COMPRESS BRN GARMENT, FACIAL HOOD, CUSTOM FABRICATED AA6504 COMPRESSON BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICAT AA6505 COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICAT AA6506 COMPRSSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICAT AA6507 COMPRESS BURN GARMENT, FOOT TO KNEE LENGTH,CUSTOM FABR AA6508 COMPRESS BURN GARMENT, FOOT TO THIGH LENGTH,CUSTOM FABR AA6509 COMPRESSION BURN GARMENT,UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS(VEST) AA6510 COMPRESSION BURN GARMENT,TRUNK,INCLUDING ARMS DOWN TO LEG OPENINGS(LEOTARD AA6511 COMPRESSION BURN GARMENT,LOWER TRUNK INCLUDING LEG OPENINGS (PANTY) AA6512 COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED AA6513 COMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED AA6545 GRADIENT COMPRESSION WRAP, NON-ELASTIC, BELOW KNEE, 30-50 MM HG, EA AA6549 GRADIENT COMPRESSION STOCKING, NOT OTHERWISE SPECIFIED AA7522 TRACHEOSTOMY LARYNGECTOMY TUBE STAINLESS STEEL OR EQUAL STERIZABLE AA8002 HELMET, PROTECTIVE, SOFT, CUSTOM FABRICATE, INCL ALL COMPONENTS AND ACCESS AA8003 HELMET,PROTECTIVE,HARD,CUSTOM FABRICATED,INCL ALL COMPONENTS/ACCESSORIES AA9999 MISCELLANEOUS DME SUPPLY OR ACCESSORY NOT OTHERWISE SPECIFIED AB4034 ENTERAL FEEDING SUPPLY KIT, SYRINGE FED, PER DAY AB4154 ENTERAL FORMULA,NUTRITIONALLY COMPLETE,FOR SPECIAL METABOLIC NEEDS AB4154 BO EF SPECMETABOLIC NONINHERIT AB4157 ENTERAL FORMULA NUTRITIONALLY COMPLETE FOR SPECIAL METABOLIC NEEDS AB4157 BO EF SPECIAL METABOLIC INHERIT AB4162 ENTERAL FORMULA,FOR PEDS,SPECIAL METABOLIC NEEDS FOR INHERITED DISEASE OF METAB AB4162 BO EF PED SPEC METABOLIC INHERIT AB9000 ENTERAL NUTRITION INFUSION PUMP, WITHOUT ALARM AB9000 RB ENTER INFUSION PUMP W/O ALRM AB9002 ENTERAL NUTRITION INFUSION PUMP, WITH ALARM AB9002 RB ENTERAL NUT. PUMP W/ALARM, EA. AB9004 RB PARENTERAL INFUS PUMP PORTAB AB9006 RB PARENTERAL INFUS PUMP STATIO AB9998 NOC FOR ENTERAL SUPPLIES AB9999 NOC FOR PARENTERAL SUPPLIES AE0105 RA Cane Adjust/Fixed Quad/3 Pro AE0105 RB CANE,QUAD OR THREE PRONGED AE0110 RA Crutch Forearm Pair AE0110 RB CRUTCHES,FOREARM,PAIR AE0111 RA Crutch Forearm Each AE0111 RB CRUTCH,FOREARM,EACH AE0130 RA Walker Rigid Adjust/Fixed Ht AE0130 RB WALKER,RIGID,ADJ.,FIXED AE0130 U4 WALKER,RIGID,ADJ. OR FIXED AE0135 RA Walker Folding Adjust/Fixed AE0135 RB WALKER,FOLDING,ADJ.,FIXED AE0135 U4 WALKER,FOLDING,ADJ. OR FIXED AE0140 WALKER WITH TRUNK SUPPORT ADJUSTABLE OR FIXED HEIGHT AE0140 U4 WALKER W TRUNK SUPPORT A

AETNA BETTER HEALTH OF MICHIGAN DME CODES THAT REQUIRE AUTHORIZATION

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E0141 RA Rigid Wheeled Walker Adj/Fix AE0141 RB WALKER,WHEELED,WITHOUTSEAT AE0141 U4 WALKER,WHEELED,W/O SEAT AE0143 RA Walker Folding Wheeled W/O S AE0143 RB FOLD. WALKER,WHEEL W/O SEAT AE0143 U4 FOLD. WALKER, WHEEL W/O SEAT AE0144 WALKER,ENCLOSED,FOUR SIDED FRAMED,RIGID OR FOLDING,WHEELED W/POSTERIOR SEAT AE0144 RA Enclosed Walker W Rear Seat AE0144 RB FLDG FRMD WALKER,WHEELS W/POST AE0144 U4 FLDG FRMD WALKER,WHEELS W/POST AE0147 WALKER,HEAVY DUTY,MULTIPLE BRAEAKING SYSTEM,VARIABLE WHEEL RESISTANCE AE0147 RA Walker Variable Wheel Resist AE0147 RB HEAVY DUTY WHEELED WALKER AE0147 U4 HEAVY DUTY WHEELED WALKER AE0148 U4 WALKER HD W/O WHEELS ANY TYPE AE0149 U4 WALKER HD W/WHEELS ANY TYPE AE0153 U4 PLATFORM,ATT.,FOREARM CRUTCH AE0154 U4 PLATFORM ATT,WALKER,EACH AE0155 U4 WHEEL ATT,RIGID WALKER ATT AE0156 U4 SEAT ATT,WALKER AE0157 U4 CRUTCH ATT,WALKER,EACH AE0158 U4 LEG EXTENSIONS,WALKER AE0159 U4 BRAKE ATTACHMT/WHEELED WALKER AE0163 RA Commode Chair With Fixed Arm AE0163 RB COMMODE,FIXED ARMS AE0163 U4 COMMODE,W/FIXED ARMS AE0165 RA Commode Chair With Detacharm AE0165 RB COMMODE,DETACH. ARMS AE0167 U4 PAIL, PAN, COMMODE, REP. AE0171 RA Commode Chair Non-Electric AE0171 RB COMMODE CHAIR NON-ELECTRIC AE0175 U4 FOOTREST,COMMODE,EACH AE0181 POWER PRESSURE REDUCE MATTRESS OVERLAY/PAD ALTERNATING W/PUMP, INCL HEAVY DUTY AE0181 RA Press Pad Alternating W/ Pum AE0181 RB POWR. PRESS. REDUC. MATTRESS OVERLAY/PAD, ALTERNATING, W/PUMP,INCL. HVYD AE0185 GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS,STANDARD MATTRESS LENGTH AND WIDTH AE0186 RA Air Pressure Mattress AE0186 RB AIR PRESSURE MATTRESS AE0187 RA Water Pressure Mattress AE0187 RB WATER PRESSURE MATTRESS AE0193 MS POWERED AIR FLOTATION BED AE0194 MS AIR FLUIDIZED BED AE0196 RA Gel Pressure Mattress AE0196 RB GEL PRESSURE MATTRESS AE0197 RA Air Pressure Pad For Mattres AE0197 RB AIR PRESSURE PAD FOR MATTRESS AE0198 RA Water Pressure Pad For Mattr AE0198 RB WATER PRESSURE PAD FOR MATTRES AE0236 RA Pump For Water Circulating P AE0236 RB PUMP FOR WATER CIRC PAD AE0240 BATH/SHOWER CHAIR, WITH OR WITHOUT WHEELS, ANY SIZE AE0241 BATHTUB WALL RAIL,EACH AE0243 TOILET RAIL EACH-E0243 AE0244 RAISED TOILET SEAT-E0244 AE0245 TUB STOOL OR BENCH-E0245 AE0247 TRANSFER BENCH FOR TUB OR TOILET W OR WO COMMODE OPENING AE0248 TRANSFER BENCH HEAVY DUTY FOR TUB OR TOILET W OR WO COMMODE OPENING AE0250 HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITH MATTRESS AE0250 RA Hosp Bed Fixed Ht W/ Mattres AE0250 RB HOSP.BED,SIDE RAILS,FIXED HGT. AE0251 HOSPITAL BED, FIXED HEIGHT, WITH ANY TYPE SIDE RAILS, WITHOUT MATTRESS A

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E0251 RA Hosp Bed Fixd Ht W/O Mattres AE0251 RB HOSP.BED,SIDE RAILS,FIXED,N.M. AE0255 HOSPITAL BED, VARIABLE HEIGHT, HI-LO, WITH ANY TYPE SIDE RAILS, WITH MATTRESS AE0255 RA Hospital Bed Var Ht W/ Mattr AE0255 RB HOSP.BED,SIDE RAILS,VAR. HGT. AE0256 HOSPITAL BED,VARIABLE HEIGHT,HI-LO,WITH ANY TYPE SIDE RAILS W/O MATTRESS AE0256 RA Hospital Bed Var Ht W/O Matt AE0256 RB HOSP BED VAR HGT S/RLS NO MAT AE0260 HOSPITAL BED,SEMI-ELEC(HEAD/FOOT ADJ) WITH ANY TYPE SIDE RAILS,WITH MATTRESS AE0260 RA Hosp Bed Semi-Electr W/ Matt AE0260 RB HOSP.BED,SIDE RAILS,SEMI-ELEC AE0261 HOSPITAL BED,SEMI-ELEC(HEAD/FOOT ADJ) WITH ANY TYPE SIDE RAILS,W/O MATTRESS AE0261 RA Hosp Bed Semi-Electr W/O Mat AE0261 RB HOSP BED,RAIL,SEMI-ELEC W/O MA AE0265 HOSPITAL BED,TOTAL ELEC (HEAD,FT,HT ADJ) WITH ANY TYPE SIDE RAILS,W/MATTRESS AE0265 RA Hosp Bed Total Electr W/ Mat AE0265 RB HOSP.BED,SIDE RAILS, ELECTRIC AE0266 HOSP BED,TOTAL ELECTRIC,WITH ANY TYPE SIDE RAILS,W/O MATTRESS AE0266 RA Hosp Bed Total Elec W/O Matt AE0266 RB HOSP.BED,SIDE RAILS,ELEC.,N.M. AE0277 POWERED PRESSURE-REDUCING AIR MATTRESS AE0277 RA Powered Pres-Redu Air Mattrs AE0277 RB ALTERNATING PRESSURE MATTRESS AE0277 RR ALTERNATING PRESSURE MATTRESS AE0290 HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS AE0290 RA Hosp Bed Fx Ht W/O Rails W/M AE0290 RB HOSPITAL BED FIXED HGT MATT AE0291 HOSPITAL BED,FIXED HEIGHT,WITHOUT SIDE RAILS,WITHOUT MATTRESS AE0291 RA Hosp Bed Fx Ht W/O Rail W/O AE0291 RB HOSPITAL BED W/O RAIL AND MATT AE0292 HOSPITAL BED, VARIABLE HEIGHT, HI-LO,WITHOUT SIDE RAILS WITH MATTRESS AE0292 RA Hosp Bed Var Ht W/O Rail W/O AE0292 RB HOSPITAL BED VAR HGT HI LO AE0293 HOSPITAL BED, VARIABLE HEIGHT, HI-LO,WITHOUT SIDE RAILS WITHOUT MATTRESS AE0293 RA Hosp Bed Var Ht W/O Rail W/ AE0293 RB HOSPITAL BED VAR HGT W/O RAIL AE0294 HOSPITAL BED, SEMI-ELEC(HEAD/FOOT ADJUSTMENTS) W/O SIDE RAILS,WITH MATTRES AE0294 RA Hosp Bed Semi-Elect W/ Mattr AE0294 RB HOSP BED SEMI ELEC AE0295 HOSPITAL BED, SEMI-ELEC(HEAD/FOOT ADJUSTMENTS) W/O SIDE RAILS,W/O MATTRESS AE0295 RA Hosp Bed Semi-Elect W/O Matt AE0295 RB HOSP BED SEMI W/O RAILS MAT AE0296 HOSPITAL BED,TOTAL ELEC(HEAD/FT/HT ADJUSTMENT)W/O SIDE RAILS,WITH MATTRESS AE0296 RA Hosp Bed Total Elect W/ Matt AE0296 RB HOSP BED ELEC W/O RAILS AE0297 HOSPITAL BED,TOTAL ELEC(HEAD/FT/HT ADJUSTMENT)W/O SIDE RAILS,W/O MATTRESS AE0297 RA Hosp Bed Total Elect W/O Mat AE0297 RB HOSP BED ELEC W/O RAILS MAT AE0301 HOSPITAL BED HEAVY DUTY XTRA WIDE W WEIGHT CAPAC GREATER THAN 350 AE0302 HOSP BED,XTRA HEAVY,XTRA WIDE,GREATER 600 LBS SIDE RAILS W/O MATTRESS AE0302 RR EX HD HOSP BED > 600 LBS. AE0303 HOSP BED,HEAVY DUTY,XTRA WIDE,WT GRTR THAN 350 LESS THN 600,SIDE RAILS W/O MATT AE0304 HOSP BED,XTRA HEAVY DUTY,XTRA WIDE,WT GRTR THAN 600,SIDE RAILS W MATTRESS AE0304 RR HOSP BED XTRA HVY DTY X WIDE AE0305 RA Rails Bed Side Half Length AE0305 RB BED RAILS,HALF LENGTH AE0310 RA Rails Bed Side Full Length AE0310 RB BED RAILS,FULL LENGTH AE0316 SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED AE0328 PEDIATRIC HOSPITAL BED, MANUAL AE0328 RR PED. HOSP. BED, MANUAL A

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E0329 PEDIATRIC HOSPITAL BED, ELECTRIC OR SEMI ELECTRIC AE0329 RR PED. HOSP. BED, SEMI/ELECT. AE0371 RB NONPWD PRESS OVERLAY/MATTRESS AE0371 RR NONPWD PRESS OVERLAY/MATTRESS AE0372 RA Powered Air Mattress Overlay AE0372 RB PWERED OVERLAY FOR MATT STD AE0372 RR PWERED OVERLAY FOR MATT STD AE0373 RA Nonpowered Pressure Mattress AE0373 RB NONPWD PRES REDUCING MATTRESS AE0373 RR NONPWD PRES REDUCING MATTRESS AE0424 STATIONARY COMPRESSED GASEOUS OXYGEN SYSTEM,RENTAL(CONT,CONTENT,REGUL,FLOW MTR) AE0424 RR STATIONARY COMPRESSED GAS RENT AE0431 PORTABLE GASEOUS OXYGEN SYSTEM,RENTAL( PROT CONTAINER, RUG, FLOWMTR ETC) AE0431 RR PORTABLE GASEOUS RENTAL AE0434 RR PORTABLE LIQUID RENTAL AE0439 RR STATIONARY LIQUID RENTAL AE0441 OXYGEN CONTENTS,GASEOUS(FOR USE W OWNED GASEOUS STATIONARY SYSTEMS AE0442 OXYGEN CONTENTS,LIQUID(USE W/OWNED LIQUID STATIONARY SYSTEM) 1 MO.SUPPLY=1 UNIT AE0443 PORTABLE OXYGEN CONTENTS,GASEOUS(FOR USE W/PORTABLE GAS SYS) 1MO SUPPLY=1 UNIT AE0444 PORTABLE OXYGEN CONTENTS,LIQUID(ONLY W/PORTABLE LIQ) 1 MO SUPPLY= 1 UNIT AE0445 OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY AE0445 RR OXIMETER NON-INVASIVE AE0450 RR VOL CONTROL VENT INVASIV INT AE0455 OXYGEN TENT, EXCLUDING CROUP OR PEDIATRIC TENTS AE0457 CHEST SHELL CUIRASS-E0457 AE0457 RR CHEST SHELL (CUIRASS) AE0460 RR NEGATIVE PRESS VENTILATOR;PORT AE0461 RR VOL CONTROL VENT NONINV INT AE0463 RR PRESS SUPP VENT INVASIVE INT AE0464 RR PRES SUPP VENT NONINV INT AE0470 RESPIRATORY ASSIST DEVICE,BI-LEVEL PRESSURE CAPABILITY W/O BACKUP RATE FEATURE AE0471 RESPIRATORY ASSIST DEVICE,BI-LEVEL PRESSURE CAPA,W/BACK UP,NONINVASIVE INTER AE0471 RR RAD W/BACKUP NON INV INTRFC AE0480 PERCUSSOR,ELECTRIC OR PNEUMATIC, HOME MODEL AE0480 RA Percussor Elect/Pneum Home M AE0480 RB PERCUSSOR,HOME MODEL AE0482 COUGH STIMULATING DEVICE,ALTERNATING POSITIVE AND NEGATIVE AIRWAY PRESSURE AE0482 RA Cough Stimulating Device AE0482 RB COUGH STIMULATING DEVICE AE0482 RR COUGH STIMULATING DEVICE AE0483 RR CHEST COMPRESSION GEN SYSTEM AE0500 IPPB MACHINE,ALL TYPES, W/BUILT-IN NEBULIZATION,MANUAL OR AUTOMATIC VALVES AE0500 RA Ippb All Types AE0500 RB IPPB,EXTERNAL POWER,MAN AE0550 HUMIDIFIER,DURABLE FOR EXTENSIVE SUPPLEMENTAL HUMIDIFICATION DURING IPPB AE0550 RA Humidif Extens Supple W Ippb AE0550 RB HUMIDIFIER,DURABLE,EXT. AE0560 RA Humidifier Supplemental W/ I AE0560 RB HUMIDIFIER,DURABLE,SUP. AE0565 COMPRESSOR,AIR POWER SOURCE FOR EQUIPMENT NOT SELF-CONTAINED OR CYLINDER DRIVEN AE0565 RA Compressor Air Power Source AE0565 RB COMPRESSOR,AIR POWER AE0570 RA Nebulizer With Compression AE0570 RB NEBULIZER WITH COMPRESSOR AE0575 NEBULIZER,ULTRASONIC, LARGE VOLUME AE0575 RA Nebulizer Ultrasonic AE0575 RB NEBULIZER,ULTRASONIC AE0585 NEBULIZER WITH COMPRESSOR AND HEATER AE0585 RA Nebulizer W/ Compressor & He AE0585 RB NEBULIZER,WITH COMPRESSOR/HEAT AE0600 RESPIRATORY SUCTION PUMP,HOME MODEL,PORTABLE OR STATIONARY, ELECTRIC A

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E0600 RA Suction Pump Portab Hom Modl AE0600 RB SUCTION PUMP,PORTABLE AE0601 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE AE0607 RA Blood Glucose Monitor Home AE0607 RB Blood Glucose Monitor Home AE0619 APNEA MONITOR, WITH RECORDING FEATURE AE0621 RA Patient Lift Sling Or Seat AE0621 RB SLING/SEAT,PATIENT LIFT AE0621 RR SLING/SEAT PATIENT LIFT AE0625 U4 PATIENT LIFT, BATHROOM OR TOILET, NOT OTHERWISE CLASSIFIED AE0630 PATIENT LIFT, HYDRAULIC OR MECHANICAL W/SEAT, SLING, STRAP OR PADS AE0630 RA Patient Lift Hydraulic AE0630 RB PATIENT LIFT,HYDRAULIC WISLING AE0635 PATIENT LIFT, ELECTRIC, WITH SEAT OR SLING AE0635 RA Patient Lift Electric AE0635 RB PATIENT LIFT ELECTRIC W/SEAT AE0635 RR PATIENT LIFT ELECTRIC W/SEAT AE0636 MULTIPOSITIONAL PATIENT SUPPORT SYSTEM,INTEGRATED LIFT,PT ACCESSIBLE CONTROL AE0636 RA Pt Support & Positioning Sys AE0636 RB PT SUPPORT 7 POSITIONING SVS AE0637 COMBINATION SIT TO STAND SYSTEM,ANY SIZE INCLUDING PEDIATRIC,W/SEATLIFT FEATURE AE0638 STANDING FRAME SYSTEM,1 POSITION ANY SIZE INCLUDING PEDS, W-W/O WHEELS AE0638 RB STANDING FRAME SYS AE0638 RR STANDING FRAME SYS AE0639 PATIENT LIFT MOVEABLE FROM ROOM TO ROOM WITH DISASSEMBLY AE0639 RA Moveable Patient Lift System AE0639 RB MOVEABLE PATIENT LIFT SYSTEM AE0639 RR MOVEABLE PATIENT LIFT SYSTEM AE0641 STANDING FRAME SYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE AE0641 RA Multi-Position Stnd Fram Sys AE0641 RB MULTI-POSITION STND FRAM SYS AE0641 RR MULTI-POSITION STND FRAM SYS AE0642 STANDING FRAME SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC AE0642 RA Dynamic Standing Frame AE0642 RB DYNAMIC STANDING FRAME AE0642 RR DYNAMIC STANDING FRAME AE0650 PNEUMATIC COMPRESSOR, NONSEGMENTAL HOME MODEL AE0650 RA Pneuma Compresor Non-Segment AE0650 RB PNEUMATIC COMPRESSOR AE0651 PNEUMATIC COMPRESSOR,SEGMENTAL HOME MODEL W/O CALIBRATED GRADIENT PRESSURE AE0651 RA Pneum Compressor Segmental AE0651 RB PNEUM.COMP.SEGMENT.HOME MODEL AE0652 PNEUMATIC COMPRESSOR,SEGMENTAL HOME MODEL W/CALIBRATED GRADIENT PRESSURE AE0652 RA Pneum Compres W/Cal Pressure AE0652 RB PNEM. COMP.SEGMENTAL CALIBRATE AE0652 RR PNEM. COMP. SEGMENTAL CALIBRAT AE0656 SEGMENTAL PNEUMATIC TRUNK AE0656 RR SEGMENTAL PNEUMATIC TRUNK AE0657 SEGMENTAL PNEUMATIC CHEST AE0657 RR SEGMENTAL PNEUMATIC CHEST AE0667 SEGMENTAL PNEUMATIC APPLIANCE/USE WITH PNEUMATIC COMPRESSOR,FULL LEG AE0668 SEGMENTAL PNEUMATIC APPLIANCE/USE WITH PNEUMATIC COMPRESSOR,FULL ARM AE0670 SEG PNEUMA INT LEGS/TRUNK AE0670 RR SEG PNEUMA INT LEGS/TRUNK AE0671 SEGMENTAL GRADIENT PRESSURE PNEUMATIC APPLIANCE, FULL LEG AE0700 RA Safety Equipment AE0700 RB SAFETY EQUIPMENT,BELT,HARNESS AE0705 RA Transfer Device AE0705 RB TRANSFER BOARD OR DEVICE AE0720 TENS DEVICE, 2 LEADS, LOCALIZED STIMULATION AE0720 RA Tens Two Lead A

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E0720 RB TENS, TWO LEAD AE0730 TENS DEVICE 4 OR MORE LEADS FOR MULTIPLE NERVE STIMULATION AE0730 RA Tens Four Lead AE0730 RB TENS, FOUR LEAD AE0747 OSTEOGENESIS STIMULATOR,ELECTRICAL NONINVASIVE,OTHER THAN SPINAL APPLICATIONS AE0748 OSTEOGENESIS STIMULATOR,ELECTRICAL,NONINVASIVE,SPINAL APPLICATIONS AE0776 IV POLE-E0776 AE0776 RA Iv Pole AE0776 RB IV POLE AE0784 EXTERNAL AMBULATORY INFUSION PUMP-INSULIN-E0784 AE0784 RA Ext Amb Infusn Pump Insulin AE0784 RB EXT. AMBULATORY INF. PUMP AE0910 RA Trapeze Bar Attached To Bed AE0910 RB TRAPEZE,ATT TO BED AE0911 TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 PDS AE0911 RA Hd Trapeze Bar Attach To Bed AE0911 RB HD TRAPEZE BAR ATTACH TO BED AE0912 TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 P AE0912 RA Hd Trapeze Bar Free Standing AE0912 RB HD TRAPEZE BAR FREE STANDING AE0920 FRACTURE FRAME,ATTACHED TO BED,INCLUDES WEIGHTS AE0936 RR CONT. PASSIVE MOTION DEVICE OTHER THAN KNEE AE0940 TRAPEZE BAR,FREESTANDING,COMPLETE WITH GRAB BAR AE0940 RA Trapeze Bar Free Standing AE0940 RB TRAPEZE BAR,STAND,W GRAB BAR AE0944 RA Pelvic Belt/Harness/Boot AE0945 RA Belt/Harness Extremity AE0947 FRACTURE FRAME,ATTACHMENTS FOR COMPLEX PELVIC TRACTION AE0948 FRACTURE FRAME,ATTACHMENTS FOR COMPLEX CERVICAL TRACTION AE0950 RA Tray AE0950 RB TRAY AE0950 U4 TRAY AE0951 RA Loop Heel AE0952 RA Toe Loop/Holder, Each AE0955 RA Cushioned Headrest AE0955 RB CUSHIONED HEADREST AE0955 U4 CUSHIONED HEADREST AE0956 WHEELCHAIR,ACCESSORY,LAT TRUNK/HIP SUPPORT,INCLUDING FIXED MOUNTING HARDWARE AE0956 RA W/C Lateral Trunk/Hip Suppor AE0956 RB W/C LATERAL TRUNK/HIP SUPPOR AE0957 RA W/C Medial Thigh Support AE0957 RB W/C MEDIAL THIGH SUPPOR AE0958 MANUAL WHEELCHAIR ACCESSORY,ONE-ARM DRIVE ATTACHMENT,EACH AE0958 RA Whlchr Att- Conv 1 Arm Drive AE0958 RB WHLCH ATT-CONV 1 ARM DRIVE AE0959 RA Amputee Adapter AE0960 RA W/C Shoulder Harness/Straps AE0960 U4 W/C SHOULDER HARNESS/STRAPS AE0961 MANUAL WHEELCHAIR ACCESSORY,WHEEL LOCK BRAKE EXTENSION(HANDLE),EA AE0961 RA Wheelchair Brake Extension AE0966 MANUAL WHEELCHAIR ACCESSORY,HEADREST EXTENSION,EACH AE0966 RA Wheelchair Head Rest Extensi AE0967 MANUAL WHEELCHAIR ACCESSORY HAND RIM W/PROJECTIONS, ANY TYPE EACH AE0967 RA Manual Wc Hand Rim W Project AE0971 MANUAL WHEELCHAIR ACCESSORY,ANTI-TIPPING DEVICE, EACH AE0973 RA W/Ch Access Det Adj Armrest AE0973 RB W/CH ACCESS DET ADJ ARMREST AE0974 RA W/Ch Access Anti-Rollback AE0978 WHEELCHAIR ACCESSORY,POSITIONING BELT/SAFETY BELT/PELVIC STRAP,EA AE0978 RA W/C Acc,Saf Belt Pelv Strap AE0978 U4 W/C ACC SAF BELT PELV STRAP A

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E0983 MANUAL WHEELCHAIR ACCESSORY,POWER ADD-ON TO CONVERT TO MOTORIZED W/CHAIR AE0984 MANUAL W/CHAIR ACCESSORY,POWER ADD-ON,CONVERT TO MOTORIZED, TILLER CONTROL AE0986 MANUAL WHEELCHAIR ACCESSORY,PUSH ACTIVATED POWER ASSIST,EACH AE0986 RA Man W/C Push-Rim Powr System AE0986 RB MAN W/C PUSH-RIM POW ASSIST AE0986 RR MAN W/C PUSH-RIM POW ASSIST AE0990 RA Wheelchair Elevating Leg Res AE0990 RB WHEELCHAIR ELEVATING LEG RES AE0992 RA Wheelchair Solid Seat Insert AE0995 RA Wheelchair Calf Rest AE1002 WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,TILT AE1002 RB PWR SEAT TILT AE1002 RR PWR SEAT TILT AE1003 WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,RECLINE ONLY W/O SHEAR REDUCTION AE1003 RA Pwr Seat Recline AE1003 RB PWR SEAT RECLINE AE1003 RR PWR SEAT RECLINE AE1004 WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,RECLINE,MECHANICAL SHEAR REDUCTION AE1004 RB WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,RECLINE,MECHANICAL SHEAR REDUCTION AE1004 RR WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,RECLINE,MECHANICAL SHEAR REDUCTION AE1005 WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,RECLINE,W/POWER SHEAR REDUCTION AE1005 RA Pwr Seat Recline Pwr AE1005 RB PWR SEAT RECLINE PWR SHEAR REDUCTION AE1006 WHEELCHAIR ACCESSORY,POWER SEAT SYSTEM,COMBINE TILT/RECLINE,W/O SHEAR REDUCTION AE1006 RA Pwr Seat Combo W/O Shear AE1006 RB PWR SEAT COMBO W/O SHEAR AE1007 WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,COMBO TILT/RECLINE,MECH SHEAR REDUC AE1007 RA Pwr Seat Combo W/Shear AE1007 RB PWR SEAT COMBO W SHEAR AE1008 WHEELCHAIR ACCESSORY,POWER SEATING SYSTEM,COMBO TILT/RECLINE,POWER SHEAR REDUC AE1008 RA Pwr Seat Combo Pwr Shear AE1008 RB PWR SEAT COMB PWR SHEAR AE1009 WHEELCHAIR. ACCESSORY, ADD TO POWER SEATING SYS, MECHAN LINKED LEG AE1009 RA Add Mech Leg Elevation AE1009 RB ADD MECH LEG ELEV AE1010 WHEELCHAIR. ACCESSORY, ADD TO POWER SEATING SYS, POWER LEG ELEVATION AE1014 RECLINING BACK, ADDITION TO PEDIATRIC WHEELCHAIR AE1017 HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY/EXTRA HEAVY DUTY MANUAL W/CHAIR AE1017 RR HD SHCK ABSRBR FOR HD MAN WC AE1018 HEAVY DUTY SHOCK ABSORBER FOR HEAVY DUTY/EXTRA HEAVY DUTY POWER W/CHAIR,EA AE1018 RR HD SHCK ABSRBER FOR HD POW WC AE1020 RESIDUAL LIMB SUPPORT SYSTEM FOR WHEELCHAIR AE1020 RA Residual Limb Support System AE1028 WHEELCHAIR. ACCESSORY, MANUAL SWINGAWAY, RETRACT OR REMOV MOUNTING AE1030 WHEELCHAIR ACCESSRY VENTILATORY TRAY GIMBALED AE1037 TRANSPRT CHAIR, PEDIATRIC SIZE AE1037 RA Transport Chair, Ped Size AE1037 RB TRANSPORT CHAIR, PED SIZE AE1038 TRANSPORT CHAIR,ADULT SIZE,PATIENT WT CAPACITY UP TO/INCLUDING 300LBS AE1038 RA Transport Chair Pt Wt<=300lb AE1038 RB TRANSPORT CHAIR PT WT<250LB AE1039 TRANSPORT CHAIR,ADULT SIZE, HEAVY DUTY,PATIENT WT GREATER THAN 300LBS AE1161 MANUAL ADULT SIZE WHEELCHAIR, INCLUDES TILT IN SPACE AE1161 RA Manual Adult Wc W Tiltinspac AE1161 RB MANUAL ADULT WC W TILTINSPAC AE1225 WHEELCHAIR ACCESSORY,MANUAL SEMI-RECLINING BACK AE1225 RA Manual Semi-Reclining Back AE1225 RB MANUAL SEMI-RECLINING BACK AE1225 RR MANUAL SEMI-RECLINING BACK AE1226 WHEELCHAIR ACCESSORY,MANUAL FULLY RECLINING BACK(RECLINE GREATER 80 DEGREE AE1226 RA Manual Fully Reclining Back A

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E1226 RB MANUAL FULLY RECLINING BACK AE1227 SPECIAL HEIGHT ARMS FOR WHEELCHAIR AE1227 RA Wheelchair Spec Sz Spec Ht A AE1228 SPECIAL BACK HEIGHT FOR WHEELCHAIR AE1228 RA Wheelchair Spec Sz Spec Ht B AE1229 WHEELCHAIR PEDIATRIC SIZE NOT OTHERWISE SPECIFIED AE1229 RA Pediatric Wheelchair Nos AE1229 RB PEDIATRIC WHEELCHAIR NOS AE1230 PWR OPERATED VEHICLE-E1230 AE1230 RA Power Operated Vehicle AE1231 WHEELCHAIR,PED SIZE,TILT IN SPACE,RIGID,ADJUSTABLE,W SEATING AE1231 RA Rigid Ped W/C Tilt-In-Space AE1231 RB RIGID PED W/C TILT-IN-SPACE AE1232 WHEELCHAIR,PEDIATRIC SIZE,TILT-IN-SPACE,FOLDING,ADJUST W/SEATING SYSTEM AE1232 RA Folding Ped Wc Tilt-In-Space AE1232 RB FOLDING PED WC TILT-IN-SPACE AE1233 WHEELCHAIR,PEDIATRIC SIZE,TILT-IN-SPACE,RIGID,ADJ W/O SEATING SYSTEM AE1233 RA Rig Ped Wc Tltnspc W/O Seat AE1233 RB RIG PED WC TILTNSPC W/O SEAT AE1234 WHEELCHAIR,PEDIATRIC SIZE,TILT-IN-SPACE,FOLDING,ADJ W/O SEATING SYSTEM AE1234 RA Fld Ped Wc Tltnspc W/O Seat AE1234 RB FLD PED WC TILTNSPC W/O SEAT AE1235 WHEELCHAIR, PEDIA TRIC SIZE, RIGID, ADJUSTABLE, WITH SEATING SYSTEM AE1235 RA Rigid Ped Wc Adjustable AE1235 RB RIGID PED W/C ADJUSTABLE AE1236 WHEELCHAIR PEDIATRIC SIZE,FOLDING,ADJUSTABLE,WITH SEATING SYSTEM AE1236 RA Folding Ped Wc Adjustable AE1236 RB FOLDING PED WC ADJUSTABLE AE1237 WHEELCHAIR,PEDIATRICC SIZE,RIGID,ADJUSTABLE,W/O SEATING SYSTEM AE1237 RA Rgd Ped Wc Adjstabl W/O Seat AE1237 RB RGD PED WC ADJSTABL W/O SEAT AE1238 WHEELCHAIR,PEDIATRIC SIZE,FOLDING,ADJUSTABLE,W/O SEATING SYSTEM AE1238 RA Fld Ped Wc Adjstabl W/O Seat AE1238 RB FLD PED WC ADJSTABLE W/O SEAT AE1239 POWER WHEELCHAIR PEDIATRIC SIZE NOT OTHERWISE SPECIFIED AE1239 RA Ped Power Wheelchair Nos AE1239 RB PED POWER WHEELCHAIR NOS AE1296 SPECIAL WHEELCHAIR SEAT HEIGHT FROM FLOOR AE1297 SPECIAL WHEELCHAIR SEAT DEPTH,BY UPHOLSTERY AE1298 SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH,BY CONSTRUCTION AE1356 BATTERY PACK/CART, PORTABLE CONCENTRATOR AE1357 BATTERY CHARGER, PORTABLE CONCENTRATOR AE1390 RR OXYGEN CONCENTRATOR AE1399 DURABLE MEDICAL EQUIPMENT, MISC AE1399 RA Durable Medical Equipment Mi AE1399 RB DURABLE MEDICAL EQUIPMENT NOC AE1399 RR DURABLE MEDICAL EQUIPMENT NOC AE1639 SCALE, FOR DIALYSIS, EACH AE1902 COMMUNICATION BOARD, NON-ELECTRONIC AUGMENTATIVE OR AE1902 RA Aac Non-Electronic Board AE1902 RB AAC NON-ELECTRONIC BOARD AE2100 BLOOD GLUCOSE MONITOR WITH INTEGRATED VOICE SYNTHESIZER AE2201 MANUAL WHEELCHAIR ACCESSORY,NONSTANDARD SEAT FRAME,20-24 IN AE2202 MANUAL WHEELCHAIR ACCESSORY,NONSTANDARD SEAT FRAME WIDTH 24-27IN AE2203 MANUAL WHEELCHAIR ACCESSORY,NONSTANDARD SEAT FRAME DEPTH,20 L/THAN 22 IN AE2204 MANUAL WCHAIR ACCESSRY NONSTANDARD SEAT FRAME DEPTH 22 TO 25 IN AE2205 MANUAL WHEELCHAIR , HANDRIM W/O PROJECT, ANY TYPE, REPLACE ONLY,EACH AE2206 MANUAL WHEELCHAIR ACCESSORY WHEEL LOCK ASSEMBLY COMPLETE EACH AE2206 RA Complete Wheel Lock Assembly AE2207 WHEELCHAIR ACCESSORY, CRUTCH AND CANE HOLDER, EACH AE2207 RA Crutch And Cane Holder A

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E2208 WHEELCHAIR ACCESSORY, CYLINDER TANK CARRIER, EACH AE2208 RA Cylinder Tank Carrier AE2209 ACCESSORY, ARM TROUGH W OR W/O HAND SUPPORT, EACH AE2209 RA Arm Trough Each AE2210 WHEELCHAIR ACCESSORY, BEARINGS, ANY TYPE, REPLACEMENT ONLY, EACH AE2211 MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC PROPULSION TIRE, ANY SIZE, EACH AE2211 RA Pneumatic Propulsion Tire AE2212 MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC PROPULSION TIRE, ANY SIZE EACH AE2212 RA Pneumatic Prop Tire Tube AE2213 MANUAL WHEELCHAIR ACCESSORY, INSERT FOR PNEUMATIC PROPULSION TIRE (REMOVABLE) AE2213 RA Pneumatic Prop Tire Insert AE2214 MANUAL WHEELCHAIR ACCESSORY, PNEUMATIC CASTER TIRE, ANY SIZE, EACH AE2214 RA Pneumatic Caster Tire Each AE2215 MANUAL WHEELCHAIR ACCESSORY, TUBE FOR PNEUMATIC CASTER TIRE, ANY SIZE, EACH AE2215 RA Pneumatic Caster Tire Tube AE2216 MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED PROPULSION TIRE, ANY SIZE, EACH AE2216 RA Foam Filled Propulsion Tire AE2217 MANUAL WHEELCHAIR ACCESSORY, FOAM FILLED CASTER TIRE, ANY SIZE, EACH AE2217 RA Foam Filled Caster Tire Each AE2219 MANUAL WHEELCHAIR ACCESSORY, FOAM CASTER TIRE, ANY SIZE, EACH AE2219 RA Foam Caster Tire Any Size Ea AE2220 MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) PROPULSION TIRE, ANY SIZE AE2220 RA Solid Propulsion Tire Each AE2221 MANUAL WHEELCHAIR ACCESSORY, SOLID (RUBBER/PLASTIC) CASTER TIRE (REMOVABLE AE2221 RA Solid Caster Tire Each AE2222 MANUAL WHEELCHAIR ACCESSORY, SOLID(RUBBER/PLASTIC) CASTER TIRE WITH INTEGR AE2222 RA Solid Caster Integrated Whl AE2224 MANUAL WHEELCHAIR ACCESSORY, PROPULSION WHEEL EXCLUDES TIRE,ANY SIZE EACH AE2224 RA Propulsion Whl Excludes Tire AE2225 MANUAL WHEELCHAIR ACCESSORY, CASTER WHEEL EXCLUDES TIRE,ANY SIZE,REPLACEMENT AE2226 MANUAL WHEELCHAIR ACCESSORY, CASTER FORK, ANY SIZE, REPLACEMENT ONLY, EACH AE2230 MANUAL STANDING SYSTEM AE2231 MANUAL WC ACCESS SOLID SEAT SUPPORT BASE (REPLACES SLING SEAT), AE2231 RA Solid Seat Support Base AE2291 BACK PLANAR FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING AE2292 SEAT PLANAR FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING AE2293 BACK CONTOURED FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING AE2294 SEAT CONTOURED FOR PEDIATRIC SIZE WHEELCHAIR INCLUDING FIXED ATTACHING AE2295 MANUAL WC ACCESSORY, FOR PED SIZE WC DYNAMIC SEATING FRAME AE2295 RA Ped Dynamic Seating Frame AE2300 POWER WHEELCHAIR ACCESSORY POWER SEAT ELEVATION SYSTEM AE2300 RA Pwr Seat Elevation Sys AE2300 RB PWR SEAT ELEVATION SYS AE2301 POWER WHEELCHAIR ACCESSRY POWER STANDING SYSTEM AE2301 RA Pwr Standing AE2301 RB PWR STANDING AE2310 POWER WHEELCHAIR ACCESSORY,ELEC CONN/WCHAIR CONTROLLER AND 1 POWER SEAT SYSTEM AE2310 RA Electro Connect Btw Control AE2310 RB ELECTRO CONNECT BTW CONTROL AE2310 RR ELECTRO. CONNECT BTW. CONTRL. AE2311 POWER WCHAIR ACCESSRY,ELECTRONIC CONNECTION BETW WCHAIR CONTROLLER AE2311 RA Electro Connect Btw 2 Sys AE2311 RB ELECTRO CONNECT BTW 2 SYS AE2311 RR ELECTRO. CONNECT BTW. 2 SYS. AE2312 PWC MINI-PROP REMOTE JOYSTICK AE2312 RA Mini-Prop Remote Joystick AE2312 RB MINI-PROP REMOTE JOYSTICK AE2313 PWC HARNESS, EXPAND CONTROL AE2321 POWER WHEELCHAIR ACCESSORY,HAND CONTROL INTERFACE,REMOTE JOYSTICK AE2321 RA Hand Interface Joystick AE2321 RB HAND INTERFACE JOYSTICK A

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E2321 RR HAND INTERFACE JOYSTICK AE2323 POWER WHEELCHAIR ACCESS, SPEC JOYSTICK HANDLE FOR HAND CONTROL AE2323 RA Special Joystick Handle AE2324 POWER WHEELCHAIR ACCESSORY, CHIN CUP FOR CHIN CONTROL INTERFACE AE2324 RA Chin Cup Interface AE2325 POWER WHEELCHAIR ACCESS, SIP AND PUFF INTERFACE, NONPROPORTIONAL AE2325 RA Sip And Puff Interface AE2325 RB SIP AND PUFF INTERFACE AE2325 RR SIP AND PUFF INTERFACE AE2326 POWER WHEELCHAIR ACCESSORY,BREATH TUBE KIT FOR SIP/PUFF INTERFACE AE2326 RA Breath Tube Kit AE2327 POWER WHEELCHAIR ACCESSORY,HEAD CONTROL INTERFACE,MECH/PROPORTIONAL AE2327 RA Head Control Interface Mech AE2327 RB HEAD CONTROL INTERFACE MECH AE2327 RR HEAD CONTROL INTERFACE MECH AE2328 POWER WHEELCHAIR ACCESORY,HEAD CONTROL OR EXTREMITY CONTROL INTERFACE AE2328 RA Head/Extremity Control Inter AE2328 RB HEAD/EXTREMITY CONTROL INTER AE2328 RR HEAD/EXTREMITY CONTROL INTER AE2329 POWER WHEELCHAIR ACCESSORY,HEAD CONTROL INTERFACE,CONTACT SWITCH MECHANISM AE2329 RA Head Control Nonproportional AE2329 RB HEAD CONTROL NONPROPORTIONAL AE2329 RR HEAD CONTROL NONPROPORTIONAL AE2330 POWER WHEELCHAIR ACCESSORY,HEAD CONTROL INTERFACE,PROXIMITY SWITCH MECHANISM AE2330 RA Head Control Proximity Switc AE2330 RB HEAD CONTROL PROXIMITY SWITC AE2330 RR HEAD CONTROL PROXIMITY SWITC AE2331 POWER WHEELCHAIR ACCESSORY,ATTENDENT CONTROL,PORPORTIONAL AE2340 POWER WHEELCHAIR ACCESSORY,NONSTANDARD SEAT FRAME WIDTH,20-23 IN AE2340 RR W/C WDTH 20-23 IN SEAT FRAME AE2341 POWER WHEELCHAIR ACCESSORY,NONSTANDARD SEAT FRAME WIDTH, 24-27 IN AE2341 RR W/C WDTH 24-27 IN SEAT FRAME AE2342 POWER WCHAIR ACCESSORY NONSTANDARD SEAT FRAME DEPTH 20 OR 21 INC AE2342 RR W/C DPTH 20-21 IN SEAT FRAME AE2343 POWER WCHAIR ACCESSORY,NONSTANDARD SEAT FRAME DEPTH 22-25 INC AE2343 RR W/C DPTH 22-25 IN SEAT FRAME AE2351 POWER WCHAIR ACCESSORY ELECTRONIC INTERFACE TO OPERATE SPEECH GEN AE2351 RR ELECTRONIC SGD INTERFACE AE2358 POWER WHEELCHAIR ACCESSORY, GROUP 34 NON-SEALED LEAD ACID BATTERY, EACH AE2358 RA Gr 34 Nonsealed Leadacid AE2358 RR GR 34 NONSEALED LEADACID AE2359 RA Gr34 Sealed Leadacid Battery AE2359 RR GR34 SEALED LEADACID BATTERY AE2360 POWER WCHAIR ACCESSORY 22 NF NON SEALED LEAD ACID BATTERY EACH AE2360 RA 22nf Nonsealed Leadacid AE2360 RR 22NF NONSEALED LEADACID AE2361 POWER WCHAIR ACCESSORY 22NF SEALED LEAD ACID BATTERY EACH AE2361 RA 22nf Sealed Leadacid Battery AE2361 RR 22NF SEALED LEADACID BATTERY AE2362 POWER WCHAIR ACCESSORY GROUP 24 NON SEALED LEAD ACID BATTERY EACH AE2362 RA Gr24 Nonsealed Leadacid AE2362 RR GR24 NONSEALED LEADACID AE2363 POWER WCHAIR ACCESSORY GROUP 24 SEALED LEAD ACID BATTERY EACH AE2363 RA Gr24 Sealed Leadacid Battery AE2363 RR GR24 SEALED LEADACID BATTERY AE2364 POWER WCHAIR ACCESSORY U-1 NON-SEALED LEAD ACID BATTERY EACH AE2364 RA U1nonsealed Leadacid Battery AE2364 RR UFNONSEALED LEADACID BATTERY AE2365 POWER WCHAIR ACCESSRY U-1 SEALED LEAD ACID BATTERY EACH AE2365 RA U1 Sealed Leadacid Battery AE2365 RR U1 SEALED LEADACID BATTERY A

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E2366 POWER WCHAIR ACCESSRY BATTERY CHARGER SINGLE MODE AE2366 RA Battery Charger, Single Mode AE2366 RR BATTERY CHARGER, SINGLE MODE AE2367 POWER WHEELCHAIR ACCESSORY,BATTERY CHARGER,DUAL MODE,WITH EITHER BATTERY TYPE AE2367 RA Battery Charger, Dual Mode AE2367 RR BATTERY CHARGER, DUAL MODE AE2368 POWER WHEELCHAIR COMPONENT,MOTOR,REPLACEMENT ONLY AE2368 RR POWER WC MOTOR REPL ONLYACEMENT AE2369 POWER WHEELCHAIR COMPONENT GEAR BOX REPLACEMENT ONLY AE2369 RR PWR WC GEAR BOX REPL ONLYACEMENT AE2370 POWER WHEELCHAIR COMPONENT,MOTOR AND GEAR BOX COMBINATION,REPLACEMENT ONLY AE2370 RR PWR WC MOTOR/GEAR BOX COMBO AE2371 POWER WHEELCHAIR ACCESSORY, GROUP 27 SEALED LEAD ACID BATTERY, (E.G. GEL CELL AE2371 RA Gr27 Sealed Leadacid Battery AE2371 RR GR27 SEALED LEADACID BATTERY AE2372 POWER WHEELCHAIR ACCESSORY, GROUP 27 NON-SEALED LEAD ACID BATTERY, EACH AE2372 RA Gr27 Non-Sealed Leadacid AE2372 RR GR27 NON-SEALED LEADACID AE2373 POWER WC ACCESSORY,HAND/CHIN CONTROL,REMOVE JOYSTICK PROPORTIONAL, REPLACE AE2373 RA Hand/Chin Ctrl Spec Joystick AE2373 RB HAND/CHIN CTRL SPEC JOYSTICK AE2374 HAND/CHIN CONTROL STANDARD JOYSTICK AE2375 NON-EXPANDABLE CONTROLLER AE2376 EXPANDABLE CONTROLLER, REPLACEMENT AE2377 EXPANDABLE CONTROLLER, INITIAL ISSUE AE2378 PW ACTUATOR REPLACEMENT (RO) AE2381 PNEUMATIC DRIVE WHEEL TIRE AE2382 TUBE, PNEUMATIC WHEEL DRIVE TIRE AE2383 INSERT, PNEUMATIC WHEEL DRIVE AE2384 PNEUMATIC CASTER TIRE AE2385 TUBE, PNEUMATIC CASTER TIRE AE2386 FOAM FILLED DRIVE WHEEL TIRE AE2386 RA Foam Filled Drive Wheel Tire AE2387 POWER WHEELCHAIR ACCESS, FOAM FILLED CASTER TIRE, ANY SIZE, REPLACE ONLY, EA AE2388 POWER WHEELCHAIR ACCESS, FOAM DRIVE WHEEL TIRE, ANY SIZE, REPLACE ONLY,EA AE2389 POWER WHEELCHAIR ACCESS, FOAM CASTER TIRE, ANY SIZE, REPLACEMENT ONLY, EA AE2390 POWER WHEELCHAIR ACCESS, SOLID DRV WHEEL TIRE, ANY SIZE,REPLACE ONLY, EA AE2391 POWER WHEELCHAIR ACCESS, SOLID CASTER TIRE ANYSIZE, REPLACE ONLY, EACH AE2392 POWER WHEELCHAIR ACCESS, SOLID CASTER W/INTEGR WHEEL ANY SIZE REP ONLY EA AE2392 RA Solid Caster Tire, Integrate AE2394 POWER WHEELCHAIR ACCESS, DRIVE WHEEL EXCL TIRE, ANY SIZE, REPL ONLY, EACH AE2395 POWER WHEELCHAIR ACCESS, CASTER WHEEL EXCL TIRE, ANY SIZE, REPL ONLY, EA AE2396 POWER WHEELCHAIR ACCESS, CASTER FORK, ANY SIZE, REPLACE ONLY, EACH AE2500 SPEECH GENERATING DEVICE DIGITIZED SPEECH USING PRE RECORDED MESSAGES AE2500 RA Sgd Digitized Pre-Rec <=8min AE2500 RB SGD DIGITIZED PRE-REC <=8MIN AE2502 SPEECH GENERATINE DEVICE,DIGITIZED SPEECH,USING PRE-RECORDED MESS.8-20MIN AE2502 RA Sgd Prerec Msg >8min <=20min AE2502 RB SGD PREREC MSG >8MIN <=20MIN AE2504 SPEECH GENERATING DEVICE,DIGITIZED SPEECH,USING PRE-RECORDED MSG.20-40 MIN AE2504 RA SPEECH GENERATING DEVICE,DIGITIZED SPEECH,USING PRE-RECORDED MSG.20-40 MIN AE2504 RB SGD PREREC MSG >20MIN <=40MIN AE2506 SPEECH GENERATING DEVICE,DIGITIZED SPEECH,PRE-RECORDED MSG,MORE THAN 40 MI AE2506 RA SPEECH GENERATING DEVICE,DIGITIZED SPEECH,PRE-RECORDED MSG,MORE THAN 40 MI AE2506 RB SGD PREREC MSG >40 MIN AE2508 SPEECH GENERATING DEVICE,SYNTHESIZED SPEECH,MSG FORM BY SPELLING ACCESS BY AE2508 RA SPEECH GENERATING DEVICE,SYNTHESIZED SPEECH,MSG FORM BY SPELLING ACCESS BY AE2508 RB SGD SPELLING PHYS CONTACT AE2508 RR SGD SPELLING PHYS CONTACT AE2510 SPEECH GENERATING DEVICE,SYNTHESIZED SPEECH,MULTIPLE METHODS OF MSG AE2510 RA SPEECH GENERATING DEVICE,SYNTHESIZED SPEECH,MULTIPLE METHODS OF MSG A

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E2510 RB SGD W MULTI METHODS MSG/ACCS AE2510 RR SGD W MULTI METHODS MSG/ACCS AE2511 SPEECH GENERATING SOFTWARD PROGRAM,FOR PERSONAL COMPUTER OR PERSONAL DIGITAL AE2511 RR SGD SFTWRE PRGM FOR PC/PKA AE2512 ACCESSORY FOR SPEECH GENRATING DEVICE MOUNTING SYSTEM AE2512 RA Sgd Accessory, Mounting Sys AE2512 RR SGD ACCESSORY, MOUNTING SYS AE2599 ACCESSORY FOR SPEECH GENERATING DEVICE NOT OTHERWISE CLASS AE2599 RA Sgd Accessory Noc AE2599 RR SGD ACCESSORY NOC AE2601 GENERAL USE WHEEL CHAIR SEAT CUSION WIDTH LESS THAN 22 INCHES AE2606 POSITIONING WHEEL CHAIR SEAT CUSSION WIDTH 22 INCHES OR GREATER AE2607 SKIN PROTECTION AND POSITIONING WHEELCHAIR SEAT CUSH WIDTH LESS THAN 22 AE2609 CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION ANY SIZE AE2612 GENERAL USE WHEELCHAIR BACK CUSHION WIDTH 22 INCHES OR GREATER AE2613 POSITIONING WHEELCHAIR BACK CUSHION POSTERIOR WIDTH LESS THAN 22 INCH AE2614 POSITIONING WHEELCHAIR BACK CUSHION,POSTERIOR,WIDTH 22IN OR GREATER ANY HEIGHT AE2615 POSITIONING WHEELCHAIR BACK CUSHION,POSTERIOR-LATERAL,WIDTH LESS THAN 22IN AE2616 POSITIONING WHEELCHAIR BACK CUSHION,POSTERIOR-LATERAL WIDTH 22IN OR GREATE AE2617 CUSTOM FABRICATED WHEELCHAIR BACK CUSHION ANY SIZE INCUDING ANY TYPE AE2620 POSITIONING WHEELCHAIR BACK CUSHION,PLANAR BACK W/LAT SUPPORTS,LESS THAN 22IN AE2621 POSITIONING WHEELCHAIR BACK CUSHION,PLANAR BACK W/LAT SUPPORT 22IN/GREATER AE2622 ADJ SKIN PRO W/C CUS WD<22IN AE2622 RA Adj Skin Pro W/C Cus Wd<22in AE2622 RB ADJ SKIN PRO W/C CUS WD<22IN AE2622 RR ADJ SKIN PRO W/C CUS WD<22IN AE2623 ADJ SKIN PRO W/C CUS WD> =22IN AE2623 RA Adj Skin Pro Wc Cus Wd>=22in AE2623 RB ADJ SKIN PRO W/C CUS WD> =22IN AE2623 RR ADJ SKIN PRO W/C CUS WD> =22IN AE2624 ADJ SKIN PRO/POS CUS<22IN AE2624 RA Adj Skin Pro/Pos Cus<22in AE2624 RB ADJ SKIN PRO/POS CUS<22IN AE2624 RR ADJ SKIN PRO/POS CUS<22IN AE2625 ADJ SKIN PRO/POS W/C CUS > = 22IN AE2625 RA Adj Skin Pro/Pos Wc Cus>=22 AE2625 RB ADJ SKIN PRO/POS W/C CUS > = 22IN AE2625 RR ADJ SKIN PRO/POS W/C CUS > = 22IN AE2626 RA Seo Mobile Arm Sup Att To Wc AE2626 RR SEO MOBILE ARM SUP ATT TO WC AE8000 GAIT TRAINER PEDIATRIC SIZE POSTERIOR SUPPORT INCLUDES ALL ACCESSORIES AE8000 RR POSTERIOR GAIT TRAINER AE8001 GAIT TRAINER PEDIATRIC SIZE UPRIGHT SUPPORT INCLUDES ALL ACCESSORIES AE8001 RR UPRIGHT GAIT TRAINER AE8002 GAIT TRAINER PEDIATRIC SIZE ANTERIOR SUPPORT INCLUDES ALL ACCESSORIES AE8002 RR ANTERIOR GAIT TRAINER AK0001 STANDARD WHEELCHAIR-K0001 AK0001 RA Standard Wheelchair AK0001 RB STANDARD WHEELCHAIR AK0002 STANDARD HEMI [LOW SEAT] WHEELCHAIR AK0002 RA Stnd Hemi (Low Seat) Whlchr AK0002 RB STANDARD HEMI (LOW SEAT) W/C AK0003 LIGHTWEIGHT WHEELCHAIR-K0003 AK0003 RA Lightweight Wheelchair AK0003 RB LIGHTWEIGHT WHEELCHAIR AK0004 HIGH STRENGTH,LIGHTWEIGHT WHEELCHAIR-K0004 AK0004 RA High Strength Ltwt Whlchr AK0004 RB HIGH STRENGTH LIGHTWEIGHT W/C AK0005 ULTRALIGHTWEIGHT WHEELCHAIR-K0005 AK0005 RA Ultralightweight Wheelchair AK0005 RB ULTRA LIGHTWEIGHT WHEELCHAIR A

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K0006 HEAVY-DUTY WHEELCHAIR-K0006 AK0006 RA Heavy Duty Wheelchair AK0006 RB HEAVY DUTY WHEELCHAIR AK0007 EXTRA HEAVY-DUTY WHEELCHAIR-K0007 AK0007 RA Extra Heavy Duty Wheelchair AK0007 RB EXTRA HEAVY DUTY WHEELCHAIR AK0009 OTHER MANUAL WHEELCHAIR/BASE-K0009 AK0009 RA Other Manual Wheelchair/Base AK0009 RB OTHER MANUAL WHEELCHAIRS AK0009 RR OTHER MANUAL WHEELCHAIRS AK0015 DETACHABLE,NON-ADJUSTABLE HEIGHT ARMREST,EACH-K0015 AK0015 RA Detach Non-Adjus Hght Armrst AK0015 RB DETACH, NON-ADJ ARMREST, EACH AK0017 DETACHABLE,ADJUSTABLE HEIGHT ARMREST,BASE,EACH-K0017 AK0017 RA Detach Adjust Armrest Base AK0017 RB DETACH, ADJ ARMREST, BASE, EA. AK0018 DETACHABLE,ADJUSTABLE HEIGHT ARMREST,UPPER PORTION, EACH AK0018 RA Detach Adjust Armrst Upper AK0018 RB DETACH. ADJ. ARMREST, UPPER,EA AK0019 ARM PAD,EACH-K0019 AK0019 RB ARM PAD, EACH AK0020 FIXED, ADJUSTABLE HEIGHT ARMREST, PAIR AK0020 RB FIXED,ADJ. HEIGHT ARMREST,PR. AK0037 HIGH MOUNT FLIP-UP FOOTREST,EACH-K0037 AK0037 RA High Mount Flip-Up Footrest AK0037 RB HIGH MOUNT FLIP UP FOOTRS,EACH AK0038 LEG STRAP,EACH-K0038 AK0038 RA Leg Strap Each AK0039 LEG STRAP,H STYLE,EACH-K0039 AK0039 RA Leg Strap H Style Each AK0040 ADJUSTABLE ANGLE FOOTPLATE,EACH-K0040 AK0040 RA Adjustable Angle Footplate AK0040 RB ADJUSTABLE ANGLE FOOTPLATE,EA AK0041 LARGE SIZE FOOTPLATE,EACH-K0041 AK0041 RA Large Size Footplate Each AK0041 RB LARGE SIZE FOOTPLATE, EACH AK0042 STANDARD SIZE FOOTPLATE,EACH-K0042 AK0042 RB STANDARD SIZED FOOTPLATE, EACH AK0043 FOOTREST,LOWER EXTENSION TUBE,EACH-K0043 AK0043 RB FOOTREST, LOWER EXTENS.TUBE,EA AK0044 FOOTREST,UPPER HANGER BRACKET,EACH-K0044 AK0044 RB FOOTREST, UPPER HANGER BRAC.EA AK0045 FOOTREST,COMPLETE ASSEMBLY-K0045 AK0045 RB FOOTREST,COMPLETE ASSEMBLY AK0046 ELEVATING LEGREST,LOWER EXTENSION TUBE,EACH-K0046 AK0046 RB ELEVATING LEGRT, L EXT.TUBE EA AK0047 ELEVATING LEGREST,UPPER HANGER BRACKET,EACH-K0047 AK0047 RB ELEVATING LEGRST,U HANGER,EA. AK0050 RATCHET ASSEMBLY-K0050 AK0050 RB RATCHET ASSEMBLY, EACH AK0051 CAM RELEASE ASSEMBLY,FOOTREST OR LEGREST,EACH-K0051 AK0051 RB CAM RELEASE ASSEMBLY, EACH AK0052 SWINGAWAY,DETACHABLE FOOTRESTS,EACH-K0052 AK0052 RA Swingaway Detach Footrest AK0053 ELEVATING FOOTRESTS,ARTICULATING[TELESCOPING],EACH AK0053 RA Elevate Footrest Articulate AK0056 SEAT HEIGHT LESS THAN 17 INCH OR LESS THAN OR EQUAL TO 21 INCH OF W/C-K0056 AK0065 SPOKE PROTECTORS EACH AK0065 RA Spoke Protectors AK0069 REAR WHEEL ASSEMBLY,COMPLETE WITH SOLID TIRE,SPOKES OR MOLDED-K0069 AK0069 RB REAR WHL ASSEMBLY,COMP W/S.T. A

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K0070 REAR WHEEL ASSEMBLY, COMPLETE WITH PNEUMATIC TIRE,SPOKES OR MOLDED,EACH AK0070 RB REAR WHL ASSM.,COMP W/ST OR SP AK0071 FRONT CASTER ASSEMBLY,COMPLETE,WITH PNEUMATIC TIRE,EACH-K0071 AK0071 RA Front Castr Compl Pneum Tire AK0071 RB FRONT CASTER ASSMBY,W/PNE.TIRE AK0072 FRONT CASTER ASSEMBLY,COMPLETE,WITH SEMIPNEUMATIC TIRE,EACH-K0072 AK0072 RA Frnt Cstr Cmpl Sem-Pneum Tir AK0072 RB FRONT CASTER ASSEMB,W/S.PNE,TR AK0073 CASTER PIN LOCK,EACH-K0073 AK0073 RB CASTER PIN LOCK, EACH AK0077 RA Front Caster Assem Complete AK0098 DRIVE BELT FOR POWER WHEELCHAIR-K0098 AK0098 RB DRIVE BELT FOR POWER CHAIR AK0105 IV HANGER EACH AK0105 RA Iv Hanger AK0108 WHEELCHAIR COMPONENT OR ACCESSORY, NOS AK0108 RA W/C Component-Accessory Nos AK0108 RB OTHER ACCESSORIES AK0108 RR OTHER ACCESSORIES AK0195 ELEVATING LEGREST,PAIR(FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE) AK0606 RR AED GARMENT W ELEC ANALYSIS AK0607 REPLACEMENT BATTERY FOR AUTOMATED EXTERNAL DEFIBRILLATOR,EACH AK0607 RA Repl Batt For Aed AK0608 REPLACEMENT GARMENT FOR USE W/AUTOMATED EXTERNAL DEFIBRILLATOR,EACH AK0608 RA Repl Garment For Aed AK0609 REPLACEMENT ELECTRODES FOR USE W/AUTOMATED EXTERNAL DEFIBRILLATOR,EACH AK0609 RA Repl Electrode For Aed AK0733 POWER WHEELCHAIR ACCESSORY 12-24 AMP HR SEALED LEAD ACID BATTERY EA. AK0733 RA 12-24hr Sealed Lead Acid AK0739 REPAIR/SVC DME NON-OXYGEN EQ PER 15 MINUTES AK0800 POWER OPERATE VEHICLE,GRP1 STD.PT.WT.CAP UP TO INCL 300 LB AK0800 RA Pov Group 1 Std Up To 300lbs AK0800 RB POV GROUP 1 STD UP TO 300LBS AK0800 RR POV GROUP 1 STD UP TO 300 LBS AK0801 POWER OPERATE VEHICLE,GRP,1 HD,PTL.WT.CAP 301 TO 450 LBS AK0801 RA Pov Group 1 Hd 301-450 Lbs AK0801 RB POV GROUP 1 HD 301-450 LBS AK0801 RR POV GROUP 1 HD 301-450 LBS AK0802 POWER OPERATED VEHICLE,GRP 1, VERY HD.PT.WT.CAP 451 TO 600 LBS AK0802 RA Pov Group 1 Vhd 451-600 Lbs AK0802 RB POV GROUP 1 VHD 451-600 LBS AK0802 RR POV GROUP 1 VHD 451-600 LBS AK0806 POWER OPERATED VEHICLE, GRP 2 STD,PT.WT.CAP UP TO INCL 300 LBS AK0806 RA Pov Group 2 Std Up To 300lbs AK0806 RB POV GROUP 2 STD UP TO 300LBS AK0806 RR POV GROUP 2 STD UP TO 300 LBS AK0807 POWER OPERATED VEHICLE, GRP 2 HD.PT.WT.CAP 301 TO 450 LBS AK0807 RA Pov Group 2 Hd 301-450 Lbs AK0807 RB POV GROUP 2 HD 301-450 LBS AK0807 RR POV GROUP 2 HD 301-450 LBS AK0808 POWER OPERATED VEHICLE,GRP 2 VERY HD.PT.WT.CAP 451 TO 600 LBS AK0808 RA Pov Group 2 Vhd 451-600 Lbs AK0808 RB POV GROUP 2 VHD 451-600 LBS AK0808 RR POV GROUP 2 VHD 451-600 LBS AK0812 POWER OPERATED VEHICLE, NOT OTHERWISE CLASSIFIED AK0812 RA Power Operated Vehicle Noc AK0812 RB POWER OPERATED VEHICLE NOC AK0812 RR POWER OPERATED VEHICLE NOC AK0813 POWER CHAIR, GRP 1 STD, PORT, SLING/SOLID SEAT/BACK PT WT.CAP INCL 300 LBS AK0813 RA Pwc Gp 1 Std Port Seat/Back AK0813 RB PWC GP 1 STD PORT SEAT/BACK A

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K0813 RR PWC GP 1 STD PORT SEAT/BACK AK0814 POWER CHAIR,GRP 1 STD.PORT, CAPTAINS CHAIR, PT.WT.CAP AND INCL 300 LBS AK0814 RA Pwc Gp 1 Std Port Cap Chair AK0814 RB PWC GP 1 STD PORT CAP CHAIR AK0814 RR PWC GP 1 STD PORT CAP CHAIR AK0815 POWER CHAIR, GRP 1 STD. SLING/SOLD SEAT/BACK, PT.WT.CAP INCL 300 LBS AK0815 RA Pwc Gp 1 Std Seat/Back AK0815 RB PWC GP 1 STD SEAT/BACK AK0815 RR PWC GP 1 STD SEAT/BACK AK0816 POWER CHAIR,GRP 1 STD.CAPTAINS CHAIR,PT WT.UP TO AND INCL 300 LBS AK0816 RA Pwc Gp 1 Std Cap Chair AK0816 RB PWC GP 1 STD CAP CHAIR AK0816 RR PWC GP 1 STD CAP CHAIR AK0820 POWER CHAIR,GRP 2 STD.PORT, SLING/SOLID SEAT/BACK,PT.WT.CAP INCL 300 LBS AK0820 RA Pwc Gp 2 Std Port Seat/Back AK0820 RB PWC GP 2 STD PORT SEAT/BACK AK0820 RR PWC GP 2 STD PORT SEAT/BACK AK0821 POWER CHAIR,GRP 2 STD,PORT, CAPTAINS CHAIR, PT WT.CAP INCL 300 LBS AK0821 RA Pwc Gp 2 Std Port Cap Chair AK0821 RB PWC GP 2 STD PORT CAP CHAIR AK0821 RR PWC GP 2 STD PORT CAP CHAIR AK0822 POWER CHAIR,GRP 2 STD, SLING/SOLID SEAT/BACK PT.WT.CAP INCL 300 LBS AK0822 RA Pwc Gp 2 Std Seat/Back AK0822 RB PWC GP 2 STD SEAT/BACK AK0822 RR PWC GP 2 STD SEAT/BACK AK0823 POWER CHAIR,GRP 2 STD,CAPTAINS,CHAIR PT.WT UP TO INCLUDING 300 LBS AK0823 RA Pwc Gp 2 Std Cap Chair AK0823 RB PWC GP 2 STD CAP CHAIR AK0823 RR PWC GP 2 STD CAP CHAIR AK0824 POWER CHAIR,GRP 2 HD. SLING/SOLID SEAT/BACK PT WT 301 TO 450 LBS AK0824 RA Pwc Gp 2 Hd Seat/Back AK0824 RB PWC GP 2 HD SEAT/BACK AK0824 RR PWC GP 2 HD SEAT/BACK AK0825 POWER CHAIR,GRP 2 HD. CAPTAINS CHAIR, PT WT. 301 TO 450 LBS AK0825 RA Pwc Gp 2 Hd Cap Chair AK0825 RB PWC GP 2 HD CAP CHAIR AK0825 RR PWC GP 2 HD CAP CHAIR AK0826 POWER CHAIR, GRP 2 VERY HD.SLING/SOLID SEAT/BACK, PT.WT.CAP 451 TO 600 LBS AK0826 RA Pwc Gp 2 Vhd Seat/Back AK0826 RB PWC GP 2 VHD SEAT/BACK AK0826 RR PWC GP 2 VHD SEAT/BACK AK0827 POWER CHAIR,GRP 2 VERY HD. CAPTAINS CHAIR PT WT CAP 451 TO 600 LBS AK0827 RA Pwc Gp Vhd Cap Chair AK0827 RB PWC GP VHD CAP CHAIR AK0827 RR PWC GP 2 VHD CAP CHAIR AK0828 POWER CHAIR, GRP 2 EXTRA HD. SLING/SOLID SEAT/BACK PT WT.CAP 601 LBS MORE AK0828 RA Pwc Gp 2 Xtra Hd Seat/Back AK0828 RB PWC GP 2 XTRA HD SEAT/BACK AK0828 RR PWC GP 2 XTRA HD SEAT/BACK AK0829 POWER CHAIR,GRP 2 EXTRA HD, CAPTAINS CHAIR PT WT CAP 601 LBS OR MORE AK0829 RA Pwc Gp 2 Xtra Hd Cap Chair AK0829 RB PWC GP 2 XTRA HD CAP CHAIR AK0829 RR PWC GP 2 XTRA HD CAP CHAIR AK0830 POWER CHAIR, GRP 2 STD, SEAT ELEVATOR, SSSB, PT WT CAP INCL 300 LBS AK0830 RA Pwc Gp2 Std Seat Elevate S/B AK0830 RB PWC GP2 STD SEAT ELEVATE S/B AK0830 RR PWC GP2 STD SEAT ELEVATE S/B AK0831 POWER CHAIR,GRP 2 STD.SEAT ELEVATOR,CAPT CHAIR WT CAP INCL 300 LBS AK0831 RA Pwc Gp2 Std Seat Elevate Cap AK0831 RB PWC GP2 STD SEAT ELEVATE CAP AK0831 RR PWC GP2 STD SEAT ELEVATE CAP A

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7/1/2015

K0835 POWER CHAIR,GRP 2 STD,SINGLE POWER OPT, SSSB, PT WT CAP INCL 300 LBS AK0835 RA Pwc Gp2 Std Sing Pow Opt S/B AK0835 RB PWC GP2 STD SING POW OPT S/B AK0835 RR PWC CP2 STD SING POW OPT S/B AK0836 POWER CHAIR,2 STD, SINGLE POWER OPT, CAPT CHAIR PT WT CAP INCL 300 LBS AK0836 RA Pwc Gp2 Std Sing Pow Opt Cap AK0836 RB PWC GP2 STD SING POW OPT CAP AK0836 RR PWC GP2 STD SING POWER OPT CAP AK0837 POWER CHAIR, GRP 2 HD.SINGLE POWER OPT, SSSB, PT WT.CAP 301 TO 450 LBS AK0837 RA Pwc Gp 2 Hd Sing Pow Opt S/B AK0837 RB PWC GP 2 HD SING POW OPT S/B AK0837 RR PWC GP 2 HD SING POW OPT S/B AK0838 POWER CHAIR,GRP 2 HD, SINGLE POWER OPT CAPT CHAIR,PT WT CAP 301 TO 450 LBS AK0838 RA Pwc Gp 2 Hd Sing Pow Opt Cap AK0838 RB PWC GP 2 HD SING POW OPT CAP AK0838 RR PWC GP 2 HD SING POW OPT CAP AK0839 POWER CHAIR,GRP 2 VERY HD. SINGLE POWER OPT,SSSB, PT WT CAP 451 TO 600 LBS AK0839 RA Pwc Gp2 Vhd Sing Pow Opt S/B AK0839 RB PWC GP2 VHD SING POW OPT S/B AK0839 RR PWC GP2 VHD SING POW OPT S/B AK0840 POWER CHAIR,GRP 2 EXTRA HD, SINGLE POWER OPT,SSSB, CAP 601 LBS OR MORE AK0840 RA Pwc Gp2 Xhd Sing Pow Opt S/B AK0840 RB PWC GP2 XHD SING POW OPT S/B AK0840 RR PWC GP2 XHD SING POW OPT S/B AK0841 POWER CHAIR,GRP 2 STD, MULT POWER OPT, SSSB, PT WT.CAP UP INCL 300 LBS AK0841 RA Pwc Gp2 Std Mult Pow Opt S/B AK0841 RB PWC GP2 STD MULT POW OPT S/B AK0841 RR PWC GP2 STD MULT POW OPT S/B AK0842 POWER CHAIR,GRP 2 STD,MULT POWER OPT,CAPT CHAIR.WT CAP UP INCL 300 LBS AK0842 RA Pwc Gp2 Std Mult Pow Opt Cap AK0842 RB PWC GP2 STD MULT POW OPT CAP AK0842 RR PWC GP2 STD MULT POW OPT CAP AK0843 POWER CHAIR,GRP 2 HD, MULT POWER OPT,SSSB, PT WT CAP 301 TO 450 LBS AK0843 RA Pwc Gp2 Hd Mult Pow Opt S/B AK0843 RB PWC GP2 HD MULT POW OPT S/B AK0843 RR PWC GP2 HD MULT POW OPT S/B AK0848 POWER CHAIR, GRP 3 STD, SSSB, PT WT.CAP UP TO AND INCL 300 LBS AK0848 RA Pwc Gp 3 Std Seat/Back AK0848 RB PWC GP 3 STD SEAT/BACK AK0848 RR PWC GP 3 STD SEAT/BACK AK0849 POWER CHAIR, GRP 3 STD, CAPTAINS CHAIR, PT WT CAP UP TO AND INCL 300 LBS AK0849 RA Pwc Gp 3 Std Cap Chair AK0849 RB PWC GP 3 STD CAP CHAIR AK0849 RR PWC GP 3 STD CAP CHAIR AK0850 POWER CHAIR,GRP 3 HD, SLING/SOLID SEAT/BACK, PT.WT. CAP 301 TO 450 LBS AK0850 RA Pwc Gp 3 Hd Seat/Back AK0850 RB PWC GP 3 HD SEAT/BACK AK0850 RR PWC GP 3 HD SEAT/BACK AK0851 POWER CHAIR,GRP 3 HD, CAPTAINS CHAIR, PT WT CAP 301 TO 450 LBS AK0851 RA Pwc Gp 3 Hd Cap Chair AK0851 RB PWC GP 3 HD CAP CHAIR AK0851 RR PWC GP 3 HD CAP CHAIR AK0852 POWER CHAIR, GRP 3 VERY HD, SSSB, PT WT CAP 451 TO 600 LBS AK0852 RA Pwc Gp 3 Vhd Seat/Back AK0852 RB PWC GP 3 VHD SEAT/BACK AK0852 RR PWC GP 3 VHD SEAT/BACK AK0853 POWER CHAIR,GRP 3 VERY HD, CAPTAINS CHAIR, PT WT CAP 451 TO 600 LBS AK0853 RA Pwc Gp 3 Vhd Cap Chair AK0853 RB PWC GP 3 VHD CAP CHAIR AK0853 RR PWC GP 3 VHD CAP CHAIR AK0854 POWER CHAIR, GRP 3 EXTRA HD, SSSB, PT WT CAP 601 LBS OR MORE A

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7/1/2015

K0854 RA Pwc Gp 3 Xhd Seat/Back AK0854 RB PWC GP 3 XHD SEAT/BACK AK0854 RR PWC GP 3 XHD SEAT/BACK AK0855 POWER CHAIR,GRP 3 EXTRA HD, CAPTAINS CHAIR, PT WT.CAP 601 LBS OR MORE AK0855 RA Pwc Gp 3 Xhd Cap Chair AK0855 RB PWC GP 3 XHD CAP CHAIR AK0855 RR PWC GP 3 XHD CAP CHAIR AK0856 POWER CHAIR,GRP 3 STD.SINGLE POWER OPT, SSSB, WT. CAP INCL 300 LBS AK0856 RA Pwc Gp3 Std Sing Pow Opt S/B AK0856 RB PWC GP3 STD SING POW OPT S/B AK0856 RR PWC GP3 STD SING POW OPT S/B AK0857 POWER CHAIR, GRP 3 STD,SINGLE POWER OPT, CAPT CHAIR WT CAP INCL 300 LBS AK0857 RA Pwc Gp3 Std Sing Pow Opt Cap AK0857 RB PWC GP3 STD SING POW OPT CAP AK0857 RR PWC GP3 STD SING POW OPT CAP AK0858 POWER CHAIR, GRP 3 HD.SINGLE POWER OPT, SSSB, PT WT.CAP 301 TO 450 LBS AK0858 RA Pwc Gp3 Hd Sing Pow Opt S/B AK0858 RB PWC GP3 HD SING POW OPT S/B AK0858 RR PWC GP3 HD SING POW OPT S/B AK0859 POWER CHAIR, GRP 3 HD, SINGLE POWER OPT, CAPT CHAIR, WT CAP 301 TO 450 LBS AK0859 RA Pwc Gp3 Hd Sing Pow Opt Cap AK0859 RB PWC GP3 HD SING POW OPT CAP AK0859 RR PWC GP3 HD SING POW OPT CAP AK0860 POWER CHAIR,GRP 3 VERY HD, SINGLE POWER OPT, SSSB, WT CAP 451 TO 600 LBS AK0860 RA Pwc Gp3 Vhd Sing Pow Opt S/B AK0860 RB PWC GP3 VHD SING POW OPT S/B AK0860 RR PWC GP3 VHD SING POW OPT S/B AK0861 POWER CHAIR,GRP 3 STD,MULT POWER OPT, SSSB, PT CAP INCL 300 LBS AK0861 RA Pwc Gp3 Std Mult Pow Opt S/B AK0861 RB PWC GP3 STD MULT POW OPT S/B AK0861 RR PWC GP3 STD MULT POW OPT S/B AK0862 POWER CHAIR, GRP 3 HD, MULT POWER OPT, SSSB, PT WT CAP 301 TO 450 LBS AK0862 RA Pwc Gp3 Hd Mult Pow Opt S/B AK0862 RB PWC GP3 HD MULT POW OPT S/B AK0862 RR PWC GP3 HD MULT POW OPT S/B AK0863 POWER CHAIR, GRP 3 VERY HD, MULT POWER OPT, SSSB, WT CAP 451 TO 600 LBS AK0863 RA Pwc Gp3 Vhd Mult Pow Opt S/B AK0863 RB PWC GP3 VHD MULT POW OPT S/B AK0863 RR PWC GP3 VHD MULT POW OPT S/B AK0864 POWER CHAIR, GRP 3 EXTRA HD, MULT POWER OPT,SSSB, CAP 601 LBS OR MORE AK0864 RA Pwc Gp3 Xhd Mult Pow Opt S/B AK0864 RB PWC GP3 XHD MULT POW OPT S/B AK0864 RR PWC GP3 XHD MULT POW OPT S/B AK0868 POWER CHAIR,GRP 4 STD, SSSB, PT.WT.CAP UP TO AND INCL 300 LBS AK0868 RA Pwc Gp 4 Std Seat/Back AK0868 RB PWC GP 4 STD SEAT/BACK AK0868 RR PWC GP 4 STD SEAT/BACK AK0869 POWER CHAIR, GRP 4 STD, CAPTAINS CHAIR,PT WT.CAP UP AND INCL 300 LBS AK0869 RA Pwc Gp 4 Std Cap Chair AK0869 RB PWC GP 4 STD CAP CHAIR AK0869 RR PWC GP 4 STD CAP CHAIR AK0870 POWER CHAIR,GRP 4 HD. SLING/SOLID SEAT/BACK. PT WT CAP 301 TO 450 LBS AK0870 RA Pwc Gp 4 Hd Seat/Back AK0870 RB PWC GP 4 HD SEAT/BACK AK0870 RR PWC GP 4 HD SEAT/BACK AK0871 POWER CHAIR, GRP 4 VERY HD, SSSB, PT WT CAP 451 TO 600 LBS AK0871 RA Pwc Gp 4 Vhd Seat/Back AK0871 RB PWC GP 4 VHD SEAT/BACK AK0871 RR PWC GP 4 VHD SEAT/BACK AK0877 POWER CHAIR, GRP 4 STD. SINGLE POWER OPT, SSSB, PT WT CAP 300 LBS AK0877 RA Pwc Gp4 Std Sing Pow Opt S/B A

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7/1/2015

K0877 RB PWC GP4 STD SING POW OPT S/B AK0877 RR PWC GP4 STD SING POW OPT S/B AK0878 POWER CHAIR,GRP 4 STD.SIINGLE POWER OPT, CAPT CHAIR.WT CAP INCL 300 LBS AK0878 RA Pwc Gp4 Std Sing Pow Opt Cap AK0878 RB PWC GP4 STD SING POW OPT CAP AK0878 RR PWC GP4 STD SING POW OPT CAP AK0879 POWER CHAIR, GRP 4 HD. SINGLE POWER OPT, SSSB, PT WT CAP 301 TO 450 LBS AK0879 RA Pwc Gp4 Hd Sing Pow Opt S/B AK0879 RB PWC GP4 HD SING POW OPT S/B AK0879 RR PWC GP4 HD SING POW OPT S/B AK0880 POWER CHAIR, GRP 4 VERY HD, SINGLE POWER OPT, SSSB, WT 451 TO 600 LBS AK0880 RA Pwc Gp4 Vhd Sing Pow Opt S/B AK0880 RB PWC GP4 VHD SING POW OPT S/B AK0880 RR PWC GP4 VHD SING POW OPT S/B AK0884 POWER CHAIR, GRP 4 STD. MULT POWER OPT, SSSB, PT WT CAP INCL 300 LBS AK0884 RA Pwc Gp4 Std Mult Pow Opt S/B AK0884 RB PWC GP4 STD MULT POW OPT S/B AK0884 RR PWC GP4 STD MULT POW OPT S/B AK0885 POWER CHAIR, GRP 4 STD. MULT POWER OPT, CAPT CHAIR, WT CAP INCL 300 LBS AK0885 RA Pwc Gp4 Std Mult Pow Opt Cap AK0885 RB PWC GP4 STD MULT POW OPT CAP AK0885 RR PWC GP4 STD MULT POW OPT CAP AK0886 POWER CHAIR, GRP 4 HD.MULT POWER OPT, SSSB, PT WT CAP 301 TO 450 LBS AK0886 RA Pwc Gp4 Hd Mult Pow S/B AK0886 RB PWC GP4 HD MULT POW S/B AK0886 RR PWC GP4 HD MULT POW S/B AK0890 POWER CHAIR, GRP 5 PED, SINGLE POWER OPT,SSSB, PT WT CAP INCL 125 LBS AK0890 RA Pwc Gp5 Ped Sing Pow Opt S/B AK0890 RB PWC GP5 PED SING POW OPT S/B AK0890 RR PWC GP5 PED SING POW OPT S/B AK0891 POWER CHAIR, GRP 5 PED, MULT POWER, SSSB, PT.WT.CAP AND INCL.125 LBS AK0891 RA Pwc Gp5 Ped Mult Pow Opt S/B AK0891 RB PWC GP5 PED MULT POW OPT S/B AK0891 RR PWC GP5 PED MULT POW OPT S/B AK0898 POWER CHAIR, NOT OTHERWISE CLASSIFIED AK0898 RA Power Wheelchair Noc AK0898 RB POWER WHEELCHAIR NOC AK0898 RR POW WHEELCHAIR NOC AL0112 CRANIAL CERVICAL ORTHOSIS CONGENITAL TORTICOLLIS TYPE AL0170 CERVICAL COLLAR MOLDED TO PT AL0180 CER POST COL OCC/MAN SUP ADJ AL0190 CERV COLLAR SUPP ADJ CERV BA AL0200 CERV COL SUPP ADJ BAR & THOR AL0430 SPINAL ORTHOSIS,ANT-POST-LAT CONTROL, W INTERFACE MATERIAL,CUSTOM FITTED AL0454 TLSO FLEX PREFAB SACROCOC-T9 AL0455 Tlso Flex Trnk Sj-T9 Pre Ots AL0456 TLSO FLEX PREFAB AL0457 Tlso Flex Trnk Sj-Ss Pre Ots AL0458 TLSO 2MOD SYMPHIS-XIPHO PRE AL0460 TLSO2MOD SYMPHYSIS-STERN PRE AL0462 TLSO 3MOD SACRO-SCAP PRE AL0464 TLSO 4MOD SACRO-SCAP PRE AL0467 Tlso R Fram Soft Pre Ots AL0468 TLSO RIGID FRAME PREFAB PELV AL0469 Tlso Rig Fram Pelvic Pre Ots AL0470 TLSO RIGID FRAME PRE SUBCLAV AL0480 TLSO RIGID PLASTIC CUSTOM FA AL0482 TLSO RIGID LINED CUSTOM FAB AL0484 TLSO RIGID PLASTIC CUST FAB AL0486 TLSO RIGIDLINED CUST FAB TWO AL0488 TLSO RIGID LINED PRE ONE PIE A

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7/1/2015

L0491 TLSO 2 PIECE RIGID SHELL AL0492 TLSO 3 PIECE RIGID SHELL AL0632 LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR AL0634 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID POSTERIOR AL0636 LSO SAGITTAL RIGID PANEL CUS AL0638 LSO SAG-CORONAL PANEL CUSTOM AL0639 LSO S/C SHELL/PANEL PREFAB AL0640 LSO S/C SHELL/PANEL CUSTOM AL0641 Lo Rig Pos Pnl L1-L5 Pre Ots AL0642 Lo Sag Ri An/Pos Pnl Pre Ots AL0643 Lso Sag Ctr Rigi Pos Pre Ots AL0648 Lso Sag R An/Pos Pnl Pre Ots AL0649 Lso Sc R Pos/Lat Pnl Pre Ots AL0650 Lso Sc R Ant/Pos Pnl Pre Ots AL0651 Lso Sag-Co Shell Pnl Pre Ots AL0700 CTLSO A-P-L CONTROL MOLDED AL0710 CTLSO A-P-L CONTROL W/ INTER AL0999 ADDITION TO SPINAL ORTHOSIS, NOS-L0999 AL1000 CTLSO MILWAUKE INITIAL MODEL AL1001 CTLSO INFANT IMMOBILIZER AL1005 TENSION BASED SCOLIOSIS ORTH AL1200 FURNSH INITIAL ORTHOSIS ONLY AL1230 MILWAUKEE TYPE SUPERSTRUCTUR AL1300 BODY JACKET MOLD TO PATIENT AL1499 UNLIST SPINAL ORTHO-L1499 AL1640 PELV BAND/SPREAD BAR THIGH C AL1652 HO BI THIGHCUFFS W SPRDR BAR AL1680 PELVIC & HIP CONTROL THIGH C AL1690 COMBINATION BILATERAL HO AL1700 LEG PERTHES ORTH TORONTO TYP AL1710 LEGG PERTHES ORTH NEWINGTON AL1720 LEGG PERTHES ORTHOSIS,TRILATERAL,(TACHDIJAN TYPE),CUSTOM FABRICATED AL1730 LEGG PERTHES ORTH SCOTTISH R AL1755 LEGG PERTHES PATTEN BOTTOM T AL1812 Ko Elastic W/Joints Pre Ots AL1832 KO ADJ JNT POS RIGID SUPPORT AL1833 Ko Adj Jnt Pos R Sup Pre Ots AL1834 KO W/0 JOINT RIGID MOLDED TO AL1840 KO DEROT ANT CRUCIATE CUSTOM AL1843 KO SINGLE UPRIGHT CUSTOM FIT AL1844 KO W/ADJ JT ROT CNTRL MOLDED AL1845 KO W/ ADJ FLEX/EXT ROTAT CUS AL1846 KO W ADJ FLEX/EXT ROTAT MOLD AL1847 KO ADJUSTABLE W AIR CHAMBERS AL1848 Ko Dbl Upright W/Air Pre Ots AL1860 KO SUPRACONDYLAR SOCKET MOLD AL1907 AFO SUPRAMALLEOLAR CUSTOM AL1940 AFO MOLDED TO PATIENT PLASTI AL1945 AFO MOLDED PLAS RIG ANT TIB AL1950 AFO SPIRAL MOLDED TO PT PLAS AL1960 AFO POS SOLID ANK PLASTIC MO AL1970 AFO PLASTIC MOLDED W/ANKLE J AL1990 AFO DOUB SOLID STIRRUP CALF AL2000 KAFO SING FRE STIRR THI/CALF AL2010 KAFO SNG SOLID STIRRUP W/O J AL2020 KAFO DBL SOLID STIRRUP BAND/ AL2030 KAFO DBL SOLID STIRRUP W/O J AL2034 KAFO PLA SIN UP W/WO K/A CUS AL2036 KAFO PLAS DOUB FREE KNEE MOL AL2037 KAFO PLAS SING FREE KNEE MOL AL2038 KAFO W/O JOINT MULTI-AXIS AN A

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7/1/2015

L2050 HKAFO TORSION CABLE HIP PELV AL2060 HKAFO TORSION BALL BEARING J AL2090 HKAFO UNILAT TORSION BALL BR AL2106 AFO TIB FX CAST PLASTER MOLD AL2108 AFO TIB FX CAST MOLDED TO PT AL2112 AFO TIBIAL FRACTURE SOFT AL2114 AFO TIB FX SEMI-RIGID AL2116 AFO TIBIAL FRACTURE RIGID AL2128 KAFO FEM FX CAST MOLDED TO P AL2136 KAFO FEMORAL FX CAST RIGID AL2280 MOLDED INNER BOOT AL2350 PROSTHETIC TYPE SOCKET MOLDE AL2510 TH/WGHT BEAR QUAD-LAT BRIM M AL2520 TH/WGHT BEAR QUAD-LAT BRIM C AL2540 THIGH/WGHT BEAR LACER MOLDED AL2570 HIP CLEVIS TYPE 2 POSIT JNT AL2627 PLASTIC MOLD RECIPRO HIP & C AL2628 METAL FRAME RECIPRO HIP & CA AL2861 TORSION MECHANISM KNEE/ANKLE AL2999 LOWER EXTREMITY ORTHOSES,NOS AL3160 FOOT,ADJUSTABLE SHOE-STYLED POSITIONING DEV-L3160 AL3649 ORTHOPEDIC SHOE,MODIFICATION,ADDITION OR TRANSFER,NOS AL3674 SO AIRPLANE W/WO JOINT CF AL3678 So Hard Plas Stabili Pre Ots AL3720 FOREARM/ARM CUFFS FREE MOTIO AL3730 FOREARM/ARM CUFFS EXT/FLEX A AL3740 CUFFS ADJ LOCK W/ ACTIVE CON AL3760 EO WITHJOINT, PREFABRICATED AL3808 WHFO, RIGIT W/O JOINTS AL3809 Whfo W/O Joints Pre Ots AL3891 TORSION MECHANISM WRIST/ELBO AL3900 HINGE EXTENSION/FLEX WRIST/F AL3904 WHFO ELECTRIC CUSTOM FITTED AL3906 WHO W/O JOINTS CF AL3918 Metacarp Fx Orthosis Pre Ots AL3927 FINGER ORTHOSIS, PIP AND DIP W//O NON TORSION JOINT/SPRING AL3930 Hfo Nontorsion Jnts Pre Ots AL3960 SEWHO AIRPLAN DESIG ABDU POS AL3962 SEWHO ERBS PALSEY DESIGN ABD AL3999 UPPER LIMB ORTHOSIS,NOS AL3999 RR UNLISTED PROC U LIMB ORTH AL4000 REPL GIRDLE MILWAUKEE ORTH (RO) AL4010 REPLACE TRILATERAL SOCKET BR (RO) AL4020 REPLACE QUADLAT SOCKET BRIM (RO) AL4030 REPLACE SOCKET BRIM CUST FIT (RO) AL4130 REPLACE PRETIBIAL SHELL (RO) AL4205 REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES-L4205 AL4210 REPR ORTHO DEV W/PTS-L4210 AL4361 Pneuma/Vac Walk Boot Pre Ots AL4387 Non-Pneum Walk Boot Pre Ots AL4397 Static Or Dynami Afo Pre Ots AL4631 AFO, WALK BOOT TYPE, CUS FAB AL5000 SHO INSERT W ARCH TOE FILLER AL5010 MOLD SOCKET ANK HGT W/ TOE F AL5020 TIBIAL TUBERCLE HGT W/ TOE F AL5050 ANK SYMES MOLD SCKT SACH FT AL5060 SYMES MET FR LEATH SOCKET AR AL5100 MOLDED SOCKET SHIN SACH FOOT AL5105 PLAST SOCKET JTS/THGH LACER AL5150 MOLD SCKT EXT KNEE SHIN SACH AL5160 MOLD SOCKET BENT KNEE SHIN S A

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L5200 KNE SING AXIS FRIC SHIN SACH AL5210 NO KNEE/ANKLE JOINTS W/ FT B AL5220 NO KNEE JOINT WITH ARTIC ALI AL5230 FEM FOCAL DEFIC CONSTANT FRI AL5250 HIP CANAD SING AXI CONS FRIC AL5270 TILT TABLE LOCKING HIP SING AL5280 HEMIPELVECT CANAD SING AXIS AL5301 BK MOLD SOCKET SACH FT ENDO AL5312 KNEE DISARTICULATION (OR THROUGH KNEE), MOLDED SOCKET, SINGLE AXIS KNEE, PYLON, SACH FOOT, AL5321 AK OPEN END SACH AL5331 HIP DISART CANADIAN SACH FT AL5341 HEMIPELVECTOMY CANADIAN SACH AL5500 INIT BK PTB PLASTER DIRECT AL5505 INIT AK ISCHAL PLSTR DIRECT AL5510 PREP BK PTB PLASTER MOLDED AL5520 PERP BK PTB THERMOPLS DIRECT AL5530 PREP BK PTB THERMOPLS MOLDED AL5535 PREP BK PTB OPEN END SOCKET AL5540 PREP BK PTB LAMINATED SOCKET AL5560 PREP AK ISCHIAL PLAST MOLDED AL5570 PREP AK ISCHIAL DIRECT FORM AL5580 PREP AK ISCHIAL THERMO MOLD AL5590 PREP AK ISCHIAL LAMINATED AL5595 HIP DISARTIC SACH THERMOPLS AL5600 HIP DISART SACH LAMINAT MOLD AL5610 ABOVE KNEE HYDRACADENCE AL5611 AK 4 BAR LINK W/FRIC SWING AL5613 AK 4 BAR LING W/HYDRAUL SWIG AL5616 AK UNIV MULTIPLEX SYS FRICT AL5622 TEST SOCKET KNEE DISARTICULA AL5624 TEST SOCKET ABOVE KNEE AL5626 TEST SOCKET HIP DISARTICULAT AL5628 TEST SOCKET HEMIPELVECTOMY AL5630 SYME TYP EXPANDABL WALL SCKT AL5631 AK/KNEE DISARTIC ACRYLIC SOC AL5632 SYMES TYPE PTB BRIM DESIGN S AL5634 SYMES TYPE POSTER OPENING SO AL5636 SYMES TYPE MEDIAL OPENING SO AL5637 BELOW KNEE TOTAL CONTACT AL5638 BELOW KNEE LEATHER SOCKET AL5639 BELOW KNEE WOOD SOCKET AL5640 KNEE DISARTICULAT LEATHER SO AL5642 ABOVE KNEE LEATHER SOCKET AL5644 ABOVE KNEE WOOD SOCKET AL5646 BELOW KNEE CUSHION SOCKET AL5648 ABOVE KNEE CUSHION SOCKET AL5650 TOT CONTACT AK/KNEE DISART S AL5652 SUCTION SUSP AK/KNEE DISART AL5653 KNEE DISART EXPAND WALL SOCK AL5654 SOCKET INSERT SYMES AL5655 SOCKET INSERT BELOW KNEE AL5656 SOCKET INSERT KNEE ARTICULAT AL5658 SOCKET INSERT ABOVE KNEE AL5666 BELOW KNEE CUFF SUSPENSION AL5668 BK MOLDED DISTAL CUSHION AL5670 BK MOLDED SUPRACONDYLAR SUSP AL5671 BK/AK LOCKING MECHANISM AL5672 BK REMOVABLE MEDIAL BRIM SUS AL5673 SOCKET INSERT W LOCK MECH AL5676 BK KNEE JOINTS SINGLE AXIS P AL5678 BK JOINT COVERS PAIR A

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L5679 SOCKET INSERT W/O LOCK MECH AL5680 BK THIGH LACER NON-MOLDED AL5681 INTL CUSTM CONG/LATYP INSERT AL5682 BK THIGH LACER GLUT/ISCHIA M AL5683 INITIAL CUSTOM SOCKET INSERT AL5684 BK FORK STRAP AL5685 BELOW KNEE SUS/SEAL SLEEVE AL5686 BK BACK CHECK AL5688 BK WAIST BELT WEBBING AL5690 BK WAIST BELT PADDED AND LIN AL5692 AK PELVIC CONTROL BELT LIGHT AL5694 AK PELVIC CONTROL BELT PAD/L AL5695 AK SLEEVE SUSP NEOPRENE/EQUA AL5696 AK/KNEE DISARTIC PELVIC JOIN AL5697 AK/KNEE DISARTIC PELVIC BAND AL5698 AK/KNEE DISARTIC SILESIAN BA AL5699 SHOULDER HARNESS AL5700 REPLACE SOCKET BELOW KNEE (RO) AL5701 REPLACE SOCKET ABOVE KNEE (RO) AL5702 REPLACE SOCKET HIP (RO) AL5703 SYMES ANKLE W/O (SACH) FOOT (RO) AL5704 CUSTOM SHAPE COVER BK AL5705 CUSTOM SHAPE COVER AK AL5706 CUSTOM SHAPE CVR KNEE DISART AL5707 CUSTOM SHAPE CVR HIP DISART AL5710 KNE-SHIN EXO SNG AXI MNL LOC AL5712 KNEE-SHIN EXO FRICT SWG & ST AL5714 KNEE-SHIN EXO VARIABLE FRICT AL5716 KNEE-SHIN EXO MECH STANCE PH AL5718 KNEE-SHIN EXO FRCT SWG & STA AL5722 KNEE-SHIN PNEUM SWG FRCT EXO AL5724 KNEE-SHIN EXO FLUID SWING PH AL5726 KNEE-SHIN EXT JNTS FLD SWG E AL5728 KNEE-SHIN FLUID SWG & STANCE AL5780 KNEE-SHIN PNEUM/HYDRA PNEUM AL5810 ENDOSKEL KNEE-SHIN MNL LOCK AL5812 ENDO KNEE-SHIN FRCT SWG & ST AL5816 ENDO KNEE-SHIN POLYC MCH STA AL5818 ENDO KNEE-SHIN FRCT SWG & ST AL5822 ENDO KNEE-SHIN PNEUM SWG FRC AL5824 ENDO KNEE-SHIN FLUID SWING P AL5828 ENDO KNEE-SHIN FLUID SWG/STA AL5830 ENDO KNEE-SHIN PNEUM/SWG PHA AL5840 ADDITION,ENDOSKELETAL KNEE-SHIN SYSTEM,4-BAR LINKAGE/MULTIAXIAL,PNEUMATIC AL5845 KNEE-SHIN SYS STANCE FLEXION AL5850 ENDO AK/HIP KNEE EXTENS ASSI AL5855 MECH HIP EXTENSION ASSIST AL5925 ABOVE KNEE MANUAL LOCK AL5962 BELOW KNEE FLEX COVER SYSTEM AL5964 ABOVE KNEE FLEX COVER SYSTEM AL5966 HIP FLEXIBLE COVER SYSTEM AL5970 FOOT EXTERNAL KEEL SACH FOOT AL5971 SACH FOOT, REPLACEMENT (RO) AL5972 FLEXIBLE KEEL FOOT AL5974 FOOT SINGLE AXIS ANKLE/FOOT AL5975 COMBO ANKLE/FOOT PROSTHESIS AL5976 ENERGY STORING FOOT AL5978 FT PROSTH MULTIAXIAL ANKL/FT AL5979 MULTI-AXIAL ANKLE/FT PROSTH AL5980 FLEX FOOT SYSTEM AL5981 FLEX-WALK SYS LOW EXT PROSTH A

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L5982 EXOSKELETAL AXIAL ROTATION U AL5984 ENDOSKELETAL AXIAL ROTATION AL5990 USER ADJUSTABLE HEEL HEIGHT AL5999 LOWER EXTREMITY PROSTHESIS,NOT OTHERWISE SPECIFIED AL6000 PART HAND THUMB REM AL6010 PART HAND LITTLE/RING AL6020 PART HAND NO FINGERS AL6050 WRST MLD SCK FLX HNG TRI PAD AL6100 ELB MOLD SOCK FLEX HINGE PAD AL6110 ELBOW MOLD SOCK SUSPENSION T AL6120 ELBOW MOLD DOUB SPLT SOC STE AL6130 ELBOW STUMP ACTIVATED LOCK H AL6200 ELBOW MOLD OUTSID LOCK HINGE AL6250 ELBOW INTER LOC ELBOW FORARM AL6300 SHLDER DISART INT LOCK ELBOW AL6350 THORACIC INTERN LOCK ELBOW AL6400 BELOW ELBOW PROSTH TISS SHAP AL6450 ELB DISART PROSTH TISS SHAP AL6500 ABOVE ELBOW PROSTH TISS SHAP AL6550 SHLDR DISAR PROSTH TISS SHAP AL6570 SCAP THORAC PROSTH TISS SHAP AL6600 POLYCENTRIC HINGE PAIR AL6605 SINGLE PIVOT HINGE PAIR AL6610 FLEXIBLE METAL HINGE PAIR AL6615 DISCONNECT LOCKING WRIST UNI AL6616 DISCONNECT INSERT LOCKING WR AL6620 FLEXION/EXTENSION WRIST UNIT AL6625 ROTATION WRST W/ CABLE LOCK AL6630 STAINLESS STEEL ANY WRIST AL6635 LIFT ASSIST FOR ELBOW AL6640 SHOULDER ABDUCTION JOINT PAI AL6645 SHOULDER FLEXION-ABDUCTION J AL6646 MULTIPO LOCKING SHOULDER JNT AL6647 SHOULDER LOCK ACTUATOR AL6650 SHOULDER UNIVERSAL JOINT AL6655 STANDARD CONTROL CABLE EXTRA AL6660 HEAVY DUTY CONTROL CABLE AL6665 TEFLON OR EQUAL CABLE LINING AL6670 HOOK TO HAND CABLE ADAPTER AL6672 HARNESS CHEST/SHLDER SADDLE AL6675 HARNESS FIGURE OF 8 SING CON AL6676 HARNESS FIGURE OF 8 DUAL CON AL6677 UE TRIPLE CONTROL HARNESS AL6680 TEST SOCK WRIST DISART/BEL E AL6682 TEST SOCK ELBW DISART/ABOVE AL6684 TEST SOCKET SHLDR DISART/THO AL6691 REMOVABLE INSERT EACH AL6692 SILICONE GEL INSERT OR EQUAL AL6693 LOCKINGELBOW FOREARM CNTRBAL AL6694 ADDITION TO UPPER EXTREMITY PROSTHESIS,BELOW/ABOVE ELBOW,USE W LOCKNG MECH AL6695 ADDITION TO UPPER EXTREM PROSTHESIS,BELOW/ABOVE ELBOW,NOT FOR USE W LOCK AL6696 ADDITION TO UPPER EXTREMITY PROSTHESIS,BELOW/ABOVE ELBOW,FOR CONGENITAL AL6697 ADDITION TO UPPER EXTREMITY PROSTHESIS,BELOW/ABOVE ELBOW,OTHER THAN CONGEN AL6698 ADDITION TO UPPER EXTREMITY PROSTHESIS,BELOW/ABOVE ELBOW,LOCK MEHCANISM AL6706 TERMINAL DEVICE,HOOK, MECH, VOLUNTARY OPEN, ANY MATL/SIZE,LINED/UNLINED AL6707 TERMINAL DEVICE,HOOK, MECH, VOLUNTARY CLOSE, ANY MATL/SIZE,LINED/UNLINED AL6708 TERMINAL DEVICE, HAND, MECH, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE AL6709 TERMINAL DEVICE, HAND, MECH, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE AL6711 PED TERM DEV, HOOK, VOL OPEN AL6712 PED TERM DEV, HOOK, VOL CLOS AL6713 PED TERM DEV, HAND, VOL OPEN A

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L6714 PED TERM DEV, HAND, VOL CLOS AL6721 HOOK/HAND, HVY DTY, VOL OPEN AL6722 HOOK/HAND, HVY DTY, VOL CLOS AL6805 TERM DEV MODIFIER WRIST UNIT AL6810 TERM DEV PRECISION PINCH DEV AL6881 TERM DEV AUTO GRASP FEATURE AL6883 REPLC SOCKT BELOW E/W DISA (RO) AL6884 REPLC SOCKT ABOVE ELBOW DISA (RO) AL6885 REPLC SOCKT SHLDR DIS/INTERC (RO) AL6890 PREFAB GLOVE FOR TERM DEVICE AL6895 CUSTOM GLOVE FOR TERM DEVICE AL6935 BELOW ELBOW MYOELECTRONIC CT AL7186 ELECTRONIC ELBOW,CHILD VARIETY VILLAGE OR EQUAL,SWITCH CONTROLLED AL7499 UPPER EXTREMITY PROSTHESIS,NOS AL7510 PROSTHETIC DEVICE REPAIR REP AL8499 UNLISTED PROCEDURE FOR MSICELLANEOUS PROSTHETIC SERVICES AL8500 ARTIFICIAL LARYNX AL8510 VOICE AMPLIFIER AS1040 CRANIAL REMOLD ORTHOSIS,PEDIATRIC RIGIT W/SOFT MATL CUSTOM FAB W/FITTING/ADJ AS5498 HOME INFUSION THERAPY, CATH CARE/MAINTENANCE,SIMPLE(SINGLE LUMEN),ADMIN SV AS5501 HOME INFUSION THERAPY,CATH CARE/MAINT,COMPLEX(MORE THAN ONE LUMEN),ADMIN SV AS5502 HOME INFUSION THERAPY,CATH CARE/MAINT,IMPLANTED ACCESS DEVICE,ADMIN SERV AS5520 HOME INFUSION THERAPY,ALL SUPPLIES NEC FOR PICC LINE INSERTION AS5521 HOME INFUSION THERAPY,ALL SUPPLIES NEC FOR MIDLINE CATHETER INSERTION AS8422 GRADIENT PRESSURE AID (SLEEVE),CUSTOM MADE,MEDIUM WEIGHT AS8423 GRADIENT PRESSURE AID (SLEEVE) CUSTOM MADE,HEAVY WEIGHT AS8425 GRADIENT PRESSURE AID (GLOVE) CUSTOM MADE,MEDIUM WEIGHT AS8426 GRADIENT PRESSURE AID(GLOVE) CUSTOM MADE,HEAVY WEIGHT AS9001 HOME UTERINE ACTIVITY MONITORING RENTAL AS9001 RR HOME UTERINE MONITOR WITH OR AS9326 HOME INFUSION THERAPY,CONTINUOUS(24HRS/MORE)PAIN MGMT INFUSION,ADMIN SERV AS9327 HOME INFUSION THERAPY,INTERMITTENT(LESS THAN 24HRS) PAIN MGMT INFUSION AS9330 HOME INFUSION THERAPY,CONTINUOUS(24HR OR MORE) CHEMOTHERAPY INFUSION,ADMIN AS9330 SH HIT CONT CHEM DIEM AS9331 HOME INFUSION THERAPY,INTERMITTENT(LESS THAN 24 HRS) CHEMOTHERAPY INFUSION AS9331 SH HIT INTERMIT CHEMO DIEM AS9338 HOME INFUSION THERAPY,IMMUNOTHERAPY,ADMIN SERV,PROF RX SERVICES,CARE COOR AS9345 HOME INFUSION THERAPY,ANTI-HEMOPHILIC AGENT INFUSION THERAPY (FACTOR VIII) AS9346 HOME INFUSION THERAPY,ALPHA-1-PROTEINASE INHIBITOR (PROLASTIN) ADMIN SERV AS9348 HOME INFUSION THERAPY,SYMPATHOMIMETIC/INOTROPIC AGENT INFUSION THERAPY AS9351 HIT, CONTINUE OR INTERMITT ANTI-EMETIC INFUSION TX AND ALL SUPPLY AND EQUIP AS9355 HOME INFUSION THERAPY,CHELATION THERAPY,ADMIN SERV,PER DIEM AS9374 HOME INFUSION THERAPY,HYDRATION THERAPY,1 LT PER DAY,ADMIN SERVICES. AS9375 HOME INFUSION THERAPY,HYDRATION THERAPY,MORE THAN 1 LTR < 2 LITERS PER DAY AS9376 HOME INFUSION THERAPY,HYDRATION THERAPY,MORE THAN 2 LTRS < 3 LTRS PER DAY AS9377 HOME INFUSION THERAPY,HYDRATION THERAPY,MORE THAN 3 LITERS PER DAY,PR DIEM AS9379 HOME INFUSION THERAPY,INFUSION THERAPY, NOC, ADMIN SERVICES,PER DIEM AS9490 HOME INFUSION THERAPY,CORTICOSTEROID INFUSION,ADMIN SERVICES,PER DIEM AS9497 HOME INFUSION THERAPY,ANTIBIOTIC,ANTIVIRAL/ANTIFUNGAL THERAPY,1 EVERY 3HRS AS9497 SH HIT ANTIBIOTIC Q3H DIEM AS9497 SJ HIT ANTIBIOTIC Q3H DIEM AS9500 HOME INFUSION THERAPY,ANTIBIOTIC,ANTIVIRAL,ANTIFUNGAL THERAPY EVERY 24 HRS AS9500 SH HIT ANTIIBIOTIC Q24H DIEM AS9500 SJ HIT ANTIIBIOTIC Q24H DIEM AS9501 HOME INFUSION THERAPY,ANTIBIOTIC,ANTIVIRAL,ANTIFUNGAL THERAPY EVERY 12 HRS AS9501 SH HIT ANTIBIOTIC Q12H DIEM AS9501 SJ HIT ANTIBIOTIC Q12H DIEM AS9502 HOME INFUSION THERAPY,ANTIBIOTIC,ANTIVIRAL,ANTIFUNGAL THERAPY EVERY 8 HRS AS9502 SH HIT ANTIBIOTIC Q8H DIEM AS9502 SJ HIT ANTIBIOTIC Q8H DIEM AS9503 HOME INFUSION THERAPY,ANTIBIOTIC,ANTIVIRAL,ANTIFUNGAL THERAPY EVERY 6 HRS A

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S9503 SH HIT ANTIBIOTIC Q6H DIEM AS9503 SJ HIT ANTIBIOTIC Q6H DIEM AS9504 HOME INFUSION THERAPY,ANTIBIOTIC,ANTIVIRAL,ANTIFUNGAL,EVERY 5 HRS,PER DIEM AS9504 SH HIT ANTIBIOTIC Q4H DIEM AS9504 SJ HIT ANTIBIOTIC Q4H DIEM AS9537 HOME THERAPY,HEMATOPOIETIC HORMONE INJECTION THERAPY,ADMIN SERV, PER DIEM AT4543 DISPOSABLE INCONTINENCE PRODUCT, BRIEF/DIAPER, BARIATRIC, EACH AT4544 ADLT DISP UND/PULL ON ABV XI AT5001 POSITIONING SEAT FOR PERSONS WITH SPECIAL ORTHOPEDIC NEEDS AV2623 PROSTHETIC EYE PLASTIC CUSTOM-V2623 AV2627 SCLERAL COVER SHELL-V2627 AV2629 PROSTHETIC EYE OTHER TYPE-V2629 A

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dme codes that require authorization · b4154 enteral formula,nutritionally complete,for special...

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