|
E2201 |
 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches
| short | Man w/ch acc seat w>=20"<24" |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2202 |
|
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches
| short | Seat width 24-27 in |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2203 |
|
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches
| short | Frame depth less than 22 in |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2204 |
|
Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches
| short | Frame depth 22 to 25 in |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2205 |
|
Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each
| short | Manual wc accessory, handrim |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2206 |
|
Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each
| short | Man wc whl lock comp repl ea |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2207 |
|
Wheelchair accessory, crutch and cane holder, each
| short | Crutch and cane holder |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2208 |
|
Wheelchair accessory, cylinder tank carrier, each
| short | Cylinder tank carrier |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2209 |
|
Accessory, arm trough, with or without hand support, each
| short | Arm trough each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
|
|
|
|
E2210 |
|
Wheelchair accessory, bearings, any type, replacement only, each
| short | Wheelchair bearings |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
E2211 |
|
Manual wheelchair accessory, pneumatic propulsion tire, any size, each
| short | Pneumatic propulsion tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2212 |
|
Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each
| short | Pneumatic prop tire tube |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2213 |
|
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each
| short | Pneumatic prop tire insert |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2214 |
|
Manual wheelchair accessory, pneumatic caster tire, any size, each
| short | Pneumatic caster tire each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2215 |
|
Manual wheelchair accessory, tube for pneumatic caster tire, any size, each
| short | Pneumatic caster tire tube |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2216 |
|
Manual wheelchair accessory, foam filled propulsion tire, any size, each
| short | Foam filled propulsion tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2217 |
|
Manual wheelchair accessory, foam filled caster tire, any size, each
| short | Foam filled caster tire each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2218 |
|
Manual wheelchair accessory, foam propulsion tire, any size, each
| short | Foam propulsion tire each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2219 |
|
Manual wheelchair accessory, foam caster tire, any size, each
| short | Foam caster tire any size ea |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2220 |
|
Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each
| short | Solid propuls tire, repl, ea |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2221 |
|
Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each
| short | Solid caster tire repl, each |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2222 |
|
Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each
| short | Solid caster integ whl, repl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2224 |
|
Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each
| short | Propulsion whl excl tire rep |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2225 |
|
Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each
| short | Caster wheel excludes tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2226 |
|
Manual wheelchair accessory, caster fork, any size, replacement only, each
| short | Caster fork replacement only |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2227 |
|
Manual wheelchair accessory, gear reduction drive wheel, each
| short | Gear reduction drive wheel |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2228 |
|
Manual wheelchair accessory, wheel braking system and lock, complete, each
| short | Mwc acc, wheelchair brake |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2230 |
|
Manual wheelchair accessory, manual standing system
| short | Manual standing system |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E2231 |
|
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware
| short | Solid seat support base |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2291 |
|
Back, planar, for pediatric size wheelchair including fixed attaching hardware
| short | Planar back for ped size wc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2292 |
|
Seat, planar, for pediatric size wheelchair including fixed attaching hardware
| short | Planar seat for ped size wc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2293 |
|
Back, contoured, for pediatric size wheelchair including fixed attaching hardware
| short | Contour back for ped size wc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2294 |
|
Seat, contoured, for pediatric size wheelchair including fixed attaching hardware
| short | Contour seat for ped size wc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2295 |
|
Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features
| short | Ped dynamic seating frame |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2300 |
|
Wheelchair accessory, power seat elevation system, any type
| short | Pwr seat elevation sys |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2301 |
|
Wheelchair accessory, power standing system, any type
| short | Pwr standing |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2310 |
|
Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware
| short | Electro connect btw control |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
E2311 |
|
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware
| short | Electro connect btw 2 sys |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
|
|
|
|
E2312 |
|
Power wheelchair accessory, hand or chin control interface, mini-proportional remote joystick, proportional, including fixed mounting hardware
| short | Mini-prop remote joystick |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2313 |
|
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each
| short | Pwc harness, expand control |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2321 |
|
Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware
| short | Hand interface joystick |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2322 |
|
Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware
| short | Mult mech switches |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2323 |
|
Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated
| short | Special joystick handle |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2324 |
|
Power wheelchair accessory, chin cup for chin control interface
| short | Chin cup interface |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2325 |
|
Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware
| short | Sip and puff interface |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2326 |
|
Power wheelchair accessory, breath tube kit for sip and puff interface
| short | Breath tube kit |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2327 |
|
Power wheelchair accessory, head control interface, mechanical, proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware
| short | Head control interface mech |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2328 |
|
Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics and fixed mounting hardware
| short | Head/extremity control inter |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2329 |
|
Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware
| short | Head control nonproportional |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2330 |
|
Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware
| short | Head control proximity switc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2331 |
|
Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware
| short | Attendant control |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2340 |
|
Power wheelchair accessory, nonstandard seat frame width, 20-23 inches
| short | W/c wdth 20-23 in seat frame |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2341 |
|
Power wheelchair accessory, nonstandard seat frame width, 24-27 inches
| short | W/c wdth 24-27 in seat frame |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2342 |
|
Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches
| short | W/c dpth 20-21 in seat frame |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2343 |
|
Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches
| short | W/c dpth 22-25 in seat frame |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2351 |
|
Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface
| short | Electronic sgd interface |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2358 |
|
Power wheelchair accessory, group 34 non-sealed lead acid battery, each
| short | Gr 34 nonsealed leadacid |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2359 |
|
Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
| short | Gr34 sealed leadacid battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2360 |
|
Power wheelchair accessory, 22nf non-sealed lead acid battery, each
| short | 22nf nonsealed leadacid |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E2361 |
|
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat)
| short | 22nf sealed leadacid battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2362 |
|
Power wheelchair accessory, group 24 non-sealed lead acid battery, each
| short | Gr24 nonsealed leadacid |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E2363 |
|
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
| short | Gr24 sealed leadacid battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2364 |
|
Power wheelchair accessory, u-1 non-sealed lead acid battery, each
| short | U1nonsealed leadacid battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E2365 |
|
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat)
| short | U1 sealed leadacid battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2366 |
|
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each
| short | Battery charger, single mode |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2367 |
|
Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each
| short | Battery charger, dual mode |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2368 |
|
Power wheelchair component, drive wheel motor, replacement only
| short | Pwr wc drivewheel motor repl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2369 |
|
Power wheelchair component, drive wheel gear box, replacement only
| short | Pwr wc drivewheel gear repl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2370 |
|
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only
| short | Pwr wc dr wh motor/gear comb |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2371 |
|
Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each
| short | Gr27 sealed leadacid battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2372 |
|
Power wheelchair accessory, group 27 non-sealed lead acid battery, each
| short | Gr27 non-sealed leadacid |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|
|
E2373 |
|
Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware
| short | Hand/chin ctrl spec joystick |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2374 |
|
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only
| short | Hand/chin ctrl std joystick |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2375 |
|
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only
| short | Non-expandable controller |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2376 |
|
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only
| short | Expandable controller, repl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2377 |
|
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue
| short | Expandable controller, initl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2378 |
|
Power wheelchair component, actuator, replacement only
| short | Pw actuator replacement |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E2381 |
|
Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each
| short | Pneum drive wheel tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2382 |
|
Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each
| short | Tube, pneum wheel drive tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2383 |
|
Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each
| short | Insert, pneum wheel drive |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2384 |
|
Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each
| short | Pneumatic caster tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2385 |
|
Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each
| short | Tube, pneumatic caster tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2386 |
|
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each
| short | Foam filled drive wheel tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2387 |
|
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each
| short | Foam filled caster tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2388 |
|
Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each
| short | Foam drive wheel tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2389 |
|
Power wheelchair accessory, foam caster tire, any size, replacement only, each
| short | Foam caster tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2390 |
|
Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each
| short | Solid drive wheel tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2391 |
|
Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each
| short | Solid caster tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2392 |
|
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each
| short | Solid caster tire, integrate |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2394 |
|
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each
| short | Drive wheel excludes tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2395 |
|
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each
| short | Caster wheel excludes tire |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2396 |
|
Power wheelchair accessory, caster fork, any size, replacement only, each
| short | Caster fork |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 4.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E2397 |
|
Power wheelchair accessory, lithium-based battery, each
| short | Pwc acc, lith-based battery |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|