TABLE I
DURABLE MEDICAL EQUIPMENT |
HCPCS
CODE | NARRATIVE DESCRIPTION |
A4459 | Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type |
A4468
| Exsufflation belt, includes all supplies and accessories
|
A4593
| Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller
|
A4594
| Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each
|
A4596
| Cranial electrotherapy stimulation (ces) system supplies and accessories, per month
|
A7049
| Expiratory positive airway pressure intranasal resistance valve
|
A8000 | Helmet, protective, soft, prefabricated, includes all components and accessories |
A8001 | Helmet, protective, hard, prefabricated, includes all components and accessories |
A8002 | Helmet, protective, soft, custom fabricated, includes all components and accessories |
A8003 | Helmet, protective, hard, custom fabricated, includes all components and accessories |
A9272 | Wound suction, disposable, includes dressing, all accessories and components, any type, each |
E0100 | Cane, includes canes of all materials, adjustable or fixed, with tip |
E0105 | Cane, quad or three-prong, includes canes of all materials, adjustable or fixed, with tips |
E0110 | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips |
E0111 | Crutch, forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrip |
E0112 | Crutches, underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips |
E0113 | Crutch, underarm, wood, adjustable or fixed, each, with pad, tip and handgrip |
E0114 | Crutches, underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
E0116 | Crutch, underarm, other than wood, adjustable or fixed, each with pad, tip, handgrip, with or without shock absorber, each |
E0117 | Crutch, underarm, articulating, spring assisted, each |
E0118 | Crutch substitute, lower leg platform, with or without wheels, each |
E0130 | Walker, rigid (pickup), adjustable or fixed height |
E0135 | Walker, folding (pickup), adjustable or fixed height |
E0140 | Walker, with trunk support, adjustable or fixed height, any type |
E0141 | Walker, rigid, wheeled, adjustable or fixed height |
E0143 | Walker, folding, wheeled, adjustable or fixed height |
E0144 | Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
E0147 | Walker, heavy duty, multiple braking system, variable wheel resistance |
E0148 | Walker, heavy duty, without wheels, rigid or folding, any type, each |
E0149 | Walker, heavy duty, wheeled, rigid or folding, any type |
E0153 | Platform attachment, forearm crutch, each |
E0154 | Platform attachment, walker,each |
E0155 | Wheel attachment, rigid pick-up walker, per pair seat attachment, walker |
E0156 | Seat attachment, walker |
E0157 | Crutch attachment, walker, each |
E0158 | Leg extensions for walker, per set of four (4) |
E0160 | Sitz type bath or equipment, portable, used with or without commode |
E0161 | Sitz type bath or equipment, portable, used with or without commode, with faucet attachment(s) |
E0162 | Sitz bath chair |
E0163 | Commode chair, mobile or stationary, with fixed arms |
E0165 | Commode chair, mobile or stationary, with detachable arms |
E0168 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
E0170 | Commode chair with integrated seat lift mechanism, electric, any type |
E0171 | Commode chair with integrated seat lift mechanism, non-electric, any type |
E0181 | Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty |
E0183
| Powered pressure reducing underlay/pad, alternating, with pump, includes heavy duty
|
E0184 | Dry pressure mattress |
E0185 | Gel or gel-like pressure pad for mattress, standard mattress length and width |
E0186 | Air pressure mattress |
E0187 | Water pressure mattress |
E0188 | Synthetic sheepskin pad |
E0189 | Lambswool sheepskin pad, any size |
E0193 | Powered air flotation bed (low air loss therapy) |
E0194 | Air fluidized bed |
E0196 | Gel pressure mattress |
E0197 | Air pressure pad for mattress, standard mattress length and width |
E0198 | Water pressure pad for mattress, standard mattress length and width |
E0199 | Dry pressure pad for mattress, standard mattress length and width |
E0200 | Heat lamp, without stand (table model), includes bulb, or infrared element |
E0202 | Phototherapy (bilirubin) light with photometer |
E0205 | Heat lamp, with stand, includes bulb, or infrared element |
E0210 | Electric heat pad, standard |
E0215 | Electric heat pad, moist |
E0221 | Infrared heating pad system |
E0235 | Paraffin bath unit, portable (see medical supply code A4265 for paraffin) |
E0250 | Hospital bed, fixed height, with any type side rails, with mattress |
E0251 | Hospital bed, fixed height, with any type side rails, without mattress |
E0255 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
E0256 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress |
E0260 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
E0261 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
E0271 | Mattress, inner spring |
E0272 | Mattress, foam rubber |
E0275 | Bed pan, standard, metal or plastic |
E0276 | Bed pan, fracture, metal or plastic |
E0277 | Powered pressure-reducing air mattress |
E0280 | Bed cradle, any type |
E0290 | Hospital bed, fixed height, without side rails, with mattress |
E0291 | Hospital bed, fixed height, without side rails, without mattress |
E0292 | Hospital bed, variable height, hi-lo, without side rails, with mattress |
E0293 | Hospital bed, variable height, hi-lo, without side rails, without mattress |
E0294 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
E0295 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
E0300 | Pediatric crib, hospital grade, fully enclosed |
E0301 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress |
E0302 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress |
E0303 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
E0304 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress |
E0305 | Bedside rails, half-length |
E0310 | Bedside rails, full-length |
E0316 | Safety enclosure frame/canopy for use with hospital bed, any type |
E0325 | Urinal; male, jug-type, any material |
E0326 | Urinal; female, jug-type, any material |
E0328 | Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress |
E0329 | Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress |
E0350 | Control unit for electronic bowel irrigation/evacuation system |
E0352 | Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system |
E0370 | Air pressure elevator for heel |
E0371 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width |
E0372 | Powered air overlay for mattress, standard mattress length and width |
E0373 | Nonpowered advanced pressure reducing mattress |
E0424 | Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
E0425 | Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
E0430 | Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
E0433 | Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge |
E0434 | Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
E0435 | Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing, and refill adapter |
E0439 | Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
E0440 | Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
E0441 | Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
E0442 | Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
E0443 | Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
E0444 | Portable oxygen contents, liquid, 1 month's supply = 1 unit |
E0446 | Topical oxygen delivery system, not otherwise specified, includes all supplies and
accessories |
E0447 | Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm) |
E0455 | Oxygen tent, excluding croup or pediatric tents |
E0457 | Chest shell (cuirass) |
E0459 | Chest wrap |
E0462 | Rocking bed, with or without side rails |
E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
E0467 | Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions |
E0468
| Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions
|
E0469
| Lung expansion airway clearance, continuous high frequency oscillation, and nebulization device
|
E0470 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, eg, nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
E0471 | Respiratory assist device, bi-level pressure capability, with backup rate
feature, used with noninvasive interface, eg, nasal or facial mask
(intermittent assist device with continuous positive airway pressure device) |
E0472 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, eg, tracheostomy tube (intermittent assist device with continuous positive airway pressure device) |
E0480 | Percussor, electric or pneumatic, home model |
E0482 | Cough stimulating device, alternating positive and negative airway pressure |
E0483 | High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each
|
E0484 | Oscillatory positive expiratory pressure device, non-electric, any type, each |
E0485 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, prefabricated, includes fitting and adjustment |
E0486 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment |
E0487 | Spirometer, electronic, includes all accessories |
E0500 | IPPB machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source |
E0530
| Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type
|
E0550 | Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery |
E0555 | Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter |
E0560 | Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery |
E0561 | Humidifier, non-heated, used with positive airway pressure device |
E0562 | Humidifier, heated, used with positive airway pressure device |
E0565 | Compressor, air power source for equipment which is not self-contained or cylinder driven |
E0570 | Nebulizer, with compressor |
E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use |
E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter |
E0585 | Nebulizer, with compressor and heater |
E0600 | Respiratory suction pump, home model, portable or stationary, electric |
E0601 | Continuous positive airway pressure (CPAP) device |
E0602 | Breast pump, manual, any type |
E0605 | Vaporizer, room type |
E0606 | Postural drainage board |
E0607 | Home blood glucose monitor |
E0610 | Pacemaker monitor, self-contained, checks battery depletion, includes audible and visible check systems |
E0615 | Pacemaker monitor, self-contained, checks battery depletion and other pacemaker components, includes digital/visible check systems |
E0616 | Implantable cardiac event recorder with memory, activator and programmer |
E0617 | External defibrillator with integrated electrocardiogram analysis |
E0618 | Apnea monitor, without recording feature |
E0619 | Apnea monitor, with recording feature |
E0620 | Skin piercing device for collection of capillary blood, laser, each |
E0621 | Sling or seat, patient lift, canvas or nylon |
E0627 | Seat lift mechanism, electric, any type |
E0629 | Seat lift mechanism, non-electric, any type |
E0630 | Patient lift, hydraulic, or mechanical, includes any seat, sling, straps(s) or pad(s) |
E0635 | Patient lift, electric, with seat or sling |
E0636 | Multipositional patient support system, with integrated lift, patient accessible controls |
E0639 | Patient lift, moveable from room to room with disassembly and
reassembly, includes all components/accessories |
E0640 | Patient lift, fixed system, includes all components/accessories |
E0650 | Pneumatic compressor, nonsegmental home model |
E0651 | Pneumatic compressor, segmental home model without calibrated gradient pressure |
E0652 | Pneumatic compressor, segmental home model with calibrated gradient pressure |
E0655 | Nonsegmental pneumatic appliance for use with pneumatic compressor, half arm |
E0656 | Segmental pneumatic appliance for use with pneumatic compressor, trunk |
E0657 | Segmental pneumatic appliance for use with pneumatic compressor, chest |
E0660 | Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg |
E0665 | Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm |
E0666 | Nonsegmental pneumatic appliance for use with pneumatic compressor, half leg |
E0667 | Segmental pneumatic appliance for use with pneumatic compressor, full leg |
E0668 | Segmental pneumatic appliance for use with pneumatic compressor, full arm |
E0669 | Segmental pneumatic appliance for use with pneumatic compressor, half leg |
E0670 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk |
E0671 | Segmental gradient pressure pneumatic appliance, full leg |
E0672 | Segmental gradient pressure pneumatic appliance, full arm |
E0673 | Segmental gradient pressure pneumatic appliance, half leg |
E0675 | Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) |
E0676 | Intermittent limb compression device (includes all accessories), not otherwise specified |
E0683
| Non-pneumatic, non-sequential, peristaltic wave compression pump
|
E0691 | Ultraviolet light therapy system, includes bulbs/lamps, timer and eye protection; treatment area 2 square ft or less |
E0692 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, four foot panel |
E0693 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, six foot panel |
E0694 | Ultraviolet multidirectional light therapy system in six foot cabinet, includes bulbs/lamps, timer and eye protection. |
E0705 | Transfer device, any type each |
E0710 | Restraint, any type (body, chest, wrist or ankle) |
E0715
| Intravaginal device intended to strengthen pelvic floor muscles during kegel exercises
|
E0716
| Supplies and accessories for intravaginal device intended to strengthen pelvic floor muscles during kegel exercises
|
E0720 | Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation |
E0721
| Transcutaneous electrical nerve stimulator for nerves in the auricular region
|
E0730 | Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation |
E0731 | Form-fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient's skin by layers of fabric) |
E0732
| Cranial electrotherapy stimulation (ces) system, any type
|
E0735
| Non-invasive vagus nerve stimulator
|
E0736
| Transcutaneous tibial nerve stimulator
|
E0737
| Transcutaneous tibial nerve stimulator, controlled by phone application
|
E0738
| Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, include microprocessor, all components and accessories
|
E0739
| Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors
|
E0740 | Non-implanted pelvic floor electrical stimulator, complete system |
E0743
| External lower extremity nerve stimulator for restless legs syndrome, each
|
E0744 | Neuromuscular stimulator for scoliosis |
E0745 | Neuromuscular stimulator, electronic shock unit |
E0747 | Osteogenesis stimulator, electrical, noninvasive, other than spinal applications |
E0748 | Osteogenesis stimulator, electrical, noninvasive, spinal applications |
E0749 | Osteogenesis stimulator, electrical, surgically implanted |
E0755 | Electronic salivary reflex stimulator (intraoral/noninvasive) |
E0760 | Osteogenesis stimulator, low intensity ultrasound, noninvasive |
E0762 | Transcutaneous electrical joint stimulation device system includes all accessories |
E0764 | Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program |
E0765 | FDA approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting |
E0767
| Intrabuccal, systemic delivery of amplitude-modulated, radiofrequency electromagnetic field device, for cancer treatment, includes all accessories
|
E0770 | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified |
E0776 | IV pole |
E0779 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
E0780 | Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours |
E0781 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
E0782 | Infusion pump, implantable, nonprogrammable (includes all components,
e.g., pump, catheter, connectors, etc.) |
E0783 | Infusion pump system, implantable, programmable (includes all
components, e.g., pump, catheter, connectors, etc.) |
E0784 | External ambulatory infusion pump, insulin |
E0787 | External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing |
E0791 | Parenteral infusion pump, stationary, single or multichannel |
E0830 | Ambulatory traction device, all types, each |
E0840 | Traction frame, attached to headboard, cervical traction |
E0849 | Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible |
E0850 | Traction stand, freestanding, cervical traction |
E0855 | Cervical traction equipment not requiring additional stand or frame |
E0856 | Cervical traction device, with inflatable air bladder(s) |
E0860 | Traction equipment, overdoor, cervical |
E0870 | Traction frame, attached to footboard, extremity traction (eg, Buck's) |
E0880 | Traction stand, free standing, extremity traction |
E0890 | Traction frame, attached to footboard, pelvic traction |
E0900 | Traction stand, freestanding, pelvic traction (eg, Buck's) |
E0910 | Trapeze bars, also known as Patient Helper, attached to bed, with grab bar |
E0911 | Trapeze bar, heavy duty for patient weight capacity greater than 250 pounds, attached to bed, with grab bar |
E0912 | Trapeze bar, heavy duty for patient weight capacity greater than 250 pounds, free standing, complete with grab bar |
E0920 | Fracture frame, attached to bed, includes weights |
E0930 | Fracture frame, freestanding, includes weights |
E0935 | Continuous passive motion exercise device for use on knee only |
E0940 | Trapeze bar, freestanding, complete with grab bar |
E0941 | Gravity assisted traction device, any type |
E0942 | Cervical head harness/halter |
E0944 | Pelvic belt/harness/boot |
E0945 | Extremity belt/harness |
E0946 | Fracture frame, dual with cross bars, attached to bed (eg, Balken, Four Poster) |
E0947 | Fracture frame, attachments for complex pelvic traction |
E0948 | Fracture frame, attachments for complex cervical traction |
E0950 | Wheelchair accessory, tray, each |
E0951 | Heel loop/holder, any type, with or without ankle strap, each |
E0952 | Toe loop/holder, any type, each |
