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E2626 |
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Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable
| short | Seo mobile arm sup att to wc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2627 |
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Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type
| short | Arm supp att to wc rancho ty |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2628 |
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Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining
| short | Mobile arm supports reclinin |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2629 |
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Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)
| short | Friction dampening arm supp |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2630 |
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Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support
| short | Monosuspension arm/hand supp |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2631 |
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Wheelchair accessory, addition to mobile arm support, elevating proximal arm
| short | Elevat proximal arm support |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2632 |
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Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control
| short | Offset/lat rocker arm w/ela |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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E2633 |
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Wheelchair accessory, addition to mobile arm support, supinator
| short | Mobile arm support supinator |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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