Therapeutic Equipment - Holistic Medical Supply

DM20: SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATTRESSES/OVERLAYS/PADS - NEW (BOC Category)

REPLACEMENT PAD FOR USE WITH MEDICALLY NECESSARY ALTERNATING PRESSURE PAD OWNED BY PATIENT

HCPCS Code

A4640

POWERED PRESSURE REDUCING MATTRESS OVERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES HEAVY DUTY

HCPCS Code

E0181

PUMP FOR ALTERNATING PRESSURE PAD, FOR REPLACEMENT ONLY

HCPCS Code

E0182

POWERED PRESSURE REDUCING UNDERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES HEAVY DUTY

HCPCS Code

E0183

DRY PRESSURE MATTRESS

HCPCS Code

E0184

GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH

HCPCS Code

E0185

AIR PRESSURE MATTRESS

HCPCS Code

E0186

WATER PRESSURE MATTRESS

HCPCS Code

E0187

SYNTHETIC SHEEPSKIN PAD

HCPCS Code

E0188

LAMBSWOOL SHEEPSKIN PAD, ANY SIZE

HCPCS Code

E0189

POWERED AIR FLOTATION BED (LOW AIR LOSS THERAPY)

HCPCS Code

E0193

AIR FLUIDIZED BED

HCPCS Code

E0194

GEL PRESSURE MATTRESS

HCPCS Code

E0196

AIR PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH

HCPCS Code

E0197

WATER PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH

HCPCS Code

E0198

DRY PRESSURE PAD FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH

HCPCS Code

E0199

POWERED PRESSURE-REDUCING AIR MATTRESS

HCPCS Code

E0277

NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH

HCPCS Code

E0371

POWERED AIR OVERLAY FOR MATTRESS, STANDARD MATTRESS LENGTH AND WIDTH

HCPCS Code

E0372

NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS

HCPCS Code

E0373

DM21: TRACTION EQUIPMENT (BOC Category)

AMBULATORY TRACTION DEVICE, ALL TYPES, EACH

HCPCS Code

E0830

TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION

HCPCS Code

E0840

TRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/FRAME, PNEUMATIC, APPLYING TRACTION FORCE TO OTHER THAN MANDIBLE

HCPCS Code

E0849

TRACTION STAND, FREE STANDING, CERVICAL TRACTION

HCPCS Code

E0850

CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME

HCPCS Code

E0855

CERVICAL TRACTION DEVICE, WITH INFLATABLE AIR BLADDER(S)

HCPCS Code

E0856

TRACTION EQUIPMENT, OVERDOOR, CERVICAL

HCPCS Code

E0860

TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G., BUCK'S)

HCPCS Code

E0870

TRACTION STAND, FREE STANDING, EXTREMITY TRACTION

HCPCS Code

E0880

TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION

HCPCS Code

E0890

TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S)

HCPCS Code

E0900

FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS

HCPCS Code

E0920

FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS

HCPCS Code

E0930

GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE

HCPCS Code

E0941

CERVICAL HEAD HARNESS/HALTER

HCPCS Code

E0942

PELVIC BELT/HARNESS/BOOT

HCPCS Code

E0944

EXTREMITY BELT/HARNESS

HCPCS Code

E0945

FRACTURE, FRAME, DUAL WITH CROSS BARS, ATTACHED TO BED, (E.G., BALKEN, 4 POSTER)

HCPCS Code

E0946

FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION

HCPCS Code

E0947

FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION

HCPCS Code

E0948

DM22: TRANSCUTANEOUS ELECTRICAL NERVE STIMULATORS (TENS) AND/OR SUPPLIES (BOC Category)

ELECTRODES, (E.G., APNEA MONITOR), PER PAIR

HCPCS Code

A4556

LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR

HCPCS Code

A4557

CONDUCTIVE GEL OR PASTE, FOR USE WITH ELECTRICAL DEVICE (E.G., TENS, NMES), PER OZ

HCPCS Code

A4558

ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G., TENS, NMES)

HCPCS Code

A4595

REPLACEMENT BATTERIES, MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL STIMULATOR, OWNED BY PATIENT

HCPCS Code

A4630

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, TWO LEAD, LOCALIZED STIMULATION

HCPCS Code

E0720

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, FOUR OR MORE LEADS, FOR MULTIPLE NERVE STIMULATION

HCPCS Code

E0730

FORM FITTING CONDUCTIVE GARMENT FOR DELIVERY OF TENS OR NMES (WITH CONDUCTIVE FIBERS SEPARATED FROM THE PATIENT'S SKIN BY LAYERS OF FABRIC)

HCPCS Code

E0731

DM24: EXTERNAL INFUSION PUMP SUPPLIES (BOC Category)

SUPPLIES FOR MAINTENANCE OF NON-INSULIN DRUG INFUSION CATHETER, PER WEEK (LIST DRUGS SEPARATELY)

HCPCS Code

A4221

INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS SEPARATELY)

HCPCS Code

A4222

SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION PUMP WITH DOSAGE RATE ADJUSTMENT USING THERAPEUTIC CONTINUOUS GLUCOSE SENSING, PER WEEK

HCPCS Code

A4226

⚠️ CODE RETIRED - DO NOT USE

ALCOHOL OR PEROXIDE, PER PINT

HCPCS Code

A4244

ALCOHOL WIPES, PER BOX

HCPCS Code

A4245

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 1.5 VOLT, EACH

HCPCS Code

A4602

SUPPLIES FOR EXTERNAL NON-INSULIN DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH

HCPCS Code

K0552

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE, 1.5 VOLT, EACH

HCPCS Code

K0601

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE, 3 VOLT, EACH

HCPCS Code

K0602

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, ALKALINE, 1.5 VOLT, EACH

HCPCS Code

K0603

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 3.6 VOLT, EACH

HCPCS Code

K0604

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 4.5 VOLT, EACH

HCPCS Code

K0605

DM25: INSULIN INFUSION PUMP SUPPLIES (BOC Category)

SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK

HCPCS Code

A4224

SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH

HCPCS Code

A4225

ALCOHOL OR PEROXIDE, PER PINT

HCPCS Code

A4244

ALCOHOL WIPES, PER BOX

HCPCS Code

A4245

SUPPLIES FOR EXTERNAL NON-INSULIN DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH

HCPCS Code

K0552

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE, 1.5 VOLT, EACH

HCPCS Code

K0601

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, SILVER OXIDE, 3 VOLT, EACH

HCPCS Code

K0602

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, ALKALINE, 1.5 VOLT, EACH

HCPCS Code

K0603

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 3.6 VOLT, EACH

HCPCS Code

K0604

REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP OWNED BY PATIENT, LITHIUM, 4.5 VOLT, EACH

HCPCS Code

K0605

DM28: REHABILITATIVE THERAPY DEVICES (BOC Category)

UPPER EXTREMITY REHABILITATION SYSTEM PROVIDING ACTIVE ASSISTANCE TO FACILITATE MUSCLE RE-EDUCATION, INCLUDE MICROPROCESSOR, ALL COMPONENTS AND ACCESSORIES

HCPCS Code

E0738

REHABILITATION SYSTEM WITH INTERACTIVE INTERFACE PROVIDING ACTIVE ASSISTANCE IN REHABILITATION THERAPY, INCLUDES ALL COMPONENTS AND ACCESSORIES, MOTORS, MICROPROCESSORS, SENSORS

HCPCS Code

E0739

GAIT MODULATION SYSTEM, RHYTHMIC AUDITORY STIMULATION, INCLUDING RESTRICTED THERAPY SOFTWARE, ALL COMPONENTS AND ACCESSORIES, PRESCRIPTION ONLY

HCPCS Code

E3200

DM29: URINARY SUCTION PUMPS (BOC Category)

EXTERNAL URINARY CATHETERS; DISPOSABLE, WITH WICKING MATERIAL, FOR USE WITH SUCTION PUMP, PER MONTH

HCPCS Code

A6590

EXTERNAL URINARY CATHETER; NON-DISPOSABLE, FOR USE WITH SUCTION PUMP, PER MONTH

HCPCS Code

A6591

CANISTER, NON-DISPOSABLE, USED WITH SUCTION PUMP, EACH

HCPCS Code

A7001

TUBING, USED WITH SUCTION PUMP, EACH

HCPCS Code

A7002

SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC, ANY TYPE, FOR USE WITH EXTERNAL URINE AND/OR FECAL MANAGEMENT SYSTEM

HCPCS Code

E2001