current social services blanket code hcpcs code billing table · current social services blanket...

Current Social Services Blanket Code HCPCS Code Billing Table Updated: 01/27/2016

Social Service Blanket Code Group Description HCPCS Code Procedure Code Short Description

SA875 Bathroom aids, toileting, and supplies SA875 E0160 Sitz type bath or equipment

SA875 Bathroom aids, toileting, and supplies SA875 E0161 Sitz bath/equipment w/faucet

SA875 Bathroom aids, toileting, and supplies SA875 E0162 Sitz bath chair

SA875 Bathroom aids, toileting, and supplies SA875 E0163 Commode chair with fixed arm

SA875 Bathroom aids, toileting, and supplies SA875 E0165 Commode chair with detacharm

SA875 Bathroom aids, toileting, and supplies SA875 E0167 Commode chair pail or pan

SA875 Bathroom aids, toileting, and supplies SA875 E0168 Heavyduty/wide commode chair

SA875 Bathroom aids, toileting, and supplies SA875 E0170 Commode chair electric

SA875 Bathroom aids, toileting, and supplies SA875 E0171 Commode chair non-electric

SA875 Bathroom aids, toileting, and supplies SA875 E0172 Seat lift mechanism toilet

SA875 Bathroom aids, toileting, and supplies SA875 E0175 Commode chair foot rest

SA875 Bathroom aids, toileting, and supplies SA875 E0240 Bath/shower chair

SA875 Bathroom aids, toileting, and supplies SA875 E0241 Bath tub wall rail

SA875 Bathroom aids, toileting, and supplies SA875 E0243 Toilet rail

SA875 Bathroom aids, toileting, and supplies SA875 E0244 Toilet seat raised

SA875 Bathroom aids, toileting, and supplies SA875 E0245 Tub stool or bench

SA875 Bathroom aids, toileting, and supplies SA875 E0246 Transfer tub rail attachment

SA875 Bathroom aids, toileting, and supplies SA875 E0247 Trans bench w/wo comm open

SA875 Bathroom aids, toileting, and supplies SA875 E0248 HDtrans bench w/wo comm open

SA875 Bathroom aids, toileting, and supplies SA875 E0275 Bed pan standard

SA875 Bathroom aids, toileting, and supplies SA875 E0276 Bed pan fracture

SA875 Bathroom aids, toileting, and supplies SA875 E0325 Urinal male jug-type

SA875 Bathroom aids, toileting, and supplies SA875 E0326 Urinal female jug-type

SA875 Bathroom aids, toileting, and supplies SA875 E1310 Whirlpool non-portable

SA876 Communication devices and supplies SA876 E2500 SGD digitized pre-rec <=8min

SA876 Communication devices and supplies SA876 E2502 SGD prerec msg >8min <=20min

SA876 Communication devices and supplies SA876 E2504 SGD prerec msg>20min <=40min

SA876 Communication devices and supplies SA876 E2506 SGD prerec msg > 40 min

SA876 Communication devices and supplies SA876 E2508 SGD spelling phys contact

SA876 Communication devices and supplies SA876 E2510 SGD w multi methods msg/accs

SA876 Communication devices and supplies SA876 E2511 SGD sftwre prgrm for PC/PDA

SA876 Communication devices and supplies SA876 E2512 SGD accessory, mounting sys

SA876 Communication devices and supplies SA876 E2599 SGD accessory noc

SA877 Diabetic equipment and supplies SA877 A4230 Infus insulin pump non needl

SA877 Diabetic equipment and supplies SA877 A4231 Infusion insulin pump needle

SA877 Diabetic equipment and supplies SA877 A4232 Syringe w/needle insulin 3cc

SA877 Diabetic equipment and supplies SA877 A4233 Alkalin batt for glucose mon

SA877 Diabetic equipment and supplies SA877 A4234 J-cell batt for glucose mon

SA877 Diabetic equipment and supplies SA877 A4235 Lithium batt for glucose mon

SA877 Diabetic equipment and supplies SA877 A4236 Silvr oxide batt glucose mon

SA877 Diabetic equipment and supplies SA877 A4245 Alcohol wipes per box

SA877 Diabetic equipment and supplies SA877 A4252 Blood ketone test or strip

SA877 Diabetic equipment and supplies SA877 A4253 Blood glucose/reagent strips

SA877 Diabetic equipment and supplies SA877 A4255 Glucose monitor platforms

SA877 Diabetic equipment and supplies SA877 A5500 Diab shoe for density insert

SA877 Diabetic equipment and supplies SA877 A5501 Diabetic custom molded shoe

SA877 Diabetic equipment and supplies SA877 A5503 Diabetic shoe w/roller/rockr

SA877 Diabetic equipment and supplies SA877 A5504 Diabetic shoe with wedge

SA877 Diabetic equipment and supplies SA877 A5505 Diab shoe w/metatarsal bar

SA877 Diabetic equipment and supplies SA877 A5506 Diabetic shoe w/off set heel

SA877 Diabetic equipment and supplies SA877 A5507 Modification diabetic shoe

SA877 Diabetic equipment and supplies SA877 A5508 Diabetic deluxe shoe

SA877 Diabetic equipment and supplies SA877 A5510 Compression form shoe insert

SA877 Diabetic equipment and supplies SA877 A5512 Multi den insert direct form

SA877 Diabetic equipment and supplies SA877 A5513 Multi den insert custom mold

SA877 Diabetic equipment and supplies SA877 A6531 Compression stocking BK30-40

SA877 Diabetic equipment and supplies SA877 E0607 Blood glucose monitor home

SA877 Diabetic equipment and supplies SA877 E2100 Bld glucose monitor w voice

SA877 Diabetic equipment and supplies SA877 E2101 Bld glucose monitor w lance

SA878 Hospital beds and supplies SA878 E0250 Hosp bed fixed ht w/ mattres

SA878 Hospital beds and supplies SA878 E0251 Hosp bed fixd ht w/o mattres

SA878 Hospital beds and supplies SA878 E0255 Hospital bed var ht w/ mattr

SA878 Hospital beds and supplies SA878 E0256 Hospital bed var ht w/o matt

SA878 Hospital beds and supplies SA878 E0260 Hosp bed semi-electr w/ matt

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SA878 Hospital beds and supplies SA878 E0261 Hosp bed semi-electr w/o mat

SA878 Hospital beds and supplies SA878 E0265 Hosp bed total electr w/ mat

SA878 Hospital beds and supplies SA878 E0266 Hosp bed total elec w/o matt

SA878 Hospital beds and supplies SA878 E0270 Hospital bed institutional t

SA878 Hospital beds and supplies SA878 E0271 Mattress innerspring

SA878 Hospital beds and supplies SA878 E0272 Mattress foam rubber

SA878 Hospital beds and supplies SA878 E0277 Powered pres-redu air mattrs

SA878 Hospital beds and supplies SA878 E0280 Bed cradle

SA878 Hospital beds and supplies SA878 E0290 Hosp bed fx ht w/o rails w/m

SA878 Hospital beds and supplies SA878 E0291 Hosp bed fx ht w/o rail w/o

SA878 Hospital beds and supplies SA878 E0292 Hosp bed var ht w/o rail w/o

SA878 Hospital beds and supplies SA878 E0293 Hosp bed var ht w/o rail w/

SA878 Hospital beds and supplies SA878 E0294 Hosp bed semi-elect w/ mattr

SA878 Hospital beds and supplies SA878 E0295 Hosp bed semi-elect w/o matt

SA878 Hospital beds and supplies SA878 E0296 Hosp bed total elect w/ matt

SA878 Hospital beds and supplies SA878 E0297 Hosp bed total elect w/o mat

SA878 Hospital beds and supplies SA878 E0300 Enclosed ped crib hosp grade

SA878 Hospital beds and supplies SA878 E0301 HD hosp bed, 350-600 lbs

SA878 Hospital beds and supplies SA878 E0302 Ex hd hosp bed > 600 lbs

SA878 Hospital beds and supplies SA878 E0303 Hosp bed hvy dty xtra wide

SA878 Hospital beds and supplies SA878 E0304 Hosp bed xtra hvy dty x wide

SA878 Hospital beds and supplies SA878 E0305 Rails bed side half length

SA878 Hospital beds and supplies SA878 E0310 Rails bed side full length

SA878 Hospital beds and supplies SA878 E0316 Bed safety enclosure

SA878 Hospital beds and supplies SA878 E0328 Ped hospital bed, manual

SA878 Hospital beds and supplies SA878 E0329 Ped hospital bed semi/elect

SA878 Hospital beds and supplies SA878 E0350 Control unit bowel system

SA878 Hospital beds and supplies SA878 E0352 Disposable pack w/bowel syst

SA878 Hospital beds and supplies SA878 E0371 Nonpower mattress overlay

SA878 Hospital beds and supplies SA878 E0372 Powered air mattress overlay

SA878 Hospital beds and supplies SA878 E0373 Nonpowered pressure mattress

SA879 Miscellaneous SA879 94005 Home vent mgmt supervision

SA879 Miscellaneous SA879 94760 Measure blood oxygen level

SA879 Miscellaneous SA879 94772 Breath recording, infant

SA879 Miscellaneous SA879 A4206 1 CC sterile syringe&needle



SA879 Miscellaneous SA879 A4209 5+ CC sterile syringe&needle

SA879 Miscellaneous SA879 A4210 Nonneedle injection device

SA879 Miscellaneous SA879 A4211 Supp for self-adm injections

SA879 Miscellaneous SA879 A4213 20+ CC syringe only

SA879 Miscellaneous SA879 A4215 Sterile needle

SA879 Miscellaneous SA879 A4216 Sterile water/saline, 10 ml

SA879 Miscellaneous SA879 A4217 Sterile water/saline, 500 ml

SA879 Miscellaneous SA879 A4220 Infusion pump refill kit

SA879 Miscellaneous SA879 A4221 Maint drug infus cath per wk

SA879 Miscellaneous SA879 A4222 Infusion supplies with pump

SA879 Miscellaneous SA879 A4223 Infusion supplies w/o pump

SA879 Miscellaneous SA879 A4244 Alcohol or peroxide per pint

SA879 Miscellaneous SA879 A4246 Betadine/phisohex solution

SA879 Miscellaneous SA879 A4247 Betadine/iodine swabs/wipes

SA879 Miscellaneous SA879 A4248 Chlorhexidine antisept

SA879 Miscellaneous SA879 A4250 Urine reagent strips/tablets

SA879 Miscellaneous SA879 A4256 Calibrator solution/chips

SA879 Miscellaneous SA879 A4258 Lancet device each

SA879 Miscellaneous SA879 A4259 Lancets per box

SA879 Miscellaneous SA879 A4265 Paraffin

SA879 Miscellaneous SA879 A4281 Replacement breastpump tube

SA879 Miscellaneous SA879 A4282 Replacement breastpump adpt

SA879 Miscellaneous SA879 A4283 Replacement breastpump cap

SA879 Miscellaneous SA879 A4284 Replcmnt breast pump shield

SA879 Miscellaneous SA879 A4285 Replcmnt breast pump bottle

SA879 Miscellaneous SA879 A4286 Replcmnt breastpump lok ring

SA879 Miscellaneous SA879 A4290 Sacral nerve stim test lead

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SA879 Miscellaneous SA879 A4435 1PC OST PCH DRAIN HGH OUTPUT

SA879 Miscellaneous SA879 A4458 Reusable enema bag

SA879 Miscellaneous SA879 A4461 Surgicl dress hold non-reuse

SA879 Miscellaneous SA879 A4463 Surgical dress holder reuse

SA879 Miscellaneous SA879 A4465 Non-elastic extremity binder

SA879 Miscellaneous SA879 A4466 Elastic garment/covering

SA879 Miscellaneous SA879 A4490 Above knee surgical stocking

SA879 Miscellaneous SA879 A4495 Thigh length surg stocking

SA879 Miscellaneous SA879 A4500 Below knee surgical stocking

SA879 Miscellaneous SA879 A4510 Full length surg stocking

SA879 Miscellaneous SA879 A4520 Incontinence garment anytype

SA879 Miscellaneous SA879 A4554 Disposable underpads

SA879 Miscellaneous SA879 A4556 Electrodes, pair

SA879 Miscellaneous SA879 A4557 Lead wires, pair

SA879 Miscellaneous SA879 A4558 Conductive gel or paste

SA879 Miscellaneous SA879 A4561 Pessary rubber, any type

SA879 Miscellaneous SA879 A4562 Pessary, non rubber,any type

SA879 Miscellaneous SA879 A4565 Slings

SA879 Miscellaneous SA879 A4566 SHOULD SLING/VEST/ABRESTRAIN

SA879 Miscellaneous SA879 A4570 Splint

SA879 Miscellaneous SA879 A4595 TENS suppl 2 lead per month

SA879 Miscellaneous SA879 A4602 REPLACE LITHIUM BATTERY 1.5V

SA879 Miscellaneous SA879 A4605 Trach suction cath close sys

SA879 Miscellaneous SA879 A4606 Oxygen probe used w oximeter

SA879 Miscellaneous SA879 A4630 Repl bat t.e.n.s. own by pt

SA879 Miscellaneous SA879 A4633 Uvl replacement bulb

SA879 Miscellaneous SA879 A4634 Replacement bulb th lightbox

SA879 Miscellaneous SA879 A4639 Infrared ht sys replcmnt pad

SA879 Miscellaneous SA879 A4640 Alternating pressure pad

SA879 Miscellaneous SA879 A4649 Surgical supplies

SA879 Miscellaneous SA879 A4928 Surgical mask

SA879 Miscellaneous SA879 A4930 Sterile, gloves per pair

SA879 Miscellaneous SA879 A4931 Reusable oral thermometer

SA879 Miscellaneous SA879 A4932 Reusable rectal thermometer

SA879 Miscellaneous SA879 A6530 Compression stocking BK18-30

SA879 Miscellaneous SA879 A6532 Compression stocking BK40-50

SA879 Miscellaneous SA879 A6533 Gc stocking thighlngth 18-30



SA879 Miscellaneous SA879 A6536 Gc stocking full lngth 18-30

SA879 Miscellaneous SA879 A9180 Lice treatment, topical

SA879 Miscellaneous SA879 E0181 Press pad alternating w/ pum

SA879 Miscellaneous SA879 E0182 Replace pump, alt press pad

SA879 Miscellaneous SA879 E0184 Dry pressure mattress

SA879 Miscellaneous SA879 E0185 Gel pressure mattress pad

SA879 Miscellaneous SA879 E0186 Air pressure mattress

SA879 Miscellaneous SA879 E0188 Synthetic sheepskin pad

SA879 Miscellaneous SA879 E0189 Lambswool sheepskin pad

SA879 Miscellaneous SA879 E0190 Positioning cushion

SA879 Miscellaneous SA879 E0191 Protector heel or elbow

SA879 Miscellaneous SA879 E0193 Powered air flotation bed

SA879 Miscellaneous SA879 E0194 Air fluidized bed

SA879 Miscellaneous SA879 E0196 Gel pressure mattress

SA879 Miscellaneous SA879 E0197 Air pressure pad for mattres

SA879 Miscellaneous SA879 E0198 Water pressure pad for mattr

SA879 Miscellaneous SA879 E0199 Dry pressure pad for mattres

SA879 Miscellaneous SA879 E0225 Hydrocollator unit

SA879 Miscellaneous SA879 E0230 Ice cap or collar

SA879 Miscellaneous SA879 E0232 Warming card for NWT

SA879 Miscellaneous SA879 E0235 Paraffin bath unit portable

SA879 Miscellaneous SA879 E0236 Pump for water circulating p

SA879 Miscellaneous SA879 E0239 Hydrocollator unit portable

SA879 Miscellaneous SA879 E0274 Over-bed table

SA879 Miscellaneous SA879 E0600 Suction pump portab hom modl

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SA879 Miscellaneous SA879 E0601 CONT AIRWAY PRESSURE DEVICE

SA879 Miscellaneous SA879 E0619 Apnea monitor w recorder

SA879 Miscellaneous SA879 E0621 Patient lift sling or seat

SA879 Miscellaneous SA879 E0627 Seat lift incorp lift-chair

SA879 Miscellaneous SA879 E0628 Seat lift for pt furn-electr

SA879 Miscellaneous SA879 E0629 Seat lift for pt furn-non-el

SA879 Miscellaneous SA879 E0630 Patient lift hydraulic

SA879 Miscellaneous SA879 E0635 Patient lift electric

SA879 Miscellaneous SA879 E0636 PT support & positioning sys

SA879 Miscellaneous SA879 E0637 COMBINATION SIT TO STAND SYS

SA879 Miscellaneous SA879 E0638 STANDING FRAME SYS

SA879 Miscellaneous SA879 E0639 Moveable patient lift system

SA879 Miscellaneous SA879 E0640 Fixed patient lift system

SA879 Miscellaneous SA879 E0641 MULTI-POSITION STND FRAM SYS

SA879 Miscellaneous SA879 E0642 DYNAMIC STANDING FRAME

SA879 Miscellaneous SA879 E0650 Pneuma compresor non-segment

SA879 Miscellaneous SA879 E0651 Pneum compressor segmental

SA879 Miscellaneous SA879 E0652 Pneum compres w/cal pressure

SA879 Miscellaneous SA879 E0655 Pneumatic appliance half arm

SA879 Miscellaneous SA879 E0656 Segmental pneumatic trunk

SA879 Miscellaneous SA879 E0657 Segmental pneumatic chest

SA879 Miscellaneous SA879 E0660 Pneumatic appliance full leg

SA879 Miscellaneous SA879 E0665 Pneumatic appliance full arm

SA879 Miscellaneous SA879 E0666 Pneumatic appliance half leg

SA879 Miscellaneous SA879 E0667 Seg pneumatic appl full leg

SA879 Miscellaneous SA879 E0668 Seg pneumatic appl full arm

SA879 Miscellaneous SA879 E0669 Seg pneumatic appli half leg

SA879 Miscellaneous SA879 E0671 Pressure pneum appl full leg

SA879 Miscellaneous SA879 E0672 Pressure pneum appl full arm

SA879 Miscellaneous SA879 E0673 Pressure pneum appl half leg

SA879 Miscellaneous SA879 E0675 Pneumatic compression device

SA879 Miscellaneous SA879 E0691 UVL PNL 2 SQ FT OR LESS

SA879 Miscellaneous SA879 E0692 Uvl sys panel 4 ft

SA879 Miscellaneous SA879 E0693 Uvl sys panel 6 ft

SA879 Miscellaneous SA879 E0694 Uvl md cabinet sys 6 ft

SA879 Miscellaneous SA879 E0700 Safety equipment

SA879 Miscellaneous SA879 E0705 Transfer device

SA879 Miscellaneous SA879 E0720 Tens two lead

SA879 Miscellaneous SA879 E0731 Conductive garment for tens/

SA879 Miscellaneous SA879 E0740 Incontinence treatment systm

SA879 Miscellaneous SA879 E0744 Neuromuscular stim for scoli

SA879 Miscellaneous SA879 E0747 Elec osteogen stim not spine

SA879 Miscellaneous SA879 E0748 Elec osteogen stim spinal

SA879 Miscellaneous SA879 E0749 Elec osteogen stim implanted

SA879 Miscellaneous SA879 E0760 Osteogen ultrasound stimltor

SA879 Miscellaneous SA879 E0762 Trans elec jt stim dev sys

SA879 Miscellaneous SA879 E0765 Nerve stimulator for tx n&v

SA879 Miscellaneous SA879 E0776 Iv pole

SA879 Miscellaneous SA879 E0779 Amb infusion pump mechanical

SA879 Miscellaneous SA879 E0780 Mech amb infusion pump <8hrs

SA879 Miscellaneous SA879 E0781 External ambulatory infus pu

SA879 Miscellaneous SA879 E0784 Ext amb infusn pump insulin

SA879 Miscellaneous SA879 E0791 Parenteral infusion pump sta

SA879 Miscellaneous SA879 E0830 Ambulatory traction device

SA879 Miscellaneous SA879 E0840 Tract frame attach headboard

SA879 Miscellaneous SA879 E0849 Cervical pneum trac equip

SA879 Miscellaneous SA879 E0850 Traction stand free standing

SA879 Miscellaneous SA879 E0855 Cervical traction equipment

SA879 Miscellaneous SA879 E0856 CERVIC COLLAR W AIR BLADDERS

SA879 Miscellaneous SA879 E0860 Tract equip cervical tract

SA879 Miscellaneous SA879 E0870 Tract frame attach footboard

SA879 Miscellaneous SA879 E0880 Trac stand free stand extrem

SA879 Miscellaneous SA879 E0890 Traction frame attach pelvic

SA879 Miscellaneous SA879 E0900 Trac stand free stand pelvic

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SA879 Miscellaneous SA879 E0910 Trapeze bar attached to bed

SA879 Miscellaneous SA879 E0911 HD trapeze bar attach to bed

SA879 Miscellaneous SA879 E0912 HD trapeze bar free standing

SA879 Miscellaneous SA879 E0920 Fracture frame attached to b

SA879 Miscellaneous SA879 E0930 Fracture frame free standing

SA879 Miscellaneous SA879 E0935 Cont pas motion exercise dev

SA879 Miscellaneous SA879 E0936 CPM device, other than knee

SA879 Miscellaneous SA879 E0940 Trapeze bar free standing

SA879 Miscellaneous SA879 E0941 Gravity assisted traction de

SA879 Miscellaneous SA879 E0942 Cervical head harness/halter

SA879 Miscellaneous SA879 E0944 Pelvic belt/harness/boot

SA879 Miscellaneous SA879 E0945 Belt/harness extremity

SA879 Miscellaneous SA879 E0946 Fracture frame dual w cross

SA879 Miscellaneous SA879 E0947 Fracture frame attachmnts pe

SA879 Miscellaneous SA879 E0948 Fracture frame attachmnts ce

SA879 Miscellaneous SA879 E1031 Rollabout chair with casters

SA879 Miscellaneous SA879 E1037 Transport chair, ped size

SA879 Miscellaneous SA879 E1038 Transport chair pt wt<=300lb

SA879 Miscellaneous SA879 E1039 Transport chair pt wt >300lb

SA879 Miscellaneous SA879 E1399 Durable medical equipment mi

SA879 Miscellaneous SA879 E2000 Gastric suction pump hme mdl

SA879 Miscellaneous SA879 E2402 Neg press wound therapy pump

SA879 Miscellaneous SA879 S1040 Cranial remolding orthosis

SA879 Miscellaneous SA879 S8431 Compression bandage

SA879 Miscellaneous SA879 T5001 Position seat spec orth need

SA879 Miscellaneous SA879 T5999 Supply, nos

SA880 Mobility Aids and supplies SA880 A4635 Underarm crutch pad

SA880 Mobility Aids and supplies SA880 A4636 Handgrip for cane etc

SA880 Mobility Aids and supplies SA880 A4637 Repl tip cane/crutch/walker

SA880 Mobility Aids and supplies SA880 E0100 Cane adjust/fixed with tip

SA880 Mobility Aids and supplies SA880 E0105 Cane adjust/fixed quad/3 pro

SA880 Mobility Aids and supplies SA880 E0110 Crutch forearm pair

SA880 Mobility Aids and supplies SA880 E0111 Crutch forearm each

SA880 Mobility Aids and supplies SA880 E0112 Crutch underarm pair wood

SA880 Mobility Aids and supplies SA880 E0113 Crutch underarm each wood

SA880 Mobility Aids and supplies SA880 E0114 Crutch underarm pair no wood

SA880 Mobility Aids and supplies SA880 E0116 Crutch underarm each no wood

SA880 Mobility Aids and supplies SA880 E0117 Underarm springassist crutch

SA880 Mobility Aids and supplies SA880 E0118 Crutch substitute

SA880 Mobility Aids and supplies SA880 E0130 Walker rigid adjust/fixed ht

SA880 Mobility Aids and supplies SA880 E0135 Walker folding adjust/fixed

SA880 Mobility Aids and supplies SA880 E0140 Walker w trunk support

SA880 Mobility Aids and supplies SA880 E0141 Rigid wheeled walker adj/fix

SA880 Mobility Aids and supplies SA880 E0143 Walker folding wheeled w/o s

SA880 Mobility Aids and supplies SA880 E0144 Enclosed walker w rear seat

SA880 Mobility Aids and supplies SA880 E0147 Walker variable wheel resist

SA880 Mobility Aids and supplies SA880 E0148 Heavyduty walker no wheels

SA880 Mobility Aids and supplies SA880 E0149 Heavy duty wheeled walker

SA880 Mobility Aids and supplies SA880 E0153 Forearm crutch platform atta

SA880 Mobility Aids and supplies SA880 E0154 Walker platform attachment

SA880 Mobility Aids and supplies SA880 E0155 Walker wheel attachment,pair

SA880 Mobility Aids and supplies SA880 E0156 Walker seat attachment

SA880 Mobility Aids and supplies SA880 E0157 Walker crutch attachment

SA880 Mobility Aids and supplies SA880 E0158 Walker leg extenders set of4

SA880 Mobility Aids and supplies SA880 E0159 Brake for wheeled walker

SA880 Mobility Aids and supplies SA880 E1800 Adjust elbow ext/flex device

SA880 Mobility Aids and supplies SA880 E1801 SPS elbow device

SA880 Mobility Aids and supplies SA880 E1802 Adjst forearm pro/sup device

SA880 Mobility Aids and supplies SA880 E1805 Adjust wrist ext/flex device

SA880 Mobility Aids and supplies SA880 E1806 SPS wrist device

SA880 Mobility Aids and supplies SA880 E1810 Adjust knee ext/flex device

SA880 Mobility Aids and supplies SA880 E1811 SPS knee device

SA880 Mobility Aids and supplies SA880 E1815 Adjust ankle ext/flex device

SA880 Mobility Aids and supplies SA880 E1816 SPS ankle device

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SA880 Mobility Aids and supplies SA880 E1818 SPS forearm device

SA880 Mobility Aids and supplies SA880 E1820 Soft interface material

SA880 Mobility Aids and supplies SA880 E1821 Replacement interface SPSD

SA880 Mobility Aids and supplies SA880 E1825 Adjust finger ext/flex devc

SA880 Mobility Aids and supplies SA880 E1830 Adjust toe ext/flex device

SA880 Mobility Aids and supplies SA880 E1840 Adj shoulder ext/flex device

SA880 Mobility Aids and supplies SA880 E1902 AAC non-electronic board

SA880 Mobility Aids and supplies SA880 E8000 Posterior gait trainer

SA880 Mobility Aids and supplies SA880 E8001 Upright gait trainer

SA880 Mobility Aids and supplies SA880 E8002 Anterior gait trainer

SA881 Nutrition equipment and supplies SA881 97804 Medical nutrition, group

SA881 Nutrition equipment and supplies SA881 B4164 Parenteral 50% dextrose solu

SA881 Nutrition equipment and supplies SA881 B4168 Parenteral sol amino acid 3.

SA881 Nutrition equipment and supplies SA881 B4172 Parenteral sol amino acid 5.

SA881 Nutrition equipment and supplies SA881 B4176 Parenteral sol amino acid 7-

SA881 Nutrition equipment and supplies SA881 B4178 Parenteral sol amino acid >

SA881 Nutrition equipment and supplies SA881 B4180 Parenteral sol carb > 50%

SA881 Nutrition equipment and supplies SA881 B4185 Parenteral sol 10 gm lipids

SA881 Nutrition equipment and supplies SA881 B4189 Parenteral sol amino acid &

SA881 Nutrition equipment and supplies SA881 B4193 Parenteral sol 52-73 gm prot

SA881 Nutrition equipment and supplies SA881 B4197 Parenteral sol 74-100 gm pro

SA881 Nutrition equipment and supplies SA881 B4199 Parenteral sol > 100gm prote

SA881 Nutrition equipment and supplies SA881 B4216 Parenteral nutrition additiv

SA881 Nutrition equipment and supplies SA881 B4220 Parenteral supply kit premix

SA881 Nutrition equipment and supplies SA881 B4222 Parenteral supply kit homemi

SA881 Nutrition equipment and supplies SA881 B4224 Parenteral administration ki

SA881 Nutrition equipment and supplies SA881 B5000 Parenteral sol renal-amirosy

SA881 Nutrition equipment and supplies SA881 B5100 PARENTERAL SOLUTION HEPATIC

SA881 Nutrition equipment and supplies SA881 B5200 PARENTERAL SOL HEPATIC FREAM

SA881 Nutrition equipment and supplies SA881 B9004 Parenteral infus pump portab

SA881 Nutrition equipment and supplies SA881 B9006 Parenteral infus pump statio

SA881 Nutrition equipment and supplies SA881 B9999 Parenteral supp not othrws c

SA882 Orthotic equipment and supplies SA882 A4280 Brst prsths adhsv attchmnt

SA882 Orthotic equipment and supplies SA882 L0112 Cranial cervical orthosis

SA882 Orthotic equipment and supplies SA882 L0113 Cranial cervical torticollis

SA882 Orthotic equipment and supplies SA882 L0120 CERV FLEX N/ADJ FOAM PRE OTS

SA882 Orthotic equipment and supplies SA882 L0130 Flex thermoplastic collar mo

SA882 Orthotic equipment and supplies SA882 L0140 Cervical semi-rigid adjustab

SA882 Orthotic equipment and supplies SA882 L0150 Cerv semi-rig adj molded chn

SA882 Orthotic equipment and supplies SA882 L0160 CERV SR WIRE OCC/MAN PRE OTS

SA882 Orthotic equipment and supplies SA882 L0170 Cervical collar molded to pt

SA882 Orthotic equipment and supplies SA882 L0172 CERV COL SR FOAM 2PC PRE OTS

SA882 Orthotic equipment and supplies SA882 L0174 CERV SR 2PC THOR EXT PRE OTS

SA882 Orthotic equipment and supplies SA882 L0180 Cer post col occ/man sup adj

SA882 Orthotic equipment and supplies SA882 L0190 Cerv collar supp adj cerv ba

SA882 Orthotic equipment and supplies SA882 L0200 Cerv col supp adj bar & thor

SA882 Orthotic equipment and supplies SA882 L0220 Thor rib belt custom fabrica

SA882 Orthotic equipment and supplies SA882 L0430 DEWALL POSTURE PROTECTOR

SA882 Orthotic equipment and supplies SA882 L0450 TLSO FLEX TRUNK/THOR PRE OTS

SA882 Orthotic equipment and supplies SA882 L0452 tlso flex custom fab thoraci

SA882 Orthotic equipment and supplies SA882 L0454 TLSO TRNK SJ-T9 PRE CST

SA882 Orthotic equipment and supplies SA882 L0456 TLSO FLEX TRNK SJ-SS PRE CST

SA882 Orthotic equipment and supplies SA882 L0458 TLSO 2Mod symphis-xipho pre

SA882 Orthotic equipment and supplies SA882 L0460 TLSO 2 SHL SYMPHYS-STERN CST

SA882 Orthotic equipment and supplies SA882 L0462 TLSO 3Mod sacro-scap pre

SA882 Orthotic equipment and supplies SA882 L0464 TLSO 4Mod sacro-scap pre

SA882 Orthotic equipment and supplies SA882 L0466 TLSO R FRAM SOFT ANT PRE CST

SA882 Orthotic equipment and supplies SA882 L0468 TLSO RIG FRAM PELVIC PRE CST

SA882 Orthotic equipment and supplies SA882 L0470 TLSO rigid frame pre subclav

SA882 Orthotic equipment and supplies SA882 L0472 TLSO rigid frame hyperex pre

SA882 Orthotic equipment and supplies SA882 L0474

TLSO, TRIPLANAR CONTROL, RIGID POSTERIOR

FRAME W/FLEX SOFT APRON ANT W/MULT STRAPS CODE

DISC PER CMS/USE L0470

SA882 Orthotic equipment and supplies SA882 L0480 TLSO rigid plastic custom fa

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SA882 Orthotic equipment and supplies SA882 L0482 TLSO rigid lined custom fab

SA882 Orthotic equipment and supplies SA882 L0484 TLSO rigid plastic cust fab

SA882 Orthotic equipment and supplies SA882 L0486 TLSO rigidlined cust fab two

SA882 Orthotic equipment and supplies SA882 L0488 TLSO rigid lined pre one pie

SA882 Orthotic equipment and supplies SA882 L0490 TLSO rigid plastic pre one

SA882 Orthotic equipment and supplies SA882 L0491 TLSO 2 piece rigid shell

SA882 Orthotic equipment and supplies SA882 L0492 TLSO 3 piece rigid shell

SA882 Orthotic equipment and supplies SA882 L0621 SIO FLEX PELVIC/SACR PRE OTS

SA882 Orthotic equipment and supplies SA882 L0622 SIO flex pelvisacral custom

SA882 Orthotic equipment and supplies SA882 L0623 SIO RIG PNL PELV/SAC PRE OTS

SA882 Orthotic equipment and supplies SA882 L0624 SIO panel custom

SA882 Orthotic equipment and supplies SA882 L0625 LO FLEX L1-BELOW L5 PRE OTS

SA882 Orthotic equipment and supplies SA882 L0626 LO SAG RIG PNL STAYS PRE CST

SA882 Orthotic equipment and supplies SA882 L0627 LO SAG RI AN/POS PNL PRE CST

SA882 Orthotic equipment and supplies SA882 L0628 LSO FLEX NO RI STAYS PRE OTS

SA882 Orthotic equipment and supplies SA882 L0629 LSO flex w/rigid stays cust

SA882 Orthotic equipment and supplies SA882 L0630 LSO R POST PNL SJ-T9 PRE CST

SA882 Orthotic equipment and supplies SA882 L0631 LSO SAG R AN/POS PNL PRE CST

SA882 Orthotic equipment and supplies SA882 L0632 LSO sag rigid frame cust

SA882 Orthotic equipment and supplies SA882 L0633 LSO SC R POS/LAT PNL PRE CST

SA882 Orthotic equipment and supplies SA882 L0634 LSO flexion control custom

SA882 Orthotic equipment and supplies SA882 L0635 LSO sagit rigid panel prefab

SA882 Orthotic equipment and supplies SA882 L0636 LSO sagittal rigid panel cus

SA882 Orthotic equipment and supplies SA882 L0637 LSO SC R ANT/POS PNL PRE CST

SA882 Orthotic equipment and supplies SA882 L0638 LSO sag-coronal panel custom

SA882 Orthotic equipment and supplies SA882 L0639 LSO S/C SHELL/PANEL PREFAB

SA882 Orthotic equipment and supplies SA882 L0640 LSO s/c shell/panel custom

SA882 Orthotic equipment and supplies SA882 L0700 Ctlso a-p-l control molded

SA882 Orthotic equipment and supplies SA882 L0710 Ctlso a-p-l control w/ inter

SA882 Orthotic equipment and supplies SA882 L0810 Halo cervical into jckt vest

SA882 Orthotic equipment and supplies SA882 L0820 Halo cervical into body jack

SA882 Orthotic equipment and supplies SA882 L0830 Halo cerv into milwaukee typ

SA882 Orthotic equipment and supplies SA882 L0859 MRI compatible system

SA882 Orthotic equipment and supplies SA882 L0861 Halo repl liner/interface

SA882 Orthotic equipment and supplies SA882 L0970 Tlso corset front

SA882 Orthotic equipment and supplies SA882 L0972 Lso corset front

SA882 Orthotic equipment and supplies SA882 L0974 Tlso full corset

SA882 Orthotic equipment and supplies SA882 L0976 Lso full corset

SA882 Orthotic equipment and supplies SA882 L0978 Axillary crutch extension

SA882 Orthotic equipment and supplies SA882 L0980 PERONEAL STRAPS PAIR PRE OTS

SA882 Orthotic equipment and supplies SA882 L0982 STOCKING SUP GRIPS 4 PRE OTS

SA882 Orthotic equipment and supplies SA882 L0984 PROTECT BODY SOCK EA PRE OTS

SA882 Orthotic equipment and supplies SA882 L0999 Add to spinal orthosis NOS

SA882 Orthotic equipment and supplies SA882 L1000 Ctlso milwauke initial model

SA882 Orthotic equipment and supplies SA882 L1001 CTLSO infant immobilizer

SA882 Orthotic equipment and supplies SA882 L1005 Tension based scoliosis orth

SA882 Orthotic equipment and supplies SA882 L1010 Ctlso axilla sling

SA882 Orthotic equipment and supplies SA882 L1020 Kyphosis pad

SA882 Orthotic equipment and supplies SA882 L1025 Kyphosis pad floating

SA882 Orthotic equipment and supplies SA882 L1030 Lumbar bolster pad

SA882 Orthotic equipment and supplies SA882 L1040 Lumbar or lumbar rib pad

SA882 Orthotic equipment and supplies SA882 L1050 Sternal pad

SA882 Orthotic equipment and supplies SA882 L1060 Thoracic pad

SA882 Orthotic equipment and supplies SA882 L1070 Trapezius sling

SA882 Orthotic equipment and supplies SA882 L1080 Outrigger

SA882 Orthotic equipment and supplies SA882 L1085 Outrigger bil w/ vert extens

SA882 Orthotic equipment and supplies SA882 L1090 Lumbar sling

SA882 Orthotic equipment and supplies SA882 L1100 Ring flange plastic/leather

SA882 Orthotic equipment and supplies SA882 L1110 Ring flange plas/leather mol

SA882 Orthotic equipment and supplies SA882 L1120 Covers for upright each

SA882 Orthotic equipment and supplies SA882 L1200 Furnsh initial orthosis only

SA882 Orthotic equipment and supplies SA882 L1210 Lateral thoracic extension

SA882 Orthotic equipment and supplies SA882 L1220 Anterior thoracic extension

SA882 Orthotic equipment and supplies SA882 L1230 Milwaukee type superstructur

25



SA882 Orthotic equipment and supplies SA882 L1240 Lumbar derotation pad

SA882 Orthotic equipment and supplies SA882 L1250 Anterior asis pad

SA882 Orthotic equipment and supplies SA882 L1260 Anterior thoracic derotation

SA882 Orthotic equipment and supplies SA882 L1270 Abdominal pad

SA882 Orthotic equipment and supplies SA882 L1280 Rib gusset (elastic) each

SA882 Orthotic equipment and supplies SA882 L1290 Lateral trochanteric pad

SA882 Orthotic equipment and supplies SA882 L1300 Body jacket mold to patient

SA882 Orthotic equipment and supplies SA882 L1310 Post-operative body jacket

SA882 Orthotic equipment and supplies SA882 L1499 Spinal orthosis NOS

SA882 Orthotic equipment and supplies SA882 L1500 THKAO MOBILITY FRAME

SA882 Orthotic equipment and supplies SA882 L1510 THKAO STANDING FRAME

SA882 Orthotic equipment and supplies SA882 L1520 THKAO SWIVEL WALKER

SA882 Orthotic equipment and supplies SA882 L1600 HO FLEX FREJKA W/COV PRE CST

SA882 Orthotic equipment and supplies SA882 L1610 HO FREJKA COV ONLY PRE CST

SA882 Orthotic equipment and supplies SA882 L1620 HO FLEX PAVLIK HARNS PRE CST

SA882 Orthotic equipment and supplies SA882 L1630 Abduct control hip semi-flex

SA882 Orthotic equipment and supplies SA882 L1640 Pelv band/spread bar thigh c

SA882 Orthotic equipment and supplies SA882 L1650 HO abduction hip adjustable

SA882 Orthotic equipment and supplies SA882 L1652 HO bi thighcuffs w sprdr bar

SA882 Orthotic equipment and supplies SA882 L1660 HO abduction static plastic

SA882 Orthotic equipment and supplies SA882 L1680 Pelvic & hip control thigh c

SA882 Orthotic equipment and supplies SA882 L1685 Post-op hip abduct custom fa

SA882 Orthotic equipment and supplies SA882 L1686 HO post-op hip abduction

SA882 Orthotic equipment and supplies SA882 L1690 Combination bilateral HO

SA882 Orthotic equipment and supplies SA882 L1700 Leg perthes orth toronto typ

SA882 Orthotic equipment and supplies SA882 L1710 Legg perthes orth newington

SA882 Orthotic equipment and supplies SA882 L1720 Legg perthes orthosis trilat

SA882 Orthotic equipment and supplies SA882 L1730 Legg perthes orth scottish r

SA882 Orthotic equipment and supplies SA882 L1755 Legg perthes patten bottom t

SA882 Orthotic equipment and supplies SA882 L1810 KO ELASTIC WITH JOINTS

SA882 Orthotic equipment and supplies SA882 L1820 Ko elas w/ condyle pads & jo

SA882 Orthotic equipment and supplies SA882 L1830 KO IMMOB CANVAS LONG PRE OTS

SA882 Orthotic equipment and supplies SA882 L1831 Knee orth pos locking joint

SA882 Orthotic equipment and supplies SA882 L1832 KO ADJ JNT POS R SUP PRE CST

SA882 Orthotic equipment and supplies SA882 L1834 Ko w/0 joint rigid molded to

SA882 Orthotic equipment and supplies SA882 L1836 KO RIGID W/O JOINTS PRE OTS

SA882 Orthotic equipment and supplies SA882 L1840 Ko derot ant cruciate custom

SA882 Orthotic equipment and supplies SA882 L1843 KO SINGLE UPRIGHT PRE CST

SA882 Orthotic equipment and supplies SA882 L1844 Ko w/adj jt rot cntrl molded

SA882 Orthotic equipment and supplies SA882 L1845 KO DOUBLE UPRIGHT PRE CST

SA882 Orthotic equipment and supplies SA882 L1846 Ko w adj flex/ext rotat mold

SA882 Orthotic equipment and supplies SA882 L1847 KO DBL UPRIGHT W/AIR PRE CST

SA882 Orthotic equipment and supplies SA882 L1850 KO SWEDISH TYPE PRE OTS

SA882 Orthotic equipment and supplies SA882 L1860 Ko supracondylar socket mold

SA882 Orthotic equipment and supplies SA882 L1900 Afo sprng wir drsflx calf bd

SA882 Orthotic equipment and supplies SA882 L1902 Afo ankle gauntlet pre ots

SA882 Orthotic equipment and supplies SA882 L1904 AFO MOLDED ANKLE GAUNTLET

SA882 Orthotic equipment and supplies SA882 L1906 AFO MULTILIG ANK SUP PRE OTS

SA882 Orthotic equipment and supplies SA882 L1907 AFO SUPRAMALLEOLAR CUSTOM

SA882 Orthotic equipment and supplies SA882 L1910 Afo sing bar clasp attach sh

SA882 Orthotic equipment and supplies SA882 L1920 Afo sing upright w/ adjust s

SA882 Orthotic equipment and supplies SA882 L1930 Afo plastic

SA882 Orthotic equipment and supplies SA882 L1932 Afo rig ant tib prefab TCF/=

SA882 Orthotic equipment and supplies SA882 L1940 Afo molded to patient plasti

SA882 Orthotic equipment and supplies SA882 L1945 Afo molded plas rig ant tib

SA882 Orthotic equipment and supplies SA882 L1950 Afo spiral molded to pt plas

SA882 Orthotic equipment and supplies SA882 L1951 AFO spiral prefabricated

SA882 Orthotic equipment and supplies SA882 L1960 Afo pos solid ank plastic mo

SA882 Orthotic equipment and supplies SA882 L1970 Afo plastic molded w/ankle j

SA882 Orthotic equipment and supplies SA882 L1971 AFO w/ankle joint, prefab

SA882 Orthotic equipment and supplies SA882 L1980 Afo sing solid stirrup calf

SA882 Orthotic equipment and supplies SA882 L1990 Afo doub solid stirrup calf

SA882 Orthotic equipment and supplies SA882 L2000 Kafo sing fre stirr thi/calf

SA882 Orthotic equipment and supplies SA882 L2005 KAFO SNG/DBL MECHANICAL ACT

25



SA882 Orthotic equipment and supplies SA882 L2010 Kafo sng solid stirrup w/o j

SA882 Orthotic equipment and supplies SA882 L2020 Kafo dbl solid stirrup band/

SA882 Orthotic equipment and supplies SA882 L2030 Kafo dbl solid stirrup w/o j

SA882 Orthotic equipment and supplies SA882 L2034 KAFO pla sin up w/wo k/a cus

SA882 Orthotic equipment and supplies SA882 L2035 KAFO plastic pediatric size

SA882 Orthotic equipment and supplies SA882 L2036 Kafo plas doub free knee mol

SA882 Orthotic equipment and supplies SA882 L2037 Kafo plas sing free knee mol

SA882 Orthotic equipment and supplies SA882 L2038 Kafo w/o joint multi-axis an

SA882 Orthotic equipment and supplies SA882 L2040 Hkafo torsion bil rot straps

SA882 Orthotic equipment and supplies SA882 L2050 Hkafo torsion cable hip pelv

SA882 Orthotic equipment and supplies SA882 L2060 Hkafo torsion ball bearing j

SA882 Orthotic equipment and supplies SA882 L2070 Hkafo torsion unilat rot str

SA882 Orthotic equipment and supplies SA882 L2080 Hkafo unilat torsion cable

SA882 Orthotic equipment and supplies SA882 L2090 Hkafo unilat torsion ball br

SA882 Orthotic equipment and supplies SA882 L2106 Afo tib fx cast plaster mold

SA882 Orthotic equipment and supplies SA882 L2108 Afo tib fx cast molded to pt

SA882 Orthotic equipment and supplies SA882 L2112 Afo tibial fracture soft

SA882 Orthotic equipment and supplies SA882 L2114 Afo tib fx semi-rigid

SA882 Orthotic equipment and supplies SA882 L2116 Afo tibial fracture rigid

SA882 Orthotic equipment and supplies SA882 L2126 Kafo fem fx cast thermoplas

SA882 Orthotic equipment and supplies SA882 L2128 Kafo fem fx cast molded to p

SA882 Orthotic equipment and supplies SA882 L2132 Kafo femoral fx cast soft

SA882 Orthotic equipment and supplies SA882 L2134 Kafo fem fx cast semi-rigid

SA882 Orthotic equipment and supplies SA882 L2136 Kafo femoral fx cast rigid

SA882 Orthotic equipment and supplies SA882 L2180 Plas shoe insert w ank joint

SA882 Orthotic equipment and supplies SA882 L2182 Drop lock knee

SA882 Orthotic equipment and supplies SA882 L2184 Limited motion knee joint

SA882 Orthotic equipment and supplies SA882 L2186 Adj motion knee jnt lerman t

SA882 Orthotic equipment and supplies SA882 L2188 Quadrilateral brim

SA882 Orthotic equipment and supplies SA882 L2190 Waist belt

SA882 Orthotic equipment and supplies SA882 L2192 Pelvic band & belt thigh fla

SA882 Orthotic equipment and supplies SA882 L2200 Limited ankle motion ea jnt

SA882 Orthotic equipment and supplies SA882 L2210 Dorsiflexion assist each joi

SA882 Orthotic equipment and supplies SA882 L2220 Dorsi & plantar flex ass/res

SA882 Orthotic equipment and supplies SA882 L2230 Split flat caliper stirr & p

SA882 Orthotic equipment and supplies SA882 L2232 Rocker bottom, contact AFO

SA882 Orthotic equipment and supplies SA882 L2240 Round caliper and plate atta

SA882 Orthotic equipment and supplies SA882 L2250 Foot plate molded stirrup at

SA882 Orthotic equipment and supplies SA882 L2260 Reinforced solid stirrup

SA882 Orthotic equipment and supplies SA882 L2265 Long tongue stirrup

SA882 Orthotic equipment and supplies SA882 L2270 Varus/valgus strap padded/li

SA882 Orthotic equipment and supplies SA882 L2275 Plastic mod low ext pad/line

SA882 Orthotic equipment and supplies SA882 L2280 Molded inner boot

SA882 Orthotic equipment and supplies SA882 L2300 Abduction bar jointed adjust

SA882 Orthotic equipment and supplies SA882 L2310 Abduction bar-straight

SA882 Orthotic equipment and supplies SA882 L2320 Non-molded lacer

SA882 Orthotic equipment and supplies SA882 L2330 Lacer molded to patient mode

SA882 Orthotic equipment and supplies SA882 L2335 Anterior swing band

SA882 Orthotic equipment and supplies SA882 L2340 Pre-tibial shell molded to p

SA882 Orthotic equipment and supplies SA882 L2350 Prosthetic type socket molde

SA882 Orthotic equipment and supplies SA882 L2360 Extended steel shank

SA882 Orthotic equipment and supplies SA882 L2370 Patten bottom

SA882 Orthotic equipment and supplies SA882 L2375 Torsion ank & half solid sti

SA882 Orthotic equipment and supplies SA882 L2380 Torsion straight knee joint

SA882 Orthotic equipment and supplies SA882 L2385 Straight knee joint heavy du

SA882 Orthotic equipment and supplies SA882 L2387 Add LE poly knee custom KAFO

SA882 Orthotic equipment and supplies SA882 L2390 Offset knee joint each

SA882 Orthotic equipment and supplies SA882 L2395 Offset knee joint heavy duty

SA882 Orthotic equipment and supplies SA882 L2397 Suspension sleeve lower ext

SA882 Orthotic equipment and supplies SA882 L2405 Knee joint drop lock ea jnt

SA882 Orthotic equipment and supplies SA882 L2415 Knee joint cam lock each joi

SA882 Orthotic equipment and supplies SA882 L2425 Knee disc/dial lock/adj flex

SA882 Orthotic equipment and supplies SA882 L2430 Knee jnt ratchet lock ea jnt

SA882 Orthotic equipment and supplies SA882 L2492 Knee lift loop drop lock rin

25



SA882 Orthotic equipment and supplies SA882 L2500 Thi/glut/ischia wgt bearing

SA882 Orthotic equipment and supplies SA882 L2510 Th/wght bear quad-lat brim m

SA882 Orthotic equipment and supplies SA882 L2520 Th/wght bear quad-lat brim c

SA882 Orthotic equipment and supplies SA882 L2525 Th/wght bear nar m-l brim mo

SA882 Orthotic equipment and supplies SA882 L2526 Th/wght bear nar m-l brim cu

SA882 Orthotic equipment and supplies SA882 L2530 Thigh/wght bear lacer non-mo

SA882 Orthotic equipment and supplies SA882 L2540 Thigh/wght bear lacer molded

SA882 Orthotic equipment and supplies SA882 L2550 Thigh/wght bear high roll cu

SA882 Orthotic equipment and supplies SA882 L2570 Hip clevis type 2 posit jnt

SA882 Orthotic equipment and supplies SA882 L2580 Pelvic control pelvic sling

SA882 Orthotic equipment and supplies SA882 L2600 Hip clevis/thrust bearing fr

SA882 Orthotic equipment and supplies SA882 L2610 Hip clevis/thrust bearing lo

SA882 Orthotic equipment and supplies SA882 L2620 Pelvic control hip heavy dut

SA882 Orthotic equipment and supplies SA882 L2622 Hip joint adjustable flexion

SA882 Orthotic equipment and supplies SA882 L2624 Hip adj flex ext abduct cont

SA882 Orthotic equipment and supplies SA882 L2627 Plastic mold recipro hip & c

SA882 Orthotic equipment and supplies SA882 L2628 Metal frame recipro hip & ca

SA882 Orthotic equipment and supplies SA882 L2630 Pelvic control band & belt u

SA882 Orthotic equipment and supplies SA882 L2640 Pelvic control band & belt b

SA882 Orthotic equipment and supplies SA882 L2650 Pelv & thor control gluteal

SA882 Orthotic equipment and supplies SA882 L2660 Thoracic control thoracic ba

SA882 Orthotic equipment and supplies SA882 L2670 Thorac cont paraspinal uprig

SA882 Orthotic equipment and supplies SA882 L2680 Thorac cont lat support upri

SA882 Orthotic equipment and supplies SA882 L2750 Plating chrome/nickel pr bar

SA882 Orthotic equipment and supplies SA882 L2755 Carbon graphite lamination

SA882 Orthotic equipment and supplies SA882 L2760 Extension per extension per

SA882 Orthotic equipment and supplies SA882 L2768 Ortho sidebar disconnect

SA882 Orthotic equipment and supplies SA882 L2780 Non-corrosive finish

SA882 Orthotic equipment and supplies SA882 L2785 Drop lock retainer each

SA882 Orthotic equipment and supplies SA882 L2795 Knee control full kneecap

SA882 Orthotic equipment and supplies SA882 L2800 Knee cap medial or lateral p

SA882 Orthotic equipment and supplies SA882 L2810 Knee control condylar pad

SA882 Orthotic equipment and supplies SA882 L2820 Soft interface below knee se

SA882 Orthotic equipment and supplies SA882 L2830 Soft interface above knee se

SA882 Orthotic equipment and supplies SA882 L2840 Tibial length sock fx or equ

SA882 Orthotic equipment and supplies SA882 L2850 Femoral lgth sock fx or equa

SA882 Orthotic equipment and supplies SA882 L2861 Torsion mechanism knee/ankle

SA882 Orthotic equipment and supplies SA882 L2999 Lower extremity orthosis NOS

SA882 Orthotic equipment and supplies SA882 L3000 Ft insert ucb berkeley shell

SA882 Orthotic equipment and supplies SA882 L3001 Foot insert remov molded spe

SA882 Orthotic equipment and supplies SA882 L3002 Foot insert plastazote or eq

SA882 Orthotic equipment and supplies SA882 L3003 Foot insert silicone gel eac

SA882 Orthotic equipment and supplies SA882 L3010 Foot longitudinal arch suppo

SA882 Orthotic equipment and supplies SA882 L3020 Foot longitud/metatarsal sup

SA882 Orthotic equipment and supplies SA882 L3030 Foot arch support remov prem

SA882 Orthotic equipment and supplies SA882 L3031 Foot lamin/prepreg composite

SA882 Orthotic equipment and supplies SA882 L3040 Ft arch suprt premold longit

SA882 Orthotic equipment and supplies SA882 L3050 Foot arch supp premold metat

SA882 Orthotic equipment and supplies SA882 L3060 Foot arch supp longitud/meta

SA882 Orthotic equipment and supplies SA882 L3070 Arch suprt att to sho longit

SA882 Orthotic equipment and supplies SA882 L3080 Arch supp att to shoe metata

SA882 Orthotic equipment and supplies SA882 L3090 Arch supp att to shoe long/m

SA882 Orthotic equipment and supplies SA882 L3100 HALLUS-VALGUS NT DYN PRE OTS

SA882 Orthotic equipment and supplies SA882 L3140 Abduction rotation bar shoe

SA882 Orthotic equipment and supplies SA882 L3150 Abduct rotation bar w/o shoe

SA882 Orthotic equipment and supplies SA882 L3160 Shoe styled positioning dev

SA882 Orthotic equipment and supplies SA882 L3170 FOOT PLAS HEEL STABI PRE OTS

SA882 Orthotic equipment and supplies SA882 L3201 Oxford w supinat/pronat inf

SA882 Orthotic equipment and supplies SA882 L3202 Oxford w/ supinat/pronator c

SA882 Orthotic equipment and supplies SA882 L3203 Oxford w/ supinator/pronator

SA882 Orthotic equipment and supplies SA882 L3204 Hightop w/ supp/pronator inf

SA882 Orthotic equipment and supplies SA882 L3206 Hightop w/ supp/pronator chi

SA882 Orthotic equipment and supplies SA882 L3207 Hightop w/ supp/pronator jun

SA882 Orthotic equipment and supplies SA882 L3208 Surgical boot each infant

25



SA882 Orthotic equipment and supplies SA882 L3209 Surgical boot each child

SA882 Orthotic equipment and supplies SA882 L3211 Surgical boot each junior

SA882 Orthotic equipment and supplies SA882 L3212 Benesch boot pair infant

SA882 Orthotic equipment and supplies SA882 L3213 Benesch boot pair child

SA882 Orthotic equipment and supplies SA882 L3214 Benesch boot pair junior

SA882 Orthotic equipment and supplies SA882 L3215 Orthopedic ftwear ladies oxf

SA882 Orthotic equipment and supplies SA882 L3216 Orthoped ladies shoes dpth i

SA882 Orthotic equipment and supplies SA882 L3217 Ladies shoes hightop depth i

SA882 Orthotic equipment and supplies SA882 L3219 Orthopedic mens shoes oxford

SA882 Orthotic equipment and supplies SA882 L3221 Orthopedic mens shoes dpth i

SA882 Orthotic equipment and supplies SA882 L3222 Mens shoes hightop depth inl

SA882 Orthotic equipment and supplies SA882 L3224 Woman's shoe oxford brace

SA882 Orthotic equipment and supplies SA882 L3225 Man's shoe oxford brace

SA882 Orthotic equipment and supplies SA882 L3230 Custom shoes depth inlay

SA882 Orthotic equipment and supplies SA882 L3250 Custom mold shoe remov prost

SA882 Orthotic equipment and supplies SA882 L3251 Shoe molded to pt silicone s

SA882 Orthotic equipment and supplies SA882 L3252 Shoe molded plastazote cust

SA882 Orthotic equipment and supplies SA882 L3253 Shoe molded plastazote cust

SA882 Orthotic equipment and supplies SA882 L3254 Orth foot non-stndard size/w

SA882 Orthotic equipment and supplies SA882 L3255 Orth foot non-standard size/

SA882 Orthotic equipment and supplies SA882 L3257 Orth foot add charge split s

SA882 Orthotic equipment and supplies SA882 L3260 Ambulatory surgical boot eac

SA882 Orthotic equipment and supplies SA882 L3265 Plastazote sandal each

SA882 Orthotic equipment and supplies SA882 L3300 Sho lift taper to metatarsal

SA882 Orthotic equipment and supplies SA882 L3310 Shoe lift elev heel/sole neo

SA882 Orthotic equipment and supplies SA882 L3320 Shoe lift elev heel/sole cor

SA882 Orthotic equipment and supplies SA882 L3330 Lifts elevation metal extens

SA882 Orthotic equipment and supplies SA882 L3332 Shoe lifts tapered to one-ha

SA882 Orthotic equipment and supplies SA882 L3334 Shoe lifts elevation heel /i

SA882 Orthotic equipment and supplies SA882 L3340 Shoe wedge sach

SA882 Orthotic equipment and supplies SA882 L3350 Shoe heel wedge

SA882 Orthotic equipment and supplies SA882 L3360 Shoe sole wedge outside sole

SA882 Orthotic equipment and supplies SA882 L3370 Shoe sole wedge between sole

SA882 Orthotic equipment and supplies SA882 L3380 Shoe clubfoot wedge

SA882 Orthotic equipment and supplies SA882 L3390 Shoe outflare wedge

SA882 Orthotic equipment and supplies SA882 L3400 Shoe metatarsal bar wedge ro

SA882 Orthotic equipment and supplies SA882 L3410 Shoe metatarsal bar between

SA882 Orthotic equipment and supplies SA882 L3420 Full sole/heel wedge btween

SA882 Orthotic equipment and supplies SA882 L3430 Sho heel count plast reinfor

SA882 Orthotic equipment and supplies SA882 L3440 Heel leather reinforced

SA882 Orthotic equipment and supplies SA882 L3450 Shoe heel sach cushion type

SA882 Orthotic equipment and supplies SA882 L3455 Shoe heel new leather standa

SA882 Orthotic equipment and supplies SA882 L3460 Shoe heel new rubber standar

SA882 Orthotic equipment and supplies SA882 L3465 Shoe heel thomas with wedge

SA882 Orthotic equipment and supplies SA882 L3470 Shoe heel thomas extend to b

SA882 Orthotic equipment and supplies SA882 L3480 Shoe heel pad & depress for

SA882 Orthotic equipment and supplies SA882 L3485 Shoe heel pad removable for

SA882 Orthotic equipment and supplies SA882 L3500 Ortho shoe add leather insol

SA882 Orthotic equipment and supplies SA882 L3510 Orthopedic shoe add rub insl

SA882 Orthotic equipment and supplies SA882 L3520 O shoe add felt w leath insl

SA882 Orthotic equipment and supplies SA882 L3530 Ortho shoe add half sole

SA882 Orthotic equipment and supplies SA882 L3540 Ortho shoe add full sole

SA882 Orthotic equipment and supplies SA882 L3550 O shoe add standard toe tap

SA882 Orthotic equipment and supplies SA882 L3560 O shoe add horseshoe toe tap

SA882 Orthotic equipment and supplies SA882 L3570 O shoe add instep extension

SA882 Orthotic equipment and supplies SA882 L3580 O shoe add instep velcro clo

SA882 Orthotic equipment and supplies SA882 L3590 O shoe convert to sof counte

SA882 Orthotic equipment and supplies SA882 L3595 Ortho shoe add march bar

SA882 Orthotic equipment and supplies SA882 L3600 Trans shoe calip plate exist

SA882 Orthotic equipment and supplies SA882 L3610 Trans shoe caliper plate new

SA882 Orthotic equipment and supplies SA882 L3620 Trans shoe solid stirrup exi

SA882 Orthotic equipment and supplies SA882 L3630 Trans shoe solid stirrup new

SA882 Orthotic equipment and supplies SA882 L3640 Shoe dennis browne splint bo

SA882 Orthotic equipment and supplies SA882 L3649 Orthopedic shoe modifica NOS

25



SA882 Orthotic equipment and supplies SA882 L3650 SO 8 ABD RESTRAINT PRE OTS

SA882 Orthotic equipment and supplies SA882 L3660 SO 8 AB RSTR CAN/WEB PRE OTS

SA882 Orthotic equipment and supplies SA882 L3670 SO ACRO/CLAV CAN WEB PRE OTS

SA882 Orthotic equipment and supplies SA882 L3671 SO CAP DESIGN W/O JNTS CF

SA882 Orthotic equipment and supplies SA882 L3672 SO airplane w/o jnts CF

SA882 Orthotic equipment and supplies SA882 L3673 SO airplane w/joint CF

SA882 Orthotic equipment and supplies SA882 L3675 SO VEST CANVAS/WEB PRE OTS

SA882 Orthotic equipment and supplies SA882 L3677 SO HARD PLAS STABILI PRE CST

SA882 Orthotic equipment and supplies SA882 L3702 EO w/o joints CF

SA882 Orthotic equipment and supplies SA882 L3710 EO ELAS W/METAL JNTS PRE OTS

SA882 Orthotic equipment and supplies SA882 L3720 Forearm/arm cuffs free motio

SA882 Orthotic equipment and supplies SA882 L3730 Forearm/arm cuffs ext/flex a

SA882 Orthotic equipment and supplies SA882 L3740 Cuffs adj lock w/ active con

SA882 Orthotic equipment and supplies SA882 L3760 EO withjoint, Prefabricated

SA882 Orthotic equipment and supplies SA882 L3762 EO RIGID W/O JOINTS PRE OTS

SA882 Orthotic equipment and supplies SA882 L3763 EWHO rigid w/o jnts CF

SA882 Orthotic equipment and supplies SA882 L3764 EWHO w/joint(s) CF

SA882 Orthotic equipment and supplies SA882 L3765 EWHFO rigid w/o jnts CF

SA882 Orthotic equipment and supplies SA882 L3766 EWHFO w/joint(s) CF

SA882 Orthotic equipment and supplies SA882 L3806 WHFO w/joint(s) custom fab

SA882 Orthotic equipment and supplies SA882 L3807 WHFO W/O JOINTS PRE CST

SA882 Orthotic equipment and supplies SA882 L3808 WHFO, rigid w/o joints

SA882 Orthotic equipment and supplies SA882 L3891 Torsion mechanism wrist/elbo

SA882 Orthotic equipment and supplies SA882 L3900 Hinge extension/flex wrist/f

SA882 Orthotic equipment and supplies SA882 L3901 Hinge ext/flex wrist finger

SA882 Orthotic equipment and supplies SA882 L3904 Whfo electric custom fitted

SA882 Orthotic equipment and supplies SA882 L3905 WHO w/nontorsion jnt(s) CF

SA882 Orthotic equipment and supplies SA882 L3906 WHO w/o joints CF

SA882 Orthotic equipment and supplies SA882 L3908 WHO COCK-UP NONMOLDE PRE OTS

SA882 Orthotic equipment and supplies SA882 L3912 HFO FLEXION GLOVE PRE OTS

SA882 Orthotic equipment and supplies SA882 L3913 HFO w/o joints CF

SA882 Orthotic equipment and supplies SA882 L3915 WHO NONTORSION JNTS PRE CST

SA882 Orthotic equipment and supplies SA882 L3917 METACARP FX ORTHOSIS PRE CST

SA882 Orthotic equipment and supplies SA882 L3919 HO w/o joints CF

SA882 Orthotic equipment and supplies SA882 L3921 HFO w/joint(s) CF

SA882 Orthotic equipment and supplies SA882 L3923 HFO WITHOUT JOINTS PRE CST

SA882 Orthotic equipment and supplies SA882 L3925 FO PIP DIP JNT/SPRNG PRE OTS

SA882 Orthotic equipment and supplies SA882 L3927 FO PIP DIP NO JT SPR PRE OTS

SA882 Orthotic equipment and supplies SA882 L3929 HFO NONTORSION JNTS PRE CST

SA882 Orthotic equipment and supplies SA882 L3931 WHFO nontorsion joint prefab

SA882 Orthotic equipment and supplies SA882 L3933 FO w/o joints CF

SA882 Orthotic equipment and supplies SA882 L3935 FO nontorsion joint CF

SA882 Orthotic equipment and supplies SA882 L3956 Add joint upper ext orthosis

SA882 Orthotic equipment and supplies SA882 L3960 Sewho airplan desig abdu pos

SA882 Orthotic equipment and supplies SA882 L3961 SEWHO cap design w/o jnts CF

SA882 Orthotic equipment and supplies SA882 L3962 Sewho erbs palsey design abd

SA882 Orthotic equipment and supplies SA882 L3964 SEO MOBILE ARM SUP ATT TO WC

SA882 Orthotic equipment and supplies SA882 L3965 ARM SUPP ATT TO WC RANCHO TY

SA882 Orthotic equipment and supplies SA882 L3966 MOBILE ARM SUPPORTS RECLININ

SA882 Orthotic equipment and supplies SA882 L3967 SEWHO airplane w/o jnts CF

SA882 Orthotic equipment and supplies SA882 L3968 FRICTION DAMPENING ARM SUPP

SA882 Orthotic equipment and supplies SA882 L3969 MONOSUSPENSION ARM/HAND SUPP

SA882 Orthotic equipment and supplies SA882 L3970 ELEVAT PROXIMAL ARM SUPPORT

SA882 Orthotic equipment and supplies SA882 L3971 SEWHO cap design w/jnt(s) CF

SA882 Orthotic equipment and supplies SA882 L3972 OFFSET/LAT ROCKER ARM W/ ELA

SA882 Orthotic equipment and supplies SA882 L3973 SEWHO airplane w/jnt(s) CF

SA882 Orthotic equipment and supplies SA882 L3974 MOBILE ARM SUPPORT SUPINATOR

SA882 Orthotic equipment and supplies SA882 L3975 SEWHFO cap design w/o jnt CF

SA882 Orthotic equipment and supplies SA882 L3976 SEWHFO airplane w/o jnts CF

SA882 Orthotic equipment and supplies SA882 L3977 SEWHFO cap desgn w/jnt(s) CF

SA882 Orthotic equipment and supplies SA882 L3978 SEWHFO airplane w/jnt(s) CF

SA882 Orthotic equipment and supplies SA882 L3980 UP EXT FX ORTHOS HUMERAL NOS

SA882 Orthotic equipment and supplies SA882 L3982 Upper ext fx orthosis rad/ul

SA882 Orthotic equipment and supplies SA882 L3984 Upper ext fx orthosis wrist

25



SA882 Orthotic equipment and supplies SA882 L3995 Sock fracture or equal each

SA882 Orthotic equipment and supplies SA882 L3999 Upper limb orthosis NOS

SA882 Orthotic equipment and supplies SA882 L4000 Repl girdle milwaukee orth

SA882 Orthotic equipment and supplies SA882 L4002 Replace strap, any orthosis

SA882 Orthotic equipment and supplies SA882 L4010 Replace trilateral socket br

SA882 Orthotic equipment and supplies SA882 L4020 Replace quadlat socket brim

SA882 Orthotic equipment and supplies SA882 L4030 Replace socket brim cust fit

SA882 Orthotic equipment and supplies SA882 L4040 Replace molded thigh lacer

SA882 Orthotic equipment and supplies SA882 L4045 Replace non-molded thigh lac

SA882 Orthotic equipment and supplies SA882 L4050 Replace molded calf lacer

SA882 Orthotic equipment and supplies SA882 L4055 Replace non-molded calf lace

SA882 Orthotic equipment and supplies SA882 L4060 Replace high roll cuff

SA882 Orthotic equipment and supplies SA882 L4070 Replace prox & dist upright

SA882 Orthotic equipment and supplies SA882 L4080 Repl met band kafo-afo prox

SA882 Orthotic equipment and supplies SA882 L4090 Repl met band kafo-afo calf/

SA882 Orthotic equipment and supplies SA882 L4100 Repl leath cuff kafo prox th

SA882 Orthotic equipment and supplies SA882 L4110 Repl leath cuff kafo-afo cal

SA882 Orthotic equipment and supplies SA882 L4130 Replace pretibial shell

SA882 Orthotic equipment and supplies SA882 L4205 Ortho dvc repair per 15 min

SA882 Orthotic equipment and supplies SA882 L4210 Orth dev repair/repl minor p

SA882 Orthotic equipment and supplies SA882 L4350 ANKLE CONTROL ORTHO PRE OTS

SA882 Orthotic equipment and supplies SA882 L4360 PNEUMAT WALKING BOOT PRE CST

SA882 Orthotic equipment and supplies SA882 L4370 PNEUM FULL LEG SPLNT PRE OTS

SA882 Orthotic equipment and supplies SA882 L4380 PNEUMATIC KNEE SPLINT

SA882 Orthotic equipment and supplies SA882 L4386 NON-PNEUM WALK BOOT PRE CST

SA882 Orthotic equipment and supplies SA882 L4392 Replace AFO soft interface

SA882 Orthotic equipment and supplies SA882 L4394 Replace foot drop spint

SA882 Orthotic equipment and supplies SA882 L4396 STATIC OR DYNAMI AFO PRE CST

SA882 Orthotic equipment and supplies SA882 L4398 FOOT DROP SPLINT PRE OTS

SA883 Ostomy care SA883 A4361 Ostomy face plate

SA883 Ostomy care SA883 A4362 Solid skin barrier

SA883 Ostomy care SA883 A4363 Ostomy clamp, replacement

SA883 Ostomy care SA883 A4366 Ostomy vent

SA883 Ostomy care SA883 A4367 Ostomy belt

SA883 Ostomy care SA883 A4368 Ostomy filter

SA883 Ostomy care SA883 A4369 Skin barrier liquid per oz

SA883 Ostomy care SA883 A4371 Skin barrier powder per oz

SA883 Ostomy care SA883 A4372 Skin barrier solid 4x4 equiv

SA883 Ostomy care SA883 A4373 Skin barrier with flange

SA883 Ostomy care SA883 A4375 Drainable plastic pch w fcpl

SA883 Ostomy care SA883 A4376 Drainable rubber pch w fcplt

SA883 Ostomy care SA883 A4377 Drainable plstic pch w/o fp

SA883 Ostomy care SA883 A4378 Drainable rubber pch w/o fp

SA883 Ostomy care SA883 A4379 Urinary plastic pouch w fcpl

SA883 Ostomy care SA883 A4380 Urinary rubber pouch w fcplt

SA883 Ostomy care SA883 A4381 Urinary plastic pouch w/o fp

SA883 Ostomy care SA883 A4382 Urinary hvy plstc pch w/o fp

SA883 Ostomy care SA883 A4383 Urinary rubber pouch w/o fp

SA883 Ostomy care SA883 A4384 Ostomy faceplt/silicone ring

SA883 Ostomy care SA883 A4385 Ost skn barrier sld ext wear

SA883 Ostomy care SA883 A4387 Ost clsd pouch w att st barr

SA883 Ostomy care SA883 A4388 Drainable pch w ex wear barr

SA883 Ostomy care SA883 A4389 Drainable pch w st wear barr

SA883 Ostomy care SA883 A4390 Drainable pch ex wear convex

SA883 Ostomy care SA883 A4391 Urinary pouch w ex wear barr

SA883 Ostomy care SA883 A4392 Urinary pouch w st wear barr

SA883 Ostomy care SA883 A4393 Urine pch w ex wear bar conv

SA883 Ostomy care SA883 A4394 Ostomy pouch liq deodorant

SA883 Ostomy care SA883 A4395 Ostomy pouch solid deodorant

SA883 Ostomy care SA883 A4396 Peristomal hernia supprt blt

SA883 Ostomy care SA883 A4397 Irrigation supply sleeve

SA883 Ostomy care SA883 A4398 Ostomy irrigation bag

SA883 Ostomy care SA883 A4399 Ostomy irrig cone/cath w brs

SA883 Ostomy care SA883 A4400 Ostomy irrigation set

25



SA883 Ostomy care SA883 A4402 Lubricant per ounce

SA883 Ostomy care SA883 A4404 Ostomy ring each

SA883 Ostomy care SA883 A4405 Nonpectin based ostomy paste

SA883 Ostomy care SA883 A4406 Pectin based ostomy paste

SA883 Ostomy care SA883 A4407 Ext wear ost skn barr <=4sq"

SA883 Ostomy care SA883 A4408 Ext wear ost skn barr >4sq"

SA883 Ostomy care SA883 A4409 Ost skn barr convex <=4 sq i

SA883 Ostomy care SA883 A4410 Ost skn barr extnd >4 sq

SA883 Ostomy care SA883 A4411 Ost skn barr extnd =4sq

SA883 Ostomy care SA883 A4412 Ost pouch drain high output

SA883 Ostomy care SA883 A4413 2 pc drainable ost pouch

SA883 Ostomy care SA883 A4414 Ost sknbar w/o conv<=4 sq in

SA883 Ostomy care SA883 A4415 Ost skn barr w/o conv >4 sqi

SA883 Ostomy care SA883 A4416 Ost pch clsd w barrier/filtr

SA883 Ostomy care SA883 A4417 Ost pch w bar/bltinconv/fltr

SA883 Ostomy care SA883 A4418 Ost pch clsd w/o bar w filtr

SA883 Ostomy care SA883 A4419 Ost pch for bar w flange/flt

SA883 Ostomy care SA883 A4420 Ost pch clsd for bar w lk fl

SA883 Ostomy care SA883 A4421 Ostomy supply misc

SA883 Ostomy care SA883 A4422 Ost pouch absorbent material

SA883 Ostomy care SA883 A4423 Ost pch for bar w lk fl/fltr

SA883 Ostomy care SA883 A4424 Ost pch drain w bar & filter

SA883 Ostomy care SA883 A4425 Ost pch drain for barrier fl

SA883 Ostomy care SA883 A4426 Ost pch drain 2 piece system

SA883 Ostomy care SA883 A4427 Ost pch drain/barr lk flng/f

SA883 Ostomy care SA883 A4428 Urine ost pouch w faucet/tap

SA883 Ostomy care SA883 A4429 Urine ost pouch w bltinconv

SA883 Ostomy care SA883 A4430 Ost urine pch w b/bltin conv

SA883 Ostomy care SA883 A4431 Ost pch urine w barrier/tapv

SA883 Ostomy care SA883 A4432 Os pch urine w bar/fange/tap

SA883 Ostomy care SA883 A4433 Urine ost pch bar w lock fln

SA883 Ostomy care SA883 A4434 Ost pch urine w lock flng/ft

SA883 Ostomy care SA883 A5051 Pouch clsd w barr attached

SA883 Ostomy care SA883 A5052 Clsd ostomy pouch w/o barr

SA883 Ostomy care SA883 A5053 Clsd ostomy pouch faceplate

SA883 Ostomy care SA883 A5054 Clsd ostomy pouch w/flange

SA883 Ostomy care SA883 A5055 Stoma cap

SA883 Ostomy care SA883 A5061 Pouch drainable w barrier at

SA883 Ostomy care SA883 A5062 Drnble ostomy pouch w/o barr

SA883 Ostomy care SA883 A5063 Drain ostomy pouch w/flange

SA883 Ostomy care SA883 A5071 Urinary pouch w/barrier

SA883 Ostomy care SA883 A5072 Urinary pouch w/o barrier

SA883 Ostomy care SA883 A5073 Urinary pouch on barr w/flng

SA883 Ostomy care SA883 A5081 STOMA PLUG OR SEAL, ANY TYPE

SA883 Ostomy care SA883 A5082 Continent stoma catheter

SA883 Ostomy care SA883 A5083 Stoma absorptive cover

SA883 Ostomy care SA883 A5093 Ostomy accessory convex inse

SA884 Respiratory equipment and supplies SA884 A4450 Non-waterproof tape

SA884 Respiratory equipment and supplies SA884 A4452 Waterproof tape

SA884 Respiratory equipment and supplies SA884 A4481 Tracheostoma filter

SA884 Respiratory equipment and supplies SA884 A4558 Conductive gel or paste

SA884 Respiratory equipment and supplies SA884 A4604 Tubing with heating element

SA884 Respiratory equipment and supplies SA884 A4606 Oxygen probe used w oximeter

SA884 Respiratory equipment and supplies SA884 A4608 TRANSTRACHEAL OXYGEN CATH

SA884 Respiratory equipment and supplies SA884 A4611 HEAVY DUTY BATTERY

SA884 Respiratory equipment and supplies SA884 A4612 BATTERY CABLES

SA884 Respiratory equipment and supplies SA884 A4613 BATTERY CHARGER

SA884 Respiratory equipment and supplies SA884 A4614 Hand-held PEFR meter

SA884 Respiratory equipment and supplies SA884 A4615 Cannula nasal

SA884 Respiratory equipment and supplies SA884 A4616 Tubing (oxygen) per foot

SA884 Respiratory equipment and supplies SA884 A4617 Mouth piece

SA884 Respiratory equipment and supplies SA884 A4618 Breathing circuits

SA884 Respiratory equipment and supplies SA884 A4619 FACE TENT

SA884 Respiratory equipment and supplies SA884 A4620 Variable concentration mask

25



SA884 Respiratory equipment and supplies SA884 A4623 Tracheostomy inner cannula

SA884 Respiratory equipment and supplies SA884 A4624 Tracheal suction tube

SA884 Respiratory equipment and supplies SA884 A4625 Trach care kit for new trach

SA884 Respiratory equipment and supplies SA884 A4626 Tracheostomy cleaning brush

SA884 Respiratory equipment and supplies SA884 A4627 Spacer bag/reservoir

SA884 Respiratory equipment and supplies SA884 A4628 Oropharyngeal suction cath

SA884 Respiratory equipment and supplies SA884 A4629 Tracheostomy care kit

SA884 Respiratory equipment and supplies SA884 A7000 Disposable canister for pump

SA884 Respiratory equipment and supplies SA884 A7001 Nondisposable pump canister

SA884 Respiratory equipment and supplies SA884 A7002 Tubing used w suction pump

SA884 Respiratory equipment and supplies SA884 A7003 Nebulizer administration set

SA884 Respiratory equipment and supplies SA884 A7004 Disposable nebulizer sml vol

SA884 Respiratory equipment and supplies SA884 A7005 Nondisposable nebulizer set

SA884 Respiratory equipment and supplies SA884 A7006 Filtered nebulizer admin set

SA884 Respiratory equipment and supplies SA884 A7007 Lg vol nebulizer disposable

SA884 Respiratory equipment and supplies SA884 A7008 Disposable nebulizer prefill

SA884 Respiratory equipment and supplies SA884 A7009 Nebulizer reservoir bottle

SA884 Respiratory equipment and supplies SA884 A7010 Disposable corrugated tubing

SA884 Respiratory equipment and supplies SA884 A7011 Nondispos corrugated tubing

SA884 Respiratory equipment and supplies SA884 A7012 Nebulizer water collec devic

SA884 Respiratory equipment and supplies SA884 A7013 Disposable compressor filter

SA884 Respiratory equipment and supplies SA884 A7014 Compressor nondispos filter

SA884 Respiratory equipment and supplies SA884 A7015 Aerosol mask used w nebulize

SA884 Respiratory equipment and supplies SA884 A7016 Nebulizer dome & mouthpiece

SA884 Respiratory equipment and supplies SA884 A7017 Nebulizer not used w oxygen

SA884 Respiratory equipment and supplies SA884 A7018 Water distilled w/nebulizer

SA884 Respiratory equipment and supplies SA884 A7020

STERILE WATER OR SALINE 1000 ML LOCAL

CODE AFTER 12/03 (50 PER 30 DYS) XWALKED FROM E1399

#870000928

SA884 Respiratory equipment and supplies SA884 A7027 Combination oral/nasal mask

SA884 Respiratory equipment and supplies SA884 A7028 Repl oral cushion combo mask

SA884 Respiratory equipment and supplies SA884 A7029 Repl nasal pillow comb mask

SA884 Respiratory equipment and supplies SA884 A7030 CPAP full face mask

SA884 Respiratory equipment and supplies SA884 A7031 Replacement facemask interfa

SA884 Respiratory equipment and supplies SA884 A7032 Replacement nasal cushion

SA884 Respiratory equipment and supplies SA884 A7033 Replacement nasal pillows

SA884 Respiratory equipment and supplies SA884 A7034 Nasal application device

SA884 Respiratory equipment and supplies SA884 A7035 Pos airway press headgear

SA884 Respiratory equipment and supplies SA884 A7036 Pos airway press chinstrap

SA884 Respiratory equipment and supplies SA884 A7037 Pos airway pressure tubing

SA884 Respiratory equipment and supplies SA884 A7038 Pos airway pressure filter

SA884 Respiratory equipment and supplies SA884 A7039 Filter, non disposable w pap

SA884 Respiratory equipment and supplies SA884 A7044 PAP oral interface

SA884 Respiratory equipment and supplies SA884 A7045 Repl exhalation port for PAP

SA884 Respiratory equipment and supplies SA884 A7046 Repl water chamber, PAP dev

SA884 Respiratory equipment and supplies SA884 A7501 Tracheostoma valve w diaphra

SA884 Respiratory equipment and supplies SA884 A7502 Replacement diaphragm/fplate

SA884 Respiratory equipment and supplies SA884 A7503 HMES filter holder or cap

SA884 Respiratory equipment and supplies SA884 A7504 Tracheostoma HMES filter

SA884 Respiratory equipment and supplies SA884 A7505 HMES or trach valve housing

SA884 Respiratory equipment and supplies SA884 A7506 HMES/trachvalve adhesivedisk

SA884 Respiratory equipment and supplies SA884 A7507 Integrated filter & holder

SA884 Respiratory equipment and supplies SA884 A7508 Housing & Integrated Adhesiv

SA884 Respiratory equipment and supplies SA884 A7509 Heat & moisture exchange sys

SA884 Respiratory equipment and supplies SA884 A7520 Trach/laryn tube non-cuffed

SA884 Respiratory equipment and supplies SA884 A7521 Trach/laryn tube cuffed

SA884 Respiratory equipment and supplies SA884 A7522 Trach/laryn tube stainless

SA884 Respiratory equipment and supplies SA884 A7523 Tracheostomy shower protect

SA884 Respiratory equipment and supplies SA884 A7524 Tracheostoma stent/stud/bttn

SA884 Respiratory equipment and supplies SA884 A7525 Tracheostomy mask

SA884 Respiratory equipment and supplies SA884 A7526 Tracheostomy tube collar

SA884 Respiratory equipment and supplies SA884 A7527 Trach/laryn tube plug/stop

SA884 Respiratory equipment and supplies SA884 A8000 Soft protect helmet prefab

SA884 Respiratory equipment and supplies SA884 A8001 Hard protect helmet prefab

25



SA884 Respiratory equipment and supplies SA884 A8002 Soft protect helmet custom

SA884 Respiratory equipment and supplies SA884 A8003 Hard protect helmet custom

SA884 Respiratory equipment and supplies SA884 A8004 Repl soft interface, helmet

SA884 Respiratory equipment and supplies SA884 E0424 Stationary compressed gas 02

SA884 Respiratory equipment and supplies SA884 E0425 Gas system stationary compre

SA884 Respiratory equipment and supplies SA884 E0431 Portable gaseous 02

SA884 Respiratory equipment and supplies SA884 E0433 PORTABLE LIQUID OXYGEN SYS

SA884 Respiratory equipment and supplies SA884 E0434 Portable liquid 02

SA884 Respiratory equipment and supplies SA884 E0439 Stationary liquid 02

SA884 Respiratory equipment and supplies SA884 E0441 Stationary O2 contents, gas

SA884 Respiratory equipment and supplies SA884 E0442 Stationary O2 contents, liq

SA884 Respiratory equipment and supplies SA884 E0443 Portable 02 contents, gas

SA884 Respiratory equipment and supplies SA884 E0444 Portable 02 contents, liquid

SA884 Respiratory equipment and supplies SA884 E0445 Oximeter non-invasive

SA884 Respiratory equipment and supplies SA884 E0450 Vol control vent invasiv int

SA884 Respiratory equipment and supplies SA884 E0459 CHEST WRAP

SA884 Respiratory equipment and supplies SA884 E0460 Neg press vent portabl/statn

SA884 Respiratory equipment and supplies SA884 E0461 Vol control vent noninv int

SA884 Respiratory equipment and supplies SA884 E0463 Press supp vent invasive int

SA884 Respiratory equipment and supplies SA884 E0464 Press supp vent noninv int

SA884 Respiratory equipment and supplies SA884 E0470 RAD w/o backup non-inv intfc

SA884 Respiratory equipment and supplies SA884 E0471 RAD w/backup non inv intrfc

SA884 Respiratory equipment and supplies SA884 E0472 RAD w backup invasive intrfc

SA884 Respiratory equipment and supplies SA884 E0480 Percussor elect/pneum home m

SA884 Respiratory equipment and supplies SA884 E0482 Cough stimulating device

SA884 Respiratory equipment and supplies SA884 E0483 Chest compression gen system

SA884 Respiratory equipment and supplies SA884 E0484 Non-elec oscillatory pep dvc

SA884 Respiratory equipment and supplies SA884 E0500 Ippb all types

SA884 Respiratory equipment and supplies SA884 E0550 Humidif extens supple w ippb

SA884 Respiratory equipment and supplies SA884 E0555 Humidifier for use w/ regula

SA884 Respiratory equipment and supplies SA884 E0560 Humidifier supplemental w/ i

SA884 Respiratory equipment and supplies SA884 E0561 Humidifier nonheated w PAP

SA884 Respiratory equipment and supplies SA884 E0562 Humidifier heated used w PAP

SA884 Respiratory equipment and supplies SA884 E0565 Compressor air power source

SA884 Respiratory equipment and supplies SA884 E0570 Nebulizer with compression

SA884 Respiratory equipment and supplies SA884 E0571 AEROSOL COMPRESSOR FOR SVNEB

SA884 Respiratory equipment and supplies SA884 E0572 Aerosol compressor adjust pr

SA884 Respiratory equipment and supplies SA884 E0574 Ultrasonic generator w svneb

SA884 Respiratory equipment and supplies SA884 E0575 Nebulizer ultrasonic

SA884 Respiratory equipment and supplies SA884 E0580 Nebulizer for use w/ regulat

SA884 Respiratory equipment and supplies SA884 E0585 Nebulizer w/ compressor & he

SA884 Respiratory equipment and supplies SA884 E0605 Vaporizer room type

SA884 Respiratory equipment and supplies SA884 E0618 Apnea monitor

SA884 Respiratory equipment and supplies SA884 E1354 Wheeled cart, port cyl/conc

SA884 Respiratory equipment and supplies SA884 E1355 Oxygen supplies stand/rack

SA884 Respiratory equipment and supplies SA884 E1356 Batt pack/cart, port conc

SA884 Respiratory equipment and supplies SA884 E1357 Battery charger, port conc

SA884 Respiratory equipment and supplies SA884 E1358 DC power adapter, port conc

SA884 Respiratory equipment and supplies SA884 E1372 Oxy suppl heater for nebuliz

SA884 Respiratory equipment and supplies SA884 E1390 Oxygen concentrator

SA884 Respiratory equipment and supplies SA884 E1391 Oxygen concentrator, dual

SA884 Respiratory equipment and supplies SA884 E1392 Portable oxygen concentrator

SA884 Respiratory equipment and supplies SA884 E1405 O2/water vapor enrich w/heat

SA884 Respiratory equipment and supplies SA884 E1406 O2/water vapor enrich w/o he

SA884 Respiratory equipment and supplies SA884 K0462 Temporary replacement eqpmnt

SA884 Respiratory equipment and supplies SA884 K0740 Repair/svc oxygen equipment

SA884 Respiratory equipment and supplies SA884 L8501 Tracheostomy speaking valve

SA884 Respiratory equipment and supplies SA884 S8185 Flutter device

SA884 Respiratory equipment and supplies SA884 S8186 Swivel adaptor

SA884 Respiratory equipment and supplies SA884 S8189 Trach supply noc

SA884 Respiratory equipment and supplies SA884 S8210 Mucus trap

SA884 Respiratory equipment and supplies SA884 S8265 Haberman feeder

SA885 Urinary/incontinence equipment SA885 A4310 Insert tray w/o bag/cath

SA885 Urinary/incontinence equipment SA885 A4311 Catheter w/o bag 2-way latex

25



SA885 Urinary/incontinence equipment SA885 A4312 Cath w/o bag 2-way silicone

SA885 Urinary/incontinence equipment SA885 A4313 Catheter w/bag 3-way

SA885 Urinary/incontinence equipment SA885 A4314 Cath w/drainage 2-way latex

SA885 Urinary/incontinence equipment SA885 A4315 Cath w/drainage 2-way silcne

SA885 Urinary/incontinence equipment SA885 A4316 Cath w/drainage 3-way

SA885 Urinary/incontinence equipment SA885 A4320 Irrigation tray

SA885 Urinary/incontinence equipment SA885 A4321 Cath therapeutic irrig agent

SA885 Urinary/incontinence equipment SA885 A4322 Irrigation syringe

SA885 Urinary/incontinence equipment SA885 A4326 Male external catheter

SA885 Urinary/incontinence equipment SA885 A4327 Fem urinary collect dev cup

SA885 Urinary/incontinence equipment SA885 A4328 Fem urinary collect pouch

SA885 Urinary/incontinence equipment SA885 A4330 Stool collection pouch

SA885 Urinary/incontinence equipment SA885 A4331 Extension drainage tubing

SA885 Urinary/incontinence equipment SA885 A4332 Lube sterile packet

SA885 Urinary/incontinence equipment SA885 A4333 Urinary cath anchor device

SA885 Urinary/incontinence equipment SA885 A4334 Urinary cath leg strap

SA885 Urinary/incontinence equipment SA885 A4335 Incontinence supply

SA885 Urinary/incontinence equipment SA885 A4336 Urethral insert

SA885 Urinary/incontinence equipment SA885 A4338 Indwelling catheter latex

SA885 Urinary/incontinence equipment SA885 A4340 Indwelling catheter special

SA885 Urinary/incontinence equipment SA885 A4344 Cath indw foley 2 way silicn

SA885 Urinary/incontinence equipment SA885 A4346 Cath indw foley 3 way

SA885 Urinary/incontinence equipment SA885 A4349 Disposable male external cat

SA885 Urinary/incontinence equipment SA885 A4351 Straight tip urine catheter

SA885 Urinary/incontinence equipment SA885 A4352 Coude tip urinary catheter

SA885 Urinary/incontinence equipment SA885 A4353 Intermittent urinary cath

SA885 Urinary/incontinence equipment SA885 A4354 Cath insertion tray w/bag

SA885 Urinary/incontinence equipment SA885 A4355 Bladder irrigation tubing

SA885 Urinary/incontinence equipment SA885 A4356 Ext ureth clmp or compr dvc

SA885 Urinary/incontinence equipment SA885 A4357 Bedside drainage bag

SA885 Urinary/incontinence equipment SA885 A4358 Urinary leg or abdomen bag

SA885 Urinary/incontinence equipment SA885 A4360 Disposable ext urethral dev

SA885 Urinary/incontinence equipment SA885 A5102 Bedside drain btl w/wo tube

SA885 Urinary/incontinence equipment SA885 A5105 Urinary suspensory

SA885 Urinary/incontinence equipment SA885 A5112 Urinary leg bag

SA885 Urinary/incontinence equipment SA885 A5113 Latex leg strap

SA885 Urinary/incontinence equipment SA885 A5114 Foam/fabric leg strap

SA885 Urinary/incontinence equipment SA885 A5120 Skin barrier, wipe or swab

SA885 Urinary/incontinence equipment SA885 A5121 Solid skin barrier 6x6

SA885 Urinary/incontinence equipment SA885 A5122 Solid skin barrier 8x8

SA885 Urinary/incontinence equipment SA885 A5126 Disk/foam pad +or- adhesive

SA885 Urinary/incontinence equipment SA885 T4521 Adult size brief/diaper sm

SA885 Urinary/incontinence equipment SA885 T4522 Adult size brief/diaper med

SA885 Urinary/incontinence equipment SA885 T4523 Adult size brief/diaper lg

SA885 Urinary/incontinence equipment SA885 T4524 Adult size brief/diaper xl

SA885 Urinary/incontinence equipment SA885 T4525 Adult size pull-on sm

SA885 Urinary/incontinence equipment SA885 T4526 Adult size pull-on med

SA885 Urinary/incontinence equipment SA885 T4527 Adult size pull-on lg

SA885 Urinary/incontinence equipment SA885 T4528 Adult size pull-on xl

SA885 Urinary/incontinence equipment SA885 T4529 Ped size brief/diaper sm/med

SA885 Urinary/incontinence equipment SA885 T4530 Ped size brief/diaper lg

SA885 Urinary/incontinence equipment SA885 T4531 Ped size pull-on sm/med

SA885 Urinary/incontinence equipment SA885 T4532 Ped size pull-on lg

SA885 Urinary/incontinence equipment SA885 T4533 Youth size brief/diaper

SA885 Urinary/incontinence equipment SA885 T4534 Youth size pull-on

SA885 Urinary/incontinence equipment SA885 T4535 Disposable liner/shield/pad

SA885 Urinary/incontinence equipment SA885 T4536 Reusable pull-on any size

SA885 Urinary/incontinence equipment SA885 T4537 Reusable underpad bed size

SA885 Urinary/incontinence equipment SA885 T4538 Diaper serv reusable diaper

SA885 Urinary/incontinence equipment SA885 T4539 Reuse diaper/brief any size

SA885 Urinary/incontinence equipment SA885 T4541 Large disposable underpad

SA885 Urinary/incontinence equipment SA885 T4542 Small disposable underpad

SA885 Urinary/incontinence equipment SA885 T4543 ADULT DISP BRIEF/DIAP ABV XL

SA885 Urinary/incontinence equipment SA885 T4544 ADLT DISP UND/PULL ON ABV XL

25



SA886 Wheelchairs and accessories SA886 E0950 Tray

SA886 Wheelchairs and accessories SA886 E0951 Loop heel

SA886 Wheelchairs and accessories SA886 E0952 Toe loop/holder, each

SA886 Wheelchairs and accessories SA886 E0955 Cushioned headrest

SA886 Wheelchairs and accessories SA886 E0956 W/c lateral trunk/hip suppor

SA886 Wheelchairs and accessories SA886 E0957 W/c medial thigh support

SA886 Wheelchairs and accessories SA886 E0958 Whlchr att- conv 1 arm drive

SA886 Wheelchairs and accessories SA886 E0959 Amputee adapter

SA886 Wheelchairs and accessories SA886 E0960 W/c shoulder harness/straps

SA886 Wheelchairs and accessories SA886 E0961 Wheelchair brake extension

SA886 Wheelchairs and accessories SA886 E0966 Wheelchair head rest extensi

SA886 Wheelchairs and accessories SA886 E0967 Manual wc hand rim w project

SA886 Wheelchairs and accessories SA886 E0968 Wheelchair commode seat

SA886 Wheelchairs and accessories SA886 E0969 Wheelchair narrowing device

SA886 Wheelchairs and accessories SA886 E0970 Wheelchair no. 2 footplates

SA886 Wheelchairs and accessories SA886 E0971 Wheelchair anti-tipping devi

SA886 Wheelchairs and accessories SA886 E0972 TRANSFER BOARD OR DEVICE

SA886 Wheelchairs and accessories SA886 E0973 W/Ch access det adj armrest

SA886 Wheelchairs and accessories SA886 E0974 W/Ch access anti-rollback

SA886 Wheelchairs and accessories SA886 E0978 W/C acc,saf belt pelv strap

SA886 Wheelchairs and accessories SA886 E0980 Wheelchair safety vest

SA886 Wheelchairs and accessories SA886 E0981 Seat upholstery, replacement

SA886 Wheelchairs and accessories SA886 E0982 Back upholstery, replacement

SA886 Wheelchairs and accessories SA886 E0983 Add pwr joystick

SA886 Wheelchairs and accessories SA886 E0984 Add pwr tiller

SA886 Wheelchairs and accessories SA886 E0985 W/c seat lift mechanism

SA886 Wheelchairs and accessories SA886 E0986 MAN W/C PUSH-RIM POWR SYSTEM

SA886 Wheelchairs and accessories SA886 E0990 Wheelchair elevating leg res

SA886 Wheelchairs and accessories SA886 E0992 Wheelchair solid seat insert

SA886 Wheelchairs and accessories SA886 E0994 Wheelchair arm rest

SA886 Wheelchairs and accessories SA886 E0995 Wheelchair calf rest

SA886 Wheelchairs and accessories SA886 E1002 Pwr seat tilt

SA886 Wheelchairs and accessories SA886 E1003 Pwr seat recline

SA886 Wheelchairs and accessories SA886 E1004 Pwr seat recline mech

SA886 Wheelchairs and accessories SA886 E1005 Pwr seat recline pwr

SA886 Wheelchairs and accessories SA886 E1006 Pwr seat combo w/o shear

SA886 Wheelchairs and accessories SA886 E1007 Pwr seat combo w/shear

SA886 Wheelchairs and accessories SA886 E1008 Pwr seat combo pwr shear

SA886 Wheelchairs and accessories SA886 E1009 Add mech leg elevation

SA886 Wheelchairs and accessories SA886 E1010 Add pwr leg elevation

SA886 Wheelchairs and accessories SA886 E1011 Ped wc modify width adjustm

SA886 Wheelchairs and accessories SA886 E1014 Reclining back add ped w/c

SA886 Wheelchairs and accessories SA886 E1015 Shock absorber for man w/c

SA886 Wheelchairs and accessories SA886 E1016 Shock absorber for power w/c

SA886 Wheelchairs and accessories SA886 E1017 HD shck absrbr for hd man wc

SA886 Wheelchairs and accessories SA886 E1018 HD shck absrber for hd powwc

SA886 Wheelchairs and accessories SA886 E1020 Residual limb support system

SA886 Wheelchairs and accessories SA886 E1028 W/c manual swingaway

SA886 Wheelchairs and accessories SA886 E1029 W/c vent tray fixed

SA886 Wheelchairs and accessories SA886 E1030 W/c vent tray gimbaled

SA886 Wheelchairs and accessories SA886 E1037 Transport chair, ped size

SA886 Wheelchairs and accessories SA886 E1038 Transport chair pt wt<=300lb

SA886 Wheelchairs and accessories SA886 E1039 Transport chair pt wt >300lb

SA886 Wheelchairs and accessories SA886 E1050 Whelchr fxd full length arms

SA886 Wheelchairs and accessories SA886 E1060 Wheelchair detachable arms

SA886 Wheelchairs and accessories SA886 E1065

POWER ATTACHMENTS(TO CONVERT ANY

WHEELCHAIR TO MOTORIZED WHEELCHAIR, E.G. SOLO)

XOVER ONLY TIL 4/04

SA886 Wheelchairs and accessories SA886 E1070 Wheelchair detachable foot r

SA886 Wheelchairs and accessories SA886 E1083 Hemi-wheelchair fixed arms

SA886 Wheelchairs and accessories SA886 E1084 Hemi-wheelchair detachable a

SA886 Wheelchairs and accessories SA886 E1085 Hemi-wheelchair fixed arms

SA886 Wheelchairs and accessories SA886 E1086 Hemi-wheelchair detachable a

SA886 Wheelchairs and accessories SA886 E1087 Wheelchair lightwt fixed arm

25



SA886 Wheelchairs and accessories SA886 E1088 Wheelchair lightweight det a


SA886 Wheelchairs and accessories SA886 E1090 Wheelchair lightweight det a

SA886 Wheelchairs and accessories SA886 E1092 Wheelchair wide w/ leg rests

SA886 Wheelchairs and accessories SA886 E1093 Wheelchair wide w/ foot rest

SA886 Wheelchairs and accessories SA886 E1100 Whchr s-recl fxd arm leg res

SA886 Wheelchairs and accessories SA886 E1110 Wheelchair semi-recl detach

SA886 Wheelchairs and accessories SA886 E1130 Whlchr stand fxd arm ft rest

SA886 Wheelchairs and accessories SA886 E1140 Wheelchair standard detach a

SA886 Wheelchairs and accessories SA886 E1150 Wheelchair standard w/ leg r

SA886 Wheelchairs and accessories SA886 E1160 Wheelchair fixed arms

SA886 Wheelchairs and accessories SA886 E1161 Manual adult wc w tiltinspac

SA886 Wheelchairs and accessories SA886 E1170 Whlchr ampu fxd arm leg rest

SA886 Wheelchairs and accessories SA886 E1171 Wheelchair amputee w/o leg r

SA886 Wheelchairs and accessories SA886 E1172 Wheelchair amputee detach ar

SA886 Wheelchairs and accessories SA886 E1180 Wheelchair amputee w/ foot r

SA886 Wheelchairs and accessories SA886 E1190 Wheelchair amputee w/ leg re

SA886 Wheelchairs and accessories SA886 E1195 Wheelchair amputee heavy dut

SA886 Wheelchairs and accessories SA886 E1200 Wheelchair amputee fixed arm

SA886 Wheelchairs and accessories SA886 E1220 Whlchr special size/constrc

SA886 Wheelchairs and accessories SA886 E1221 Wheelchair spec size w foot

SA886 Wheelchairs and accessories SA886 E1222 Wheelchair spec size w/ leg

SA886 Wheelchairs and accessories SA886 E1223 Wheelchair spec size w foot

SA886 Wheelchairs and accessories SA886 E1224 Wheelchair spec size w/ leg

SA886 Wheelchairs and accessories SA886 E1225 Manual semi-reclining back

SA886 Wheelchairs and accessories SA886 E1226 Manual fully reclining back

SA886 Wheelchairs and accessories SA886 E1227 Wheelchair spec sz spec ht a

SA886 Wheelchairs and accessories SA886 E1228 Wheelchair spec sz spec ht b

SA886 Wheelchairs and accessories SA886 E1229 Pediatric wheelchair NOS

SA886 Wheelchairs and accessories SA886 E1231 Rigid ped w/c tilt-in-space

SA886 Wheelchairs and accessories SA886 E1232 Folding ped wc tilt-in-space

SA886 Wheelchairs and accessories SA886 E1233 Rig ped wc tltnspc w/o seat

SA886 Wheelchairs and accessories SA886 E1234 Fld ped wc tltnspc w/o seat

SA886 Wheelchairs and accessories SA886 E1235 Rigid ped wc adjustable

SA886 Wheelchairs and accessories SA886 E1236 Folding ped wc adjustable

SA886 Wheelchairs and accessories SA886 E1237 Rgd ped wc adjstabl w/o seat

SA886 Wheelchairs and accessories SA886 E1238 Fld ped wc adjstabl w/o seat

SA886 Wheelchairs and accessories SA886 E1239 Ped power wheelchair NOS

SA886 Wheelchairs and accessories SA886 E1240 Whchr litwt det arm leg rest


SA886 Wheelchairs and accessories SA886 E1260 Wheelchair lightwt foot rest

SA886 Wheelchairs and accessories SA886 E1270 Wheelchair lightweight leg r

SA886 Wheelchairs and accessories SA886 E1280 Whchr h-duty det arm leg res

SA886 Wheelchairs and accessories SA886 E1285 Wheelchair heavy duty fixed

SA886 Wheelchairs and accessories SA886 E1290 Wheelchair hvy duty detach a

SA886 Wheelchairs and accessories SA886 E1295 Wheelchair heavy duty fixed

SA886 Wheelchairs and accessories SA886 E1296 Wheelchair special seat heig

SA886 Wheelchairs and accessories SA886 E1297 Wheelchair special seat dept

SA886 Wheelchairs and accessories SA886 E1298 Wheelchair spec seat depth/w

SA886 Wheelchairs and accessories SA886 E2201 Man w/ch acc seat w>=20o<24o

SA886 Wheelchairs and accessories SA886 E2202 Seat width 24-27 in

SA886 Wheelchairs and accessories SA886 E2203 Frame depth less than 22 in

SA886 Wheelchairs and accessories SA886 E2204 Frame depth 22 to 25 in

SA886 Wheelchairs and accessories SA886 E2205 Manual wc accessory, handrim

SA886 Wheelchairs and accessories SA886 E2206 Complete wheel lock assembly

SA886 Wheelchairs and accessories SA886 E2207 Crutch and cane holder

SA886 Wheelchairs and accessories SA886 E2208 Cylinder tank carrier

SA886 Wheelchairs and accessories SA886 E2209 Arm trough each

SA886 Wheelchairs and accessories SA886 E2210 Wheelchair bearings

SA886 Wheelchairs and accessories SA886 E2211 Pneumatic propulsion tire

SA886 Wheelchairs and accessories SA886 E2212 Pneumatic prop tire tube

SA886 Wheelchairs and accessories SA886 E2213 Pneumatic prop tire insert

SA886 Wheelchairs and accessories SA886 E2214 Pneumatic caster tire each

SA886 Wheelchairs and accessories SA886 E2215 Pneumatic caster tire tube

25



SA886 Wheelchairs and accessories SA886 E2216 Foam filled propulsion tire

SA886 Wheelchairs and accessories SA886 E2217 Foam filled caster tire each

SA886 Wheelchairs and accessories SA886 E2218 Foam propulsion tire each

SA886 Wheelchairs and accessories SA886 E2219 Foam caster tire any size ea

SA886 Wheelchairs and accessories SA886 E2220 Solid propulsion tire each

SA886 Wheelchairs and accessories SA886 E2221 Solid caster tire each

SA886 Wheelchairs and accessories SA886 E2222 Solid caster integrated whl

SA886 Wheelchairs and accessories SA886 E2224 Propulsion whl excludes tire

SA886 Wheelchairs and accessories SA886 E2225 Caster wheel excludes tire

SA886 Wheelchairs and accessories SA886 E2226 Caster fork replacement only

SA886 Wheelchairs and accessories SA886 E2227 Gear reduction drive wheel

SA886 Wheelchairs and accessories SA886 E2228 Mwc acc, wheelchair brake

SA886 Wheelchairs and accessories SA886 E2230 Manual standing system

SA886 Wheelchairs and accessories SA886 E2231 Solid seat support base

SA886 Wheelchairs and accessories SA886 E2291 Planar back for ped size wc

SA886 Wheelchairs and accessories SA886 E2292 Planar seat for ped size wc

SA886 Wheelchairs and accessories SA886 E2293 Contour back for ped size wc

SA886 Wheelchairs and accessories SA886 E2294 Contour seat for ped size wc

SA886 Wheelchairs and accessories SA886 E2295 Ped dynamic seating frame

SA886 Wheelchairs and accessories SA886 E2300 PWR SEAT ELEVATION SYS

SA886 Wheelchairs and accessories SA886 E2301 PWR STANDING

SA886 Wheelchairs and accessories SA886 E2310 Electro connect btw control

SA886 Wheelchairs and accessories SA886 E2311 Electro connect btw 2 sys

SA886 Wheelchairs and accessories SA886 E2312 Mini-prop remote joystick

SA886 Wheelchairs and accessories SA886 E2313 PWC harness, expand control

SA886 Wheelchairs and accessories SA886 E2321 Hand interface joystick

SA886 Wheelchairs and accessories SA886 E2322 Mult mech switches

SA886 Wheelchairs and accessories SA886 E2323 Special joystick handle

SA886 Wheelchairs and accessories SA886 E2324 Chin cup interface

SA886 Wheelchairs and accessories SA886 E2325 Sip and puff interface

SA886 Wheelchairs and accessories SA886 E2326 Breath tube kit

SA886 Wheelchairs and accessories SA886 E2327 Head control interface mech

SA886 Wheelchairs and accessories SA886 E2328 Head/extremity control inter

SA886 Wheelchairs and accessories SA886 E2329 Head control nonproportional

SA886 Wheelchairs and accessories SA886 E2330 Head control proximity switc

SA886 Wheelchairs and accessories SA886 E2331 Attendant control

SA886 Wheelchairs and accessories SA886 E2340 W/c wdth 20-23 in seat frame

SA886 Wheelchairs and accessories SA886 E2341 W/c wdth 24-27 in seat frame

SA886 Wheelchairs and accessories SA886 E2342 W/c dpth 20-21 in seat frame

SA886 Wheelchairs and accessories SA886 E2343 W/c dpth 22-25 in seat frame

SA886 Wheelchairs and accessories SA886 E2351 Electronic SGD interface

SA886 Wheelchairs and accessories SA886 E2360 22nf nonsealed leadacid

SA886 Wheelchairs and accessories SA886 E2361 22nf sealed leadacid battery

SA886 Wheelchairs and accessories SA886 E2362 Gr24 nonsealed leadacid

SA886 Wheelchairs and accessories SA886 E2363 Gr24 sealed leadacid battery

SA886 Wheelchairs and accessories SA886 E2364 U1nonsealed leadacid battery

SA886 Wheelchairs and accessories SA886 E2365 U1 sealed leadacid battery

SA886 Wheelchairs and accessories SA886 E2366 Battery charger, single mode

SA886 Wheelchairs and accessories SA886 E2367 Battery charger, dual mode

SA886 Wheelchairs and accessories SA886 E2368 Power wc motor replacement

SA886 Wheelchairs and accessories SA886 E2369 Pwr wc gear box replacement

SA886 Wheelchairs and accessories SA886 E2370 Pwr wc motor/gear box combo

SA886 Wheelchairs and accessories SA886 E2371 Gr27 sealed leadacid battery

SA886 Wheelchairs and accessories SA886 E2372 Gr27 non-sealed leadacid

SA886 Wheelchairs and accessories SA886 E2373 Hand/chin ctrl spec joystick

SA886 Wheelchairs and accessories SA886 E2374 Hand/chin ctrl std joystick

SA886 Wheelchairs and accessories SA886 E2375 Non-expandable controller

SA886 Wheelchairs and accessories SA886 E2376 Expandable controller, repl

SA886 Wheelchairs and accessories SA886 E2377 Expandable controller, initl

SA886 Wheelchairs and accessories SA886 E2378 PW ACTUATOR REPLACEMENT

SA886 Wheelchairs and accessories SA886 E2381 Pneum drive wheel tire

SA886 Wheelchairs and accessories SA886 E2382 Tube, pneum wheel drive tire

SA886 Wheelchairs and accessories SA886 E2383 Insert, pneum wheel drive

SA886 Wheelchairs and accessories SA886 E2384 Pneumatic caster tire

25



SA886 Wheelchairs and accessories SA886 E2385 Tube, pneumatic caster tire

SA886 Wheelchairs and accessories SA886 E2386 Foam filled drive wheel tire

SA886 Wheelchairs and accessories SA886 E2387 Foam filled caster tire

SA886 Wheelchairs and accessories SA886 E2388 Foam drive wheel tire

SA886 Wheelchairs and accessories SA886 E2389 Foam caster tire

SA886 Wheelchairs and accessories SA886 E2390 Solid drive wheel tire

SA886 Wheelchairs and accessories SA886 E2391 Solid caster tire

SA886 Wheelchairs and accessories SA886 E2392 Solid caster tire, integrate

SA886 Wheelchairs and accessories SA886 E2394 Drive wheel excludes tire

SA886 Wheelchairs and accessories SA886 E2395 Caster wheel excludes tire

SA886 Wheelchairs and accessories SA886 E2396 Caster fork

SA886 Wheelchairs and accessories SA886 E2397 Pwc acc, lith-based battery

SA886 Wheelchairs and accessories SA886 E2601 Gen w/c cushion wdth < 22 in

SA886 Wheelchairs and accessories SA886 E2602 Gen w/c cushion wdth >=22 in

SA886 Wheelchairs and accessories SA886 E2603 Skin protect wc cus wd <22in

SA886 Wheelchairs and accessories SA886 E2604 Skin protect wc cus wd>=22in

SA886 Wheelchairs and accessories SA886 E2605 Position wc cush wdth <22 in

SA886 Wheelchairs and accessories SA886 E2606 Position wc cush wdth>=22 in

SA886 Wheelchairs and accessories SA886 E2607 Skin pro/pos wc cus wd <22in

SA886 Wheelchairs and accessories SA886 E2608 Skin pro/pos wc cus wd>=22in

SA886 Wheelchairs and accessories SA886 E2609 Custom fabricate w/c cushion

SA886 Wheelchairs and accessories SA886 E2610 Powered w/c cushion

SA886 Wheelchairs and accessories SA886 E2611 Gen use back cush wdth <22in

SA886 Wheelchairs and accessories SA886 E2612 Gen use back cush wdth>=22in

SA886 Wheelchairs and accessories SA886 E2613 Position back cush wd <22in

SA886 Wheelchairs and accessories SA886 E2614 Position back cush wd>=22in

SA886 Wheelchairs and accessories SA886 E2615 Pos back post/lat wdth <22in

SA886 Wheelchairs and accessories SA886 E2616 Pos back post/lat wdth>=22in

SA886 Wheelchairs and accessories SA886 E2617 Custom fab w/c back cushion

SA886 Wheelchairs and accessories SA886 E2619 Replace cover w/c seat cush

SA886 Wheelchairs and accessories SA886 E2620 WC planar back cush wd <22in

SA886 Wheelchairs and accessories SA886 E2621 WC planar back cush wd>=22in

SA886 Wheelchairs and accessories SA886 E2622 ADJ SKIN PRO W/C CUS WD<22IN

SA886 Wheelchairs and accessories SA886 E2623 ADJ SKIN PRO WC CUS WD>=22IN

SA886 Wheelchairs and accessories SA886 E2624 ADJ SKIN PRO/POS CUS<22IN

SA886 Wheelchairs and accessories SA886 E2625 ADJ SKIN PRO/POS WC CUS>=22

SA886 Wheelchairs and accessories SA886 K0001 Standard wheelchair

SA886 Wheelchairs and accessories SA886 K0002 Stnd hemi (low seat) whlchr

SA886 Wheelchairs and accessories SA886 K0003 Lightweight wheelchair

SA886 Wheelchairs and accessories SA886 K0004 High strength ltwt whlchr

SA886 Wheelchairs and accessories SA886 K0005 Ultralightweight wheelchair

SA886 Wheelchairs and accessories SA886 K0006 Heavy duty wheelchair

SA886 Wheelchairs and accessories SA886 K0007 Extra heavy duty wheelchair

SA886 Wheelchairs and accessories SA886 K0009 OTHER MANUAL WHEELCHAIR/BASE

SA886 Wheelchairs and accessories SA886 K0010 Stnd wt frame power whlchr

SA886 Wheelchairs and accessories SA886 K0011 Stnd wt pwr whlchr w control

SA886 Wheelchairs and accessories SA886 K0012 Ltwt portbl power whlchr

SA886 Wheelchairs and accessories SA886 K0015 Detach non-adjus hght armrst

SA886 Wheelchairs and accessories SA886 K0017 Detach adjust armrest base

SA886 Wheelchairs and accessories SA886 K0018 Detach adjust armrst upper

SA886 Wheelchairs and accessories SA886 K0019 Arm pad each

SA886 Wheelchairs and accessories SA886 K0020 Fixed adjust armrest pair

SA886 Wheelchairs and accessories SA886 K0037 High mount flip-up footrest

SA886 Wheelchairs and accessories SA886 K0038 Leg strap each

SA886 Wheelchairs and accessories SA886 K0039 Leg strap h style each

SA886 Wheelchairs and accessories SA886 K0040 Adjustable angle footplate

SA886 Wheelchairs and accessories SA886 K0041 Large size footplate each

SA886 Wheelchairs and accessories SA886 K0042 Standard size footplate each

SA886 Wheelchairs and accessories SA886 K0043 Ftrst lower extension tube

SA886 Wheelchairs and accessories SA886 K0044 Ftrst upper hanger bracket

SA886 Wheelchairs and accessories SA886 K0045 Footrest complete assembly

SA886 Wheelchairs and accessories SA886 K0046 Elevat legrst low extension

SA886 Wheelchairs and accessories SA886 K0047 Elevat legrst up hangr brack

SA886 Wheelchairs and accessories SA886 K0050 Ratchet assembly

25



SA886 Wheelchairs and accessories SA886 K0051 Cam relese assem ftrst/lgrst

SA886 Wheelchairs and accessories SA886 K0052 Swingaway detach footrest

SA886 Wheelchairs and accessories SA886 K0053 Elevate footrest articulate

SA886 Wheelchairs and accessories SA886 K0056 Seat ht <17 or >=21 ltwt wc

SA886 Wheelchairs and accessories SA886 K0065 Spoke protectors

SA886 Wheelchairs and accessories SA886 K0069 Rear whl complete solid tire

SA886 Wheelchairs and accessories SA886 K0070 Rear whl compl pneum tire

SA886 Wheelchairs and accessories SA886 K0071 Front castr compl pneum tire

SA886 Wheelchairs and accessories SA886 K0072 Frnt cstr cmpl sem-pneum tir

SA886 Wheelchairs and accessories SA886 K0073 Caster pin lock each

SA886 Wheelchairs and accessories SA886 K0077 Front caster assem complete

SA886 Wheelchairs and accessories SA886 K0098 Drive belt power wheelchair

SA886 Wheelchairs and accessories SA886 K0105 Iv hanger

SA886 Wheelchairs and accessories SA886 K0108 W/c component-accessory NOS

SA886 Wheelchairs and accessories SA886 K0195 Elevating whlchair leg rests

SA886 Wheelchairs and accessories SA886 K0601 Repl batt silver oxide 1.5 v

SA886 Wheelchairs and accessories SA886 K0602 Repl batt silver oxide 3 v

SA886 Wheelchairs and accessories SA886 K0603 Repl batt alkaline 1.5 v

SA886 Wheelchairs and accessories SA886 K0604 Repl batt lithium 3.6 v

SA886 Wheelchairs and accessories SA886 K0605 Repl batt lithium 4.5 v

SA886 Wheelchairs and accessories SA886 K0669 SEAT/BACK CUS NO DMEPDAC VER

SA886 Wheelchairs and accessories SA886 K0672 Removable soft interface LE

SA886 Wheelchairs and accessories SA886 K0733 12-24hr sealed lead acid

SA886 Wheelchairs and accessories SA886 K0734 Adj skin pro w/c cus wd<22in

SA886 Wheelchairs and accessories SA886 K0735 Adj skin pro wc cus wd>=22in

SA886 Wheelchairs and accessories SA886 K0736 Adj skin pro/pos wc cus<22in

SA886 Wheelchairs and accessories SA886 K0737 Adj skin pro/pos wc cus>=22o

SA886 Wheelchairs and accessories SA886 K0738 Portable gas oxygen system

SA886 Wheelchairs and accessories SA886 K0800 POV group 1 std up to 300lbs

SA886 Wheelchairs and accessories SA886 K0801 POV group 1 hd 301-450 lbs

SA886 Wheelchairs and accessories SA886 K0802 POV group 1 vhd 451-600 lbs

SA886 Wheelchairs and accessories SA886 K0806 POV group 2 std up to 300lbs

SA886 Wheelchairs and accessories SA886 K0807 POV group 2 hd 301-450 lbs

SA886 Wheelchairs and accessories SA886 K0808 POV group 2 vhd 451-600 lbs

SA886 Wheelchairs and accessories SA886 K0812 Power operated vehicle NOC

SA886 Wheelchairs and accessories SA886 K0813 PWC gp 1 std port seat/back

SA886 Wheelchairs and accessories SA886 K0814 PWC gp 1 std port cap chair

SA886 Wheelchairs and accessories SA886 K0815 PWC gp 1 std seat/back

SA886 Wheelchairs and accessories SA886 K0816 PWC gp 1 std cap chair

SA886 Wheelchairs and accessories SA886 K0820 PWC gp 2 std port seat/back

SA886 Wheelchairs and accessories SA886 K0821 PWC gp 2 std port cap chair



SA886 Wheelchairs and accessories SA886 K0824 PWC gp 2 hd seat/back

SA886 Wheelchairs and accessories SA886 K0825 PWC gp 2 hd cap chair

SA886 Wheelchairs and accessories SA886 K0826 PWC gp 2 vhd seat/back

SA886 Wheelchairs and accessories SA886 K0827 PWC gp vhd cap chair

SA886 Wheelchairs and accessories SA886 K0828 PWC gp 2 xtra hd seat/back

SA886 Wheelchairs and accessories SA886 K0829 PWC gp 2 xtra hd cap chair

SA886 Wheelchairs and accessories SA886 K0830 PWC gp2 std seat elevate s/b

SA886 Wheelchairs and accessories SA886 K0831 PWC gp2 std seat elevate cap

SA886 Wheelchairs and accessories SA886 K0835 PWC gp2 std sing pow opt s/b

SA886 Wheelchairs and accessories SA886 K0836 PWC gp2 std sing pow opt cap

SA886 Wheelchairs and accessories SA886 K0837 PWC gp 2 hd sing pow opt s/b

SA886 Wheelchairs and accessories SA886 K0838 PWC gp 2 hd sing pow opt cap

SA886 Wheelchairs and accessories SA886 K0839 PWC gp2 vhd sing pow opt s/b

SA886 Wheelchairs and accessories SA886 K0840 PWC gp2 xhd sing pow opt s/b

SA886 Wheelchairs and accessories SA886 K0841 PWC gp2 std mult pow opt s/b

SA886 Wheelchairs and accessories SA886 K0842 PWC gp2 std mult pow opt cap

SA886 Wheelchairs and accessories SA886 K0843 PWC gp2 hd mult pow opt s/b




SA886 Wheelchairs and accessories SA886 K0851 PWC gp 3 hd cap chair

25




SA886 Wheelchairs and accessories SA886 K0853 PWC gp 3 vhd cap chair

SA886 Wheelchairs and accessories SA886 K0854 PWC gp 3 xhd seat/back

SA886 Wheelchairs and accessories SA886 K0855 PWC gp 3 xhd cap chair



SA886 Wheelchairs and accessories SA886 K0858 PWC gp3 hd sing pow opt s/b

SA886 Wheelchairs and accessories SA886 K0859 PWC gp3 hd sing pow opt cap



SA886 Wheelchairs and accessories SA886 K0862 PWC gp3 hd mult pow opt s/b

SA886 Wheelchairs and accessories SA886 K0863 PWC gp3 vhd mult pow opt s/b

SA886 Wheelchairs and accessories SA886 K0864 PWC gp3 xhd mult pow opt s/b







SA886 Wheelchairs and accessories SA886 K0879 PWC gp4 hd sing pow opt s/b



SA886 Wheelchairs and accessories SA886 K0885 PWC gp4 std mult pow opt cap

SA886 Wheelchairs and accessories SA886 K0886 PWC gp4 hd mult pow s/b

SA886 Wheelchairs and accessories SA886 K0890 PWC gp5 ped sing pow opt s/b

SA886 Wheelchairs and accessories SA886 K0891 PWC gp5 ped mult pow opt s/b

SA886 Wheelchairs and accessories SA886 K0898 Power wheelchair NOC

SA886 Wheelchairs and accessories SA886 K0899 Pow mobil dev no dmepdac

SA887 Wound care SA887 A4364 Adhesive, liquid or equal

SA887 Wound care SA887 A4450 Non-waterproof tape

SA887 Wound care SA887 A4452 Waterproof tape

SA887 Wound care SA887 A4455 Adhesive remover per ounce

SA887 Wound care SA887 A5131 Appliance cleaner

SA887 Wound care SA887 A6000 Wound warming wound cover

SA887 Wound care SA887 A6010 Collagen based wound filler

SA887 Wound care SA887 A6011 Collagen gel/paste wound fil

SA887 Wound care SA887 A6021 Collagen dressing <=16 sq in

SA887 Wound care SA887 A6022 Collagen drsg>16<=48 sq in

SA887 Wound care SA887 A6023 Collagen dressing >48 sq in

SA887 Wound care SA887 A6024 Collagen dsg wound filler

SA887 Wound care SA887 A6025 Silicone gel sheet, each

SA887 Wound care SA887 A6154 Wound pouch each

SA887 Wound care SA887 A6196 Alginate dressing <=16 sq in

SA887 Wound care SA887 A6197 Alginate drsg >16 <=48 sq in

SA887 Wound care SA887 A6198 alginate dressing > 48 sq in

SA887 Wound care SA887 A6199 Alginate drsg wound filler

SA887 Wound care SA887 A6203 Composite drsg <= 16 sq in

SA887 Wound care SA887 A6204 Composite drsg >16<=48 sq in

SA887 Wound care SA887 A6205 Composite drsg > 48 sq in

SA887 Wound care SA887 A6206 Contact layer <= 16 sq in

SA887 Wound care SA887 A6207 Contact layer >16<= 48 sq in

SA887 Wound care SA887 A6208 Contact layer > 48 sq in

SA887 Wound care SA887 A6209 Foam drsg <=16 sq in w/o bdr

SA887 Wound care SA887 A6210 Foam drg >16<=48 sq in w/o b

SA887 Wound care SA887 A6211 Foam drg > 48 sq in w/o brdr

SA887 Wound care SA887 A6212 Foam drg <=16 sq in w/border

SA887 Wound care SA887 A6213 Foam drg >16<=48 sq in w/bdr

SA887 Wound care SA887 A6214 Foam drg > 48 sq in w/border

SA887 Wound care SA887 A6215 Foam dressing wound filler

SA887 Wound care SA887 A6216 Non-sterile gauze<=16 sq in

SA887 Wound care SA887 A6217 Non-sterile gauze>16<=48 sq

SA887 Wound care SA887 A6218 Non-sterile gauze > 48 sq in

SA887 Wound care SA887 A6219 Gauze <= 16 sq in w/border

SA887 Wound care SA887 A6220 Gauze >16 <=48 sq in w/bordr

25



SA887 Wound care SA887 A6221 Gauze > 48 sq in w/border

SA887 Wound care SA887 A6222 Gauze <=16 in no w/sal w/o b

SA887 Wound care SA887 A6223 Gauze >16<=48 no w/sal w/o b

SA887 Wound care SA887 A6224 Gauze > 48 in no w/sal w/o b

SA887 Wound care SA887 A6228 Gauze <= 16 sq in water/sal

SA887 Wound care SA887 A6229 Gauze >16<=48 sq in watr/sal

SA887 Wound care SA887 A6230 Gauze > 48 sq in water/salne

SA887 Wound care SA887 A6231 Hydrogel dsg<=16 sq in

SA887 Wound care SA887 A6232 Hydrogel dsg>16<=48 sq in

SA887 Wound care SA887 A6233 Hydrogel dressing >48 sq in

SA887 Wound care SA887 A6234 Hydrocolld drg <=16 w/o bdr

SA887 Wound care SA887 A6235 Hydrocolld drg >16<=48 w/o b

SA887 Wound care SA887 A6236 Hydrocolld drg > 48 in w/o b

SA887 Wound care SA887 A6237 Hydrocolld drg <=16 in w/bdr

SA887 Wound care SA887 A6238 Hydrocolld drg >16<=48 w/bdr

SA887 Wound care SA887 A6239 Hydrocolld drg > 48 in w/bdr

SA887 Wound care SA887 A6240 Hydrocolld drg filler paste

SA887 Wound care SA887 A6241 Hydrocolloid drg filler dry

SA887 Wound care SA887 A6242 Hydrogel drg <=16 in w/o bdr

SA887 Wound care SA887 A6243 Hydrogel drg >16<=48 w/o bdr

SA887 Wound care SA887 A6244 Hydrogel drg >48 in w/o bdr

SA887 Wound care SA887 A6245 Hydrogel drg <= 16 in w/bdr

SA887 Wound care SA887 A6246 Hydrogel drg >16<=48 in w/b

SA887 Wound care SA887 A6247 Hydrogel drg > 48 sq in w/b

SA887 Wound care SA887 A6248 Hydrogel drsg gel filler

SA887 Wound care SA887 A6250 Skin seal protect moisturizr

SA887 Wound care SA887 A6251 Absorpt drg <=16 sq in w/o b

SA887 Wound care SA887 A6252 Absorpt drg >16 <=48 w/o bdr

SA887 Wound care SA887 A6253 Absorpt drg > 48 sq in w/o b

SA887 Wound care SA887 A6254 Absorpt drg <=16 sq in w/bdr

SA887 Wound care SA887 A6255 Absorpt drg >16<=48 in w/bdr

SA887 Wound care SA887 A6256 Absorpt drg > 48 sq in w/bdr

SA887 Wound care SA887 A6257 Transparent film <= 16 sq in

SA887 Wound care SA887 A6258 Transparent film >16<=48 in

SA887 Wound care SA887 A6259 Transparent film > 48 sq in

SA887 Wound care SA887 A6260 Wound cleanser any type/size

SA887 Wound care SA887 A6261 Wound filler gel/paste /oz

SA887 Wound care SA887 A6262 Wound filler dry form / gram

SA887 Wound care SA887 A6266 Impreg gauze no h20/sal/yard

SA887 Wound care SA887 A6402 Sterile gauze <= 16 sq in

SA887 Wound care SA887 A6403 Sterile gauze>16 <= 48 sq in

SA887 Wound care SA887 A6404 Sterile gauze > 48 sq in

SA887 Wound care SA887 A6407 Packing strips, non-impreg

SA887 Wound care SA887 A6410 Sterile eye pad

SA887 Wound care SA887 A6411 Non-sterile eye pad

SA887 Wound care SA887 A6412 Occlusive eye patch

SA887 Wound care SA887 A6441 Pad band w>=3" <5"/yd

SA887 Wound care SA887 A6442 Conform band n/s w<3"/yd

SA887 Wound care SA887 A6443 Conform band n/s w>=3"<5"/yd

SA887 Wound care SA887 A6444 Conform band n/s w>=5"/yd

SA887 Wound care SA887 A6445 Conform band s w <3"/yd

SA887 Wound care SA887 A6446 Conform band s w>=3" <5"/yd

SA887 Wound care SA887 A6447 Conform band s w >=5"/yd

SA887 Wound care SA887 A6448 Lt compres band <3"/yd

SA887 Wound care SA887 A6449 Lt compres band >=3" <5"/yd

SA887 Wound care SA887 A6450 Lt compres band >=5"/yd

SA887 Wound care SA887 A6451 Mod compres band w>=3"<5"/yd

SA887 Wound care SA887 A6452 High compres band w>=3"<5"yd

SA887 Wound care SA887 A6453 Self-adher band w <3"/yd

SA887 Wound care SA887 A6454 Self-adher band w>=3" <5"/yd

SA887 Wound care SA887 A6455 Self-adher band >=5"/yd

SA887 Wound care SA887 A6456 Zinc paste band w >=3"<5"/yd

SA887 Wound care SA887 A6457 Tubular dressing

SA887 Wound care SA887 A6501 Compres burngarment bodysuit

25



SA887 Wound care SA887 A6502 Compres burngarment chinstrp

SA887 Wound care SA887 A6503 Compres burngarment facehood

SA887 Wound care SA887 A6504 Cmprsburngarment glove-wrist

SA887 Wound care SA887 A6505 Cmprsburngarment glove-elbow

SA887 Wound care SA887 A6506 Cmprsburngrmnt glove-axilla

SA887 Wound care SA887 A6507 Cmprs burngarment foot-knee

SA887 Wound care SA887 A6508 Cmprs burngarment foot-thigh

SA887 Wound care SA887 A6509 Compres burn garment jacket

SA887 Wound care SA887 A6510 Compres burn garment leotard

SA887 Wound care SA887 A6511 Compres burn garment panty

SA887 Wound care SA887 A6512 Compres burn garment, noc

SA887 Wound care SA887 A6513 Compress burn mask face/neck

SA887 Wound care SA887 A6549 G compression stocking

SA887 Wound care SA887 A6550 Neg pres wound ther drsg set

SA893 Hearing Hardware L7510 Prosthetic device repair rep

SA893 Hearing Hardware L8615 Coch implant headset replace

SA893 Hearing Hardware L8616 Coch implant microphone repl

SA893 Hearing Hardware L8617 Coch implant trans coil repl

SA893 Hearing Hardware L8618 Coch implant tran cable repl

SA893 Hearing Hardware L8619 Coch imp ext proc/contr rplc

SA893 Hearing Hardware L8621 Repl zinc air battery

SA893 Hearing Hardware L8622 Repl alkaline battery

SA893 Hearing Hardware L8623 Lith ion batt CID,non-earlvl

SA893 Hearing Hardware L8624 Lith ion batt CID, ear level

SA893 Hearing Hardware L8627 CID ext speech process repl

SA893 Hearing Hardware L8628 CID ext controller repl

SA893 Hearing Hardware L8629 CID transmit coil and cable

SA893 Hearing Hardware L8691 Osseointegrated snd proc rpl

SA893 Hearing Hardware L8692 Non-osseointegrated snd proc

SA893 Hearing Hardware L8693 AUD OSSEO DEV, ABUTMENT

SA893 Hearing Hardware L9900 O&P supply/accessory/service

25

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