{ "dataset": "VerifiedCareData — Medicare DME Coverage & Recall Data", "license": "CC-BY-4.0", "attribution": "https://verifiedcaredata.com", "source": "https://verifiedcaredata.com", "generated": "2026-07-27", "methodology": "https://verifiedcaredata.com/methodology/", "note": "Medicare durable-medical-equipment coverage and safety-recall data for surgery-recovery equipment (canes, crutches, walkers, commodes, bath/toilet safety items, hospital beds and rails, patient lift slings, seat lift mechanisms, manual wheelchairs). No affiliate parameters, tracking tags, or buy links appear anywhere in this endpoint — those exist only on the human-rendered pages at verifiedcaredata.com.", "coverage": { "source_dataset": "CMS HCPCS Level II quarterly file (July 2026 release) + CMS DMEPOS Fee Schedule (July 2026, DME26-C) + CMS DMEPOS utilization by Geography/Service (DY2024, live data.cms.gov) + CMS Medicare Coverage Database DME MAC Policy Articles", "target_code_count": 68, "fee_range_methodology": "min/max across all state '(NR)' [non-rural] purchase (modifier NU) fee columns in the DMEPOS fee schedule; national Ceiling/Floor columns are 0.00 for DME categories and are not usable.", "utilization_lag_disclosure": "DY2024 is the most recent CMS-published utilization year as of this July 2026 dataset — roughly an 18-month publication lag behind the current date.", "count": 68, "codes": [ { "hcpcs": "E0100", "description": "Cane, includes canes of all materials, adjustable or fixed, with tip", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 25.53, "fee_ceiling_national_nr": 48.89, "fee_schedule_modifier": "NU", "dy2024_services": 27202, "dy2024_beneficiaries": 27043, "dy2024_est_total_medicare_payment": 539915.93, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0105", "description": "Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 59.5, "fee_ceiling_national_nr": 86.55, "fee_schedule_modifier": "NU", "dy2024_services": 16190, "dy2024_beneficiaries": 15802, "dy2024_est_total_medicare_payment": 726544.95, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0110", "description": "Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 93.99, "fee_ceiling_national_nr": 141.62, "fee_schedule_modifier": "NU", "dy2024_services": 1179, "dy2024_beneficiaries": 1156, "dy2024_est_total_medicare_payment": 85254.76, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0111", "description": "Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 64.5, "fee_ceiling_national_nr": 80.49, "fee_schedule_modifier": "NU", "dy2024_services": 96, "dy2024_beneficiaries": 65, "dy2024_est_total_medicare_payment": 4582.66, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0112", "description": "Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 44.83, "fee_ceiling_national_nr": 63.92, "fee_schedule_modifier": "NU", "dy2024_services": 21, "dy2024_beneficiaries": 21, "dy2024_est_total_medicare_payment": 684.33, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0113", "description": "Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 25.61, "fee_ceiling_national_nr": 55.77, "fee_schedule_modifier": "NU", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0114", "description": "Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 57.17, "fee_ceiling_national_nr": 88.73, "fee_schedule_modifier": "NU", "dy2024_services": 44541, "dy2024_beneficiaries": 44428, "dy2024_est_total_medicare_payment": 1944667.22, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0116", "description": "Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 33.62, "fee_ceiling_national_nr": 44.38, "fee_schedule_modifier": "NU", "dy2024_services": 115, "dy2024_beneficiaries": 93, "dy2024_est_total_medicare_payment": 2818.26, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": null }, { "hcpcs": "E0117", "description": "Crutch, underarm, articulating, spring assisted, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 27.45, "fee_ceiling_national_nr": 32.96, "fee_schedule_modifier": "RR", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": "Code E0117 describes an articulating crutch which has two crutch legs connected by a bar between them which helps propel the beneficiary forward." }, { "hcpcs": "E0118", "description": "Crutch substitute, lower leg platform, with or without wheels, each", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Canes and Crutches - Policy Article (A52459), LCD L33733", "policy_note": "Code E0118 describes a crutch substitute which can be either a device strapped to the lower leg with a platform or a device with wheels and a platform the beneficiary propels with their sound limb." }, { "hcpcs": "E0130", "description": "Walker, rigid (pickup), adjustable or fixed height", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 53.5, "fee_ceiling_national_nr": 86.89, "fee_schedule_modifier": "NU", "dy2024_services": 235, "dy2024_beneficiaries": 218, "dy2024_est_total_medicare_payment": 9425.04, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0135", "description": "Walker, folding (pickup), adjustable or fixed height", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 53.5, "fee_ceiling_national_nr": 105.44, "fee_schedule_modifier": "NU", "dy2024_services": 15241, "dy2024_beneficiaries": 14819, "dy2024_est_total_medicare_payment": 653414.24, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0140", "description": "Walker, with trunk support, adjustable or fixed height, any type", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 31.98, "fee_ceiling_national_nr": 45.71, "fee_schedule_modifier": "RR", "dy2024_services": 15834, "dy2024_beneficiaries": 2598, "dy2024_est_total_medicare_payment": 291580.92, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": null }, { "hcpcs": "E0141", "description": "Walker, rigid, wheeled, adjustable or fixed height", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 55.55, "fee_ceiling_national_nr": 122.01, "fee_schedule_modifier": "NU", "dy2024_services": 8030, "dy2024_beneficiaries": 7722, "dy2024_est_total_medicare_payment": 486712.47, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "A wheeled walker (E0141, E0143, E0149) is one with either 2, 3, or 4 wheels. It may be fixed height or adjustable height. It may or may not include glide-type brakes (or equivalent). The wheels may be fixed or swivel." }, { "hcpcs": "E0143", "description": "Walker, folding, wheeled, adjustable or fixed height", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 55.55, "fee_ceiling_national_nr": 125.91, "fee_schedule_modifier": "NU", "dy2024_services": 508460, "dy2024_beneficiaries": 496596, "dy2024_est_total_medicare_payment": 24064634.86, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "A wheeled walker (E0141, E0143, E0149) is one with either 2, 3, or 4 wheels. It may be fixed height or adjustable height. It may or may not include glide-type brakes (or equivalent). The wheels may be fixed or swivel." }, { "hcpcs": "E0144", "description": "Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 34.36, "fee_ceiling_national_nr": 40.66, "fee_schedule_modifier": "RR", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Code E0144 describes a rigid or folding wheeled walker which has a frame that completely surrounds the beneficiary and an attached seat in the back." }, { "hcpcs": "E0147", "description": "Walker, heavy duty, multiple braking system, variable wheel resistance", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 485.8, "fee_ceiling_national_nr": 704.04, "fee_schedule_modifier": "NU", "dy2024_services": 1885, "dy2024_beneficiaries": 1704, "dy2024_est_total_medicare_payment": 643943.03, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "When code E0147 is billed, the claim must include the manufacturer’s name and product name/number." }, { "hcpcs": "E0148", "description": "Walker, heavy duty, without wheels, rigid or folding, any type, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 97.28, "fee_ceiling_national_nr": 150.1, "fee_schedule_modifier": "NU", "dy2024_services": 2149, "dy2024_beneficiaries": 1526, "dy2024_est_total_medicare_payment": 114352.98, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "If a heavy duty walker (E0148, E0149) is provided and if the supplier has documentation in their records that the beneficiary's weight (within one month of providing the walker) is greater than 300 pounds, the KX modifier should be added to the code." }, { "hcpcs": "E0149", "description": "Walker, heavy duty, wheeled, rigid or folding, any type", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 12.3, "fee_ceiling_national_nr": 24.46, "fee_schedule_modifier": "RR", "dy2024_services": 71219, "dy2024_beneficiaries": 12479, "dy2024_est_total_medicare_payment": 650002.38, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "If a heavy duty walker (E0148, E0149) is provided and if the supplier has documentation in their records that the beneficiary's weight (within one month of providing the walker) is greater than 300 pounds, the KX modifier should be added to the code." }, { "hcpcs": "E0154", "description": "Platform attachment, walker, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 56.73, "fee_ceiling_national_nr": 100.28, "fee_schedule_modifier": "NU", "dy2024_services": 8306, "dy2024_beneficiaries": 6179, "dy2024_est_total_medicare_payment": 342861.5, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0155", "description": "Wheel attachment, rigid pick-up walker, per pair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 24.46, "fee_ceiling_national_nr": 43.61, "fee_schedule_modifier": "NU", "dy2024_services": 2042, "dy2024_beneficiaries": 1943, "dy2024_est_total_medicare_payment": 35992.57, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0156", "description": "Seat attachment, walker", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 18.52, "fee_ceiling_national_nr": 87.45, "fee_schedule_modifier": "NU", "dy2024_services": 146461, "dy2024_beneficiaries": 141311, "dy2024_est_total_medicare_payment": 2097043.71, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0157", "description": "Crutch attachment, walker, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 61.44, "fee_ceiling_national_nr": 84.96, "fee_schedule_modifier": "NU", "dy2024_services": 34, "dy2024_beneficiaries": 24, "dy2024_est_total_medicare_payment": 1596.04, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0158", "description": "Leg extensions for walker, per set of four (4)", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 25.09, "fee_ceiling_national_nr": 39.29, "fee_schedule_modifier": "NU", "dy2024_services": 1081, "dy2024_beneficiaries": 1029, "dy2024_est_total_medicare_payment": 19980.5, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0159", "description": "Brake attachment for wheeled walker, replacement, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 16.72, "fee_ceiling_national_nr": 22.09, "fee_schedule_modifier": "NU", "dy2024_services": 3556, "dy2024_beneficiaries": 2098, "dy2024_est_total_medicare_payment": 43752.95, "policy_citation": "Walkers - Policy Article (A52503), LCD L33791", "policy_note": "Codes A4636, A4637, and E0159 are only used to bill for replacement items for covered, beneficiary-owned walkers. Codes E0154, E0156, E0157, and E0158 can be used for accessories provided with the initial issue of a walker or for replacement components. Code E0155 can be used for replacements on covered, beneficiary-owned wheeled walkers or when wheels are subsequently added to a covered, beneficiary-owned nonwheeled walker (E0130, E0135). Code E0155 cannot be used for wheels provided at the time of, or within one month of, the initial issue of a non-wheeled walker." }, { "hcpcs": "E0163", "description": "Commode chair, mobile or stationary, with fixed arms", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 60.15, "fee_ceiling_national_nr": 139.61, "fee_schedule_modifier": "NU", "dy2024_services": 139220, "dy2024_beneficiaries": 135659, "dy2024_est_total_medicare_payment": 7078214.16, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "For commodes (E0163, E0165, E0168, E0170, and E0171) used as a raised toilet seat by positioning it over the toilet, the GY modifier must be added to the code, and the KX, GA, or GZ modifier must not be used." }, { "hcpcs": "E0165", "description": "Commode chair, mobile or stationary, with detachable arms", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 13.91, "fee_ceiling_national_nr": 27.01, "fee_schedule_modifier": "RR", "dy2024_services": 74923, "dy2024_beneficiaries": 14296, "dy2024_est_total_medicare_payment": 678107.03, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "For commodes (E0163, E0165, E0168, E0170, and E0171) used as a raised toilet seat by positioning it over the toilet, the GY modifier must be added to the code, and the KX, GA, or GZ modifier must not be used." }, { "hcpcs": "E0167", "description": "Pail or pan for use with commode chair, replacement only", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 12.56, "fee_ceiling_national_nr": 17.35, "fee_schedule_modifier": "NU", "dy2024_services": 42, "dy2024_beneficiaries": 42, "dy2024_est_total_medicare_payment": 391.19, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": null }, { "hcpcs": "E0168", "description": "Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 137.84, "fee_ceiling_national_nr": 208.99, "fee_schedule_modifier": "NU", "dy2024_services": 8491, "dy2024_beneficiaries": 4486, "dy2024_est_total_medicare_payment": 431227.27, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "For commodes (E0163, E0165, E0168, E0170, and E0171) used as a raised toilet seat by positioning it over the toilet, the GY modifier must be added to the code, and the KX, GA, or GZ modifier must not be used." }, { "hcpcs": "E0170", "description": "Commode chair with integrated seat lift mechanism, electric, any type", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 195.98, "fee_ceiling_national_nr": 251.67, "fee_schedule_modifier": "RR", "dy2024_services": 1507, "dy2024_beneficiaries": 316, "dy2024_est_total_medicare_payment": 176822.78, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "For commodes (E0163, E0165, E0168, E0170, and E0171) used as a raised toilet seat by positioning it over the toilet, the GY modifier must be added to the code, and the KX, GA, or GZ modifier must not be used." }, { "hcpcs": "E0171", "description": "Commode chair with integrated seat lift mechanism, non-electric, any type", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 36.34, "fee_ceiling_national_nr": 45.67, "fee_schedule_modifier": "RR", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "For commodes (E0163, E0165, E0168, E0170, and E0171) used as a raised toilet seat by positioning it over the toilet, the GY modifier must be added to the code, and the KX, GA, or GZ modifier must not be used." }, { "hcpcs": "E0172", "description": "Seat lift mechanism placed over or on top of toilet, any type", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "Toilet seat lift mechanisms (E0172) are not primarily medical in nature; therefore do not meet the statutory definition of durable medical equipment. They are non-covered." }, { "hcpcs": "E0175", "description": "Foot rest, for use with commode chair, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 77.38, "fee_ceiling_national_nr": 99.45, "fee_schedule_modifier": "NU", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "A footrest (E0175) is non-covered because it is not medical in nature." }, { "hcpcs": "E0240", "description": "Bath/shower chair, with or without wheels, any size", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0241", "description": "Bath tub wall rail, each", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0242", "description": "Bath tub rail, floor base", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0243", "description": "Toilet rail, each", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0244", "description": "Raised toilet seat", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Commodes - Policy Article (A52461), LCD L33736", "policy_note": "A raised toilet seat (E0244) is noncovered; therefore, a commode chair that is used as a raised toilet seat by positioning it over the toilet is also noncovered. When a commode chair is provided for use in this manner, the GY modifier must be added to the code for the commode chair and the KX modifier must not be used." }, { "hcpcs": "E0245", "description": "Tub stool or bench", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0246", "description": "Transfer tub rail attachment", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0247", "description": "Transfer bench for tub or toilet with or without commode opening", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0248", "description": "Transfer bench, heavy duty, for tub or toilet with or without commode opening", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "No DME MAC LCD/Policy Article -- excluded from DME benefit category", "policy_note": "Analogous to E0244 (see Commodes Policy Article A52461): items in this HCPCS range are not primarily medical in nature and therefore do not meet the statutory definition of Durable Medical Equipment (Social Security Act section 1861(s)(6)); consistently absent from the DMEPOS fee schedule." }, { "hcpcs": "E0250", "description": "Hospital bed, fixed height, with any type side rails, with mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 72.8, "fee_ceiling_national_nr": 122.46, "fee_schedule_modifier": "RR", "dy2024_services": 16861, "dy2024_beneficiaries": 3523, "dy2024_est_total_medicare_payment": 800320.42, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0251, bill as E0250" }, { "hcpcs": "E0251", "description": "Hospital bed, fixed height, with any type side rails, without mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 67.51, "fee_ceiling_national_nr": 100.46, "fee_schedule_modifier": "RR", "dy2024_services": 959, "dy2024_beneficiaries": 192, "dy2024_est_total_medicare_payment": 37812.19, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0251, bill as E0250" }, { "hcpcs": "E0255", "description": "Hospital bed, variable height, hi-lo, with any type side rails, with mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 72.8, "fee_ceiling_national_nr": 144.83, "fee_schedule_modifier": "RR", "dy2024_services": 13347, "dy2024_beneficiaries": 2752, "dy2024_est_total_medicare_payment": 649479.47, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0292, bill as E0255" }, { "hcpcs": "E0256", "description": "Hospital bed, variable height, hi-lo, with any type side rails, without mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 71.35, "fee_ceiling_national_nr": 117.4, "fee_schedule_modifier": "RR", "dy2024_services": 735, "dy2024_beneficiaries": 155, "dy2024_est_total_medicare_payment": 31089.45, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0293, bill as E0256" }, { "hcpcs": "E0260", "description": "Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 72.8, "fee_ceiling_national_nr": 128.14, "fee_schedule_modifier": "RR", "dy2024_services": 758660, "dy2024_beneficiaries": 162264, "dy2024_est_total_medicare_payment": 37429249.2, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0294, bill as E0260" }, { "hcpcs": "E0261", "description": "Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 72.8, "fee_ceiling_national_nr": 161.23, "fee_schedule_modifier": "RR", "dy2024_services": 122881, "dy2024_beneficiaries": 25848, "dy2024_est_total_medicare_payment": 5939865.37, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0295, bill as E0261" }, { "hcpcs": "E0265", "description": "Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 184.01, "fee_ceiling_national_nr": 267.38, "fee_schedule_modifier": "RR", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0266, bill as E0265" }, { "hcpcs": "E0266", "description": "Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 160.11, "fee_ceiling_national_nr": 235.83, "fee_schedule_modifier": "RR", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "When combined with E0266, bill as E0265" }, { "hcpcs": "E0303", "description": "Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 189.35, "fee_ceiling_national_nr": 330.83, "fee_schedule_modifier": "RR", "dy2024_services": 15297, "dy2024_beneficiaries": 3031, "dy2024_est_total_medicare_payment": 1977986.25, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "E0301 and E0303 are hospital beds that are capable of supporting a beneficiary who weighs more than 350 pounds, but no more than 600 pounds." }, { "hcpcs": "E0304", "description": "Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 573.26, "fee_ceiling_national_nr": 898.22, "fee_schedule_modifier": "RR", "dy2024_services": 420, "dy2024_beneficiaries": 83, "dy2024_est_total_medicare_payment": 162748.58, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "E0302 and E0304 are hospital beds that are capable of supporting a beneficiary who weighs more than 600 pounds." }, { "hcpcs": "E0305", "description": "Bed side rails, half length", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 12.31, "fee_ceiling_national_nr": 22.32, "fee_schedule_modifier": "RR", "dy2024_services": 18334, "dy2024_beneficiaries": 3281, "dy2024_est_total_medicare_payment": 140289.05, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "E0271, E0272, E0305, E0310" }, { "hcpcs": "E0310", "description": "Bed side rails, full length", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 129.76, "fee_ceiling_national_nr": 203.16, "fee_schedule_modifier": "NU", "dy2024_services": 2487, "dy2024_beneficiaries": 2062, "dy2024_est_total_medicare_payment": 188709.72, "policy_citation": "Hospital Beds And Accessories - Policy Article (A52508), LCD L33820", "policy_note": "E0271, E0272, E0305, E0310" }, { "hcpcs": "E0621", "description": "Sling or seat, patient lift, canvas or nylon", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 95.7, "fee_ceiling_national_nr": 129.94, "fee_schedule_modifier": "NU", "dy2024_services": 913, "dy2024_beneficiaries": 568, "dy2024_est_total_medicare_payment": 35876.45, "policy_citation": "Patient Lifts - Policy Article (A52516), LCD L33799", "policy_note": null }, { "hcpcs": "E0627", "description": "Seat lift mechanism, electric, any type", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 288.47, "fee_ceiling_national_nr": 476.06, "fee_schedule_modifier": "NU", "dy2024_services": 2391, "dy2024_beneficiaries": 2316, "dy2024_est_total_medicare_payment": 585521.88, "policy_citation": "Seat Lift Mechanisms - Policy Article (A52518), LCD L33801", "policy_note": "A seat lift mechanism that is electrically operated is billed using HCPCS code E0627." }, { "hcpcs": "E0629", "description": "Seat lift mechanism, non-electric, any type", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 288.47, "fee_ceiling_national_nr": 476.06, "fee_schedule_modifier": "NU", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Seat Lift Mechanisms - Policy Article (A52518), LCD L33801", "policy_note": "A manually operated seat lift mechanism is billed using HCPCS code E0629." }, { "hcpcs": "E0951", "description": "Heel loop/holder, any type, with or without ankle strap, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 14.88, "fee_ceiling_national_nr": 42.44, "fee_schedule_modifier": "NU", "dy2024_services": 138099, "dy2024_beneficiaries": 53893, "dy2024_est_total_medicare_payment": 1374065.79, "policy_citation": null, "policy_note": null }, { "hcpcs": "E0952", "description": "Toe loop/holder, any type, each", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 19.67, "fee_ceiling_national_nr": 35.63, "fee_schedule_modifier": "NU", "dy2024_services": 3558, "dy2024_beneficiaries": 1784, "dy2024_est_total_medicare_payment": 55953.65, "policy_citation": null, "policy_note": null }, { "hcpcs": "K0001", "description": "Standard wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 25.23, "fee_ceiling_national_nr": 53.63, "fee_schedule_modifier": "RR", "dy2024_services": 1305390, "dy2024_beneficiaries": 253698, "dy2024_est_total_medicare_payment": 24581789.98, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "If documentation of the medical necessity for a transport chair (E1037, E1038 and E1039) is requested, it must include a description of why the beneficiary is unable to make use of a standard manual wheelchair (K0001, K0002, K0003, K0004, and K0005) on their own, and provide specific information that the beneficiary has a caregiver who is available, willing, and able to provide assistance with the wheelchair." }, { "hcpcs": "K0002", "description": "Standard hemi (low seat) wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 38.93, "fee_ceiling_national_nr": 101.05, "fee_schedule_modifier": "RR", "dy2024_services": 69565, "dy2024_beneficiaries": 12924, "dy2024_est_total_medicare_payment": 2147958.16, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "If documentation of the medical necessity for a transport chair (E1037, E1038 and E1039) is requested, it must include a description of why the beneficiary is unable to make use of a standard manual wheelchair (K0001, K0002, K0003, K0004, and K0005) on their own, and provide specific information that the beneficiary has a caregiver who is available, willing, and able to provide assistance with the wheelchair." }, { "hcpcs": "K0003", "description": "Lightweight wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 36.91, "fee_ceiling_national_nr": 115.29, "fee_schedule_modifier": "RR", "dy2024_services": 471617, "dy2024_beneficiaries": 89774, "dy2024_est_total_medicare_payment": 13079796.32, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "If documentation of the medical necessity for a transport chair (E1037, E1038 and E1039) is requested, it must include a description of why the beneficiary is unable to make use of a standard manual wheelchair (K0001, K0002, K0003, K0004, and K0005) on their own, and provide specific information that the beneficiary has a caregiver who is available, willing, and able to provide assistance with the wheelchair." }, { "hcpcs": "K0004", "description": "High strength, lightweight wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 48.55, "fee_ceiling_national_nr": 163.93, "fee_schedule_modifier": "RR", "dy2024_services": 47898, "dy2024_beneficiaries": 8900, "dy2024_est_total_medicare_payment": 1811704.86, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "If documentation of the medical necessity for a K0005 wheelchair is requested, it must include a description of the beneficiary's routine activities. This may include the types of activities the beneficiary frequently encounters and whether the beneficiary is fully independent in the use of the wheelchair. Describe the features of the K0005 base which are needed compared to the K0004 base." }, { "hcpcs": "K0005", "description": "Ultralightweight wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 2590.67, "fee_ceiling_national_nr": 2797.9, "fee_schedule_modifier": "NU", "dy2024_services": 21620, "dy2024_beneficiaries": 21151, "dy2024_est_total_medicare_payment": 40854858.57, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "If documentation of the medical necessity for a K0005 wheelchair is requested, it must include a description of the beneficiary's routine activities. This may include the types of activities the beneficiary frequently encounters and whether the beneficiary is fully independent in the use of the wheelchair. Describe the features of the K0005 base which are needed compared to the K0004 base." }, { "hcpcs": "K0006", "description": "Heavy duty wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 68.77, "fee_ceiling_national_nr": 169.03, "fee_schedule_modifier": "RR", "dy2024_services": 66273, "dy2024_beneficiaries": 12685, "dy2024_est_total_medicare_payment": 3364491.76, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "Manual Wheelchair Bases (E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009)" }, { "hcpcs": "K0007", "description": "Extra heavy duty wheelchair", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 96.4, "fee_ceiling_national_nr": 211.59, "fee_schedule_modifier": "RR", "dy2024_services": 42671, "dy2024_beneficiaries": 8160, "dy2024_est_total_medicare_payment": 3146790.79, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "Manual Wheelchair Bases (E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009)" }, { "hcpcs": "K0008", "description": "Custom manual wheelchair/base", "covered": false, "evidence": "absent_zero_claims", "fee_floor_national_nr": null, "fee_ceiling_national_nr": null, "fee_schedule_modifier": null, "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "A custom manual wheelchair base (K0008) must be uniquely constructed or substantially modified for a specific beneficiary according to the description and orders of the beneficiary's treating practitioner. The beneficiary's needs cannot be accommodated by any other existing manual wheelchair and accessories, including customized seating arrangements. See 42 CFR Section 414.224, and Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 20, Section 30.3 for more information on customized DME." }, { "hcpcs": "K0009", "description": "Other manual wheelchair/base", "covered": true, "evidence": "fee_schedule", "fee_floor_national_nr": 101.86, "fee_ceiling_national_nr": 122.26, "fee_schedule_modifier": "RR", "dy2024_services": 0, "dy2024_beneficiaries": 0, "dy2024_est_total_medicare_payment": 0, "policy_citation": "Manual Wheelchair Bases - Policy Article (A52497)", "policy_note": "Manual Wheelchair Bases (E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009)" } ] }, "recalls_summary": { "sources": [ "CPSC SaferProducts.gov Recall API (ProductName search)", "openFDA device/recall.json (phrase-quoted product_description search)", "openFDA device/enforcement.json (phrase-quoted product_description search)" ], "cpsc_search_terms": [ "bed rail", "adult portable bed rail", "portable bed rail", "walker", "rollator", "shower chair", "lift chair", "commode", "patient lift" ], "openfda_search_terms": [ "walker", "rollator", "commode", "shower chair", "bed rail", "patient lift", "lift chair" ], "total_records": 191, "by_source": { "CPSC": 81, "FDA_recall": 69, "FDA_enforcement": 41 }, "deaths_mentioned_methodology": "CPSC only. Regex-parsed from the free-text Injuries[].Name narrative field (CPSC API has no structured death-count field). 'None reported'/'no injuries' -> 0. FDA records have deaths_mentioned=null (openFDA recall/enforcement records are firm corrective actions, not injury reports; no comparable narrative field)." } }