Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1630 Date: NOVEMBER 7, 2008

Transcription

1 anual ystem Pub edicare laims Processing Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 1630 Date: NOVEBE 7, 2008 hange equest 6270 ubject: Fee chedule Update for 2009 for Durable edical Equipment, Prosthetics, Orthotics and upplies. UY OF HNGE: This recurring update notification provides specific instructions regarding the 2009 annual update for the DEPO fee schedule. The initial release of this N can be found in chapter 23, section 60 of the edicare laims Processing nternet-only anual. New / evised aterial Effective Date: January 1, 2009 mplementation Date: January 5, 2009 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. HNGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED-Only One Per ow. /N/D hapter / ection / ubsection / Title 23/60/Durable edical Equipment Prosthetics, Orthotics and upplies (DEPO) Fee chedule 23/60.2/Quarterly Update chedule for DEPO Fee chedule 23/60.3/Gap-filling DEPO Fees 23/60.4/Process for ubmitting evisions to DEPO Fee chedule to. FUNDNG: ETON : For Fiscal ntermediaries and arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. ETON B: For edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question

2 and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTHENT: anual nstruction ecurring Update Notification *Unless otherwise specified, the effective date is the date of service.

3 ttachment ecurring Update Notification Pub Transmittal: 1630 Date: November 7, 2008 hange equest: 6270 UBJET: Fee chedule Update for 2009 for Durable edical Equipment, Prosthetics, Orthotics and upplies Effective Date: January 1, 2009 mplementation Date: January 5, GENEL NFOTON. Background: The DEPO fee schedules are updated on an annual basis in accordance with statute and regulations. The update process for the DEPO fee schedule is located in 60, hapter 23 of the edicare laims Processing anual (Pub ). B. Policy: This recurring update notification provides specific instructions regarding the 2009 annual update for the DEPO fee schedule. Payment on a fee schedule basis is required for durable medical equipment (DE), prosthetic devices, orthotics, prosthetics, and surgical dressings by 1834(a), (h), and (i) of the ocial ecurity ct. Payment on a fee schedule basis is required for parenteral and enteral nutrition (PEN) by regulations contained at 42 F The Division of Data ystems (DD) is scheduled to electronically release the 2009 DEPO Fee chedule file (filename: U00.@BF12393.DEPO.T V1107) to the Pricing, Data nalysis and oding (PD) ontractor, DE s, /B s, and local Part B carriers via s mainframe telecommunication system on November 7, The DD is scheduled to release a separate 2009 DEPO Fee chedule file (filename: U00.@BF12393.DEPO.T V1114.F) to the /B s, intermediaries, regional home health intermediaries, ailroad etirement Board (B), ndian Health ervice, and United ine Workers on November 14, The fee schedule file is scheduled to be available through the homepage by November 14, 2008, for interested parties like the tate edicaid gencies and managed care organizations. The 2009 fee schedule for PEN is scheduled to be released to the PD and DE s in a separate file (filename: U00.@BF12393.PEN.Y09.V1107) on November 7, The following codes are being deleted from the HP effective January 1, 2009, and are therefore being removed from the DEPO fee schedule files: L5993 L5994 L5995 L7611 L7612 L7613 L7614 L7621 L7622 For new codes added to the HP on January 1, 2009, DEPO fee schedule amounts will be established as part of the July 2009 DEPO Fee chedule Update, when applicable. The DE s shall establish local fee schedule amounts to pay claims for the new codes from January 1, 2009 through June 30, Please note that the HP codes listed as new codes in this are not yet final and are subject to change. The new codes are not to be used for billing purposes until they are effective on January 1, 2009.

4 For gap-filling purposes, the 2008 deflation factors by payment category are: for Oxygen, for apped ental, for Prosthetics and Orthotics, for urgical Dressings, and for Parental and Enteral Nutrition. The fee schedule amounts for HP code K0672 (ddition to Lower Extremity Orthosis, emovable oft nterface, ll omponents, eplacement Only, Each) are added to the fee schedule file on January 1, 2009, and are effective for claims submitted with dates of service on or after January 1, HP code E2295 (anual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features) was added to the HP file on January 1, Due to the expected low volume of edicare claims, will not be establishing fee schedule amounts for this code. ontractors shall establish local fee schedule amounts to pay claims for code E2295. s part of this update, we are revising the fee schedule amounts for HP codes L3905, L3808 and L3806. n the July Quarterly Update for 2008 (transmittal 1516, #6022) the fees for these codes were revised in order to correct fee schedule calculation errors. However, upon further review has determined that the gap-filled fees originally established for codes L3905, L3808 and L3806 in 2006 and 2007, respectively, were calculated correctly in accordance with the fee schedule gap-filling process outlined in section 60.3 of chapter 23 of the edicare laims Processing nternet Only anual. Thus, the fees for codes L3905, L3808 and L3806 contained in this update revert back to the fee schedule amounts in place prior to the July 2008 fee schedule update. laims for the above codes with dates of service on or after July 1, 2008 through December 31, 2008 that have already been processed will not be adjusted to reflect the revised fee schedule amounts if they are submitted for adjustments Fee chedule Updates following the Enactment of PP ection 154(a)(2) of the edicare mprovements for Patients and Providers ct (PP) of 2008 mandates a fee schedule covered item update of -9.5% for 2009 for items included in ound 1 of the DEPO ompetitive Bidding Program. The reduction applies to items furnished on or after January 1, 2009, in any geographical area. Therefore, where applicable, items selected for competitive bidding in 2008 will receive a - 9.5% update for 2009 with the exception of HP codes E1392, K0738, E0441, E0442, E0443 and E0444. These 6 oxygen generating portable equipment (OGPE) and oxygen contents codes will receive a 0% update for 2009 as the fees for these items are not adjusted by the covered item update specified in 1834(a)(14), and therefore, are not reduced by the -9.5%, even though they are competitive bid items. Non-competitive bid items will receive a 5.0% covered item update for list of the HP codes that were selected for competitive bidding in 2008 and are subject to the - 9.5% covered item update for 2009 can be found in ttachment. new HP modifier was added to the HP on January 1, 2009, and is effective for claims with dates of service on or after January 1, 2009: KE Bid Under ound One of the DEPO ompetitive Bidding Program for use with Non- ompetitive Bid Base Equipment To accommodate the fee schedule updates required per the PP, we are adding the KE modifier to the fee schedule for all power mobility device (PD) accessory items selected for competitive bidding in 2008 as part of this update. The KE modifier is a pricing modifier that suppliers must use to identify when the same accessory HP code can be furnished in multiple competitive and non-competitive bidding product categories. For example, HP code E0981 Wheelchair ccessory, eat Upholstery, eplacement Only, Each can be used with both competitively bid standard and complex rehabilitative power wheelchairs (K0813 thru K0829 and K0835 thru K0864), as well as with non-competitively bid manual wheelchairs (K0001 thru K0009) or a miscellaneous power wheelchair (K0898). ll fee schedules for PD accessory codes with the KE modifier will receive a 5% covered item update for 2009, whereas the fee schedules for the PD accessory codes without the KE modifier will receive the PP-required 9.5% reduction for uppliers shall be

5 instructed that if a competitively bid PD accessory code is used with a competitively bid standard PD base code (K0813 thru K0829) or complex rehabilitative PD base code (K0835 thru K0864), claims for the PD accessory code should be submitted without the KE modifier. uppliers should bill the accessory code with the KE modifier when the accessory is used in conjunction with a non-competitively bid manual wheelchair (K0001 through K0009) or a miscellaneous PD (K0898). n the case of the complex rehabilitative only PD accessory code E2373 K, suppliers should bill for the replacement only of E2373 without the KE modifier, but with the K modifier when the accessory is used with a competitively bid complex rehabilitative PD base code (K0835 thru K0864). When the replacement only code E2373 is used with a non-competitively bid manual or miscellaneous wheelchair, suppliers should bill code E2373 without the K modifier, but with the KE modifier. For the aforementioned reasons, we are also adding the KE modifier to the fee schedule for the following competitively bid HP codes: 4636, 4637, 7000, and E0776. uppliers shall be instructed that if codes 4636 and 4637 are used in conjunction with a competitively bid walker code (E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, and E0149), claims for the replacement handgrip (4636) or tip (4637) should be submitted without the KE modifier. uppliers should bill codes 4636 and 4637 with the KE modifier when the codes are used with non-competitively bid cane or crutch codes. Likewise, suppliers should bill the disposable canister code 7000 without the KE modifier when this code is used in conjunction with the competitively bid negative pressure wound therapy pump code E2402. When code 7000 is used with a noncompetitively bid respiratory or gastric suction pump, suppliers should bill code 7000 with the KE modifier. imilarly, when an V pole (E0776) is used in conjunction with competitively bid enteral nutrient codes (B4149, B4150, and B4152 thru B4155), suppliers should bill code E0776 with the B modifier, but without the KE modifier. When code E0776 is used with non-competitively bid parenteral nutrient codes, suppliers should bill code E0776 without the B modifier, but with the KE modifier. Further instruction on the use of the KE modifier with codes competitively bid in 2008 is available in ttachment B. Note: uppliers should not use the KE modifier on any claims for payment for items that were included under ound 1 such as an accessory for a standard power wheelchair. s part of this update, we are also adding the KL modifier to the fee schedule for the following diabetic supply HP codes: 4233, 4234, 4235, 4236, 4253, 4256, 4258, and s indicated in transmittal 1263 (July Quarterly Update for 2007 DEPO Fee chedule, change request 5641), suppliers began using the KL modifier as an informational modifier to identify diabetic supplies (HP codes , 4253, 4256, 4258 and 4259) furnished via mail order on or after July 1, Effective January 1, 2009, the KL modifier has been changed from an informational modifier to a pricing modifier in the HP file. uppliers must use the KL modifier on all claims for the aforementioned diabetic supply codes that are furnished via mail order to beneficiaries. The KL modifier is not used with diabetic supply codes that are not delivered to the beneficiary s residence and are obtained from local supplier storefronts. nappropriate use of a competitive bidding modifier on a competitive bidding claim is in violation of the law and may lead to claims denial and/or other corrective actions. The use of a competitive bidding modifier does not supersede existing edicare modifier use requirements for a particular code, but rather should be used in addition, as required National onthly Payment mounts for tationary Oxygen Equipment s part of this update, we are implementing the 2009 national monthly payment rates for stationary oxygen equipment (HP codes E0424, E0439, E1390 and E1391), effective for claims with dates of service on or after January 1, We are revising the fee schedule file to include the new national 2009 monthly payment rate of $ for stationary oxygen equipment. s required by statute, the payment rates must be adjusted on an annual basis, as necessary, to ensure budget neutrality of the addition of the new oxygen generating portable equipment (OGPE) class. The revised 2009 monthly payment rate of $ includes the 9.5% covered item reduction ascribed to items selected for competitive bidding in 2008 which was applied after the budget

6 neutrality calculation. The previously announced payment amount for 2009 of $ did not include the 9.5% reduction and assumed a higher shift to OGPE. s a result of the above adjustments, we are also revising the fee schedule amounts for HP codes E1405 and E1406 as part of this update. ince 1989, the fees for codes E1405 and E1406 have been established based on a combination of the edicare payment amounts for stationary oxygen equipment and nebulizer codes E0585 and E0570, respectively. Update to hapter 23, ections 60 of the edicare laims Processing anual has made refinements to the fee schedule update process so that fee schedule amounts are now added to the national DEPO fee schedule files on a semiannual basis. Previously, the national DEPO fee schedule files were updated on a quarterly basis (January, pril, July and October) with the January notification serving to update the fee schedule with the covered item update, as well as to implement fee schedule amounts for new permanent codes. Under the new schedule, the January update applies the covered item update to the fee schedule, adds fees for temporary codes added in the previous calendar year, and instructs contractors to calculate fees for the new permanent codes. The July update adds the fees for the permanent codes added January 1, makes any necessary fee corrections and provides instructions for contractors to calculate fees for temporary codes added during the year. pril and October updates to the fee schedule may be implemented when determines they are necessary. For new codes added to the HP file, the DE s shall establish local fee schedule amounts to pay claims for the new codes until national fee schedule amounts are added. This update revises hapter 23, section 60 of the edicare laims Processing anual to reflect the new fee schedule update process. Billing nstructions for Power Wheelchair Harness (HP code E2313) The pril Quarterly Update for the 2007 DEPO Fee chedule included instructions for suppliers to submit claims for the electronics necessary to upgrade from a non-expandable controller to an expandable controller at initial issue using HP code E2399. This instruction was intended as a temporary measure until a new code could be added to describe the electronics/cables/junction boxes used when upgrading from a non-expandable controller at initial issue. HP code E2313 (Power Wheelchair ccessory, Harness For Upgrade to Expandable ontroller, ncluding all Fasteners, onnectors and ounting Hardware, Each) was added to the HP effective January 1, 2008, for use in paying claims for the electronics furnished when upgrading from a non-expandable controller at initial issue. Hence, suppliers shall submit claims for the electronics provided at initial issue using HP code E2313 for dates of service on or after January 1, 2008, and shall no longer use code E2399 for submission of such items. laims submitted for the electronics necessary to upgrade from a non-expandable controller to an expandable controller using HP code E2399 are invalid and shall be denied as contractor/supplier responsibility. HP ode E0760 Per the local coverage decision for Osteogenesis timulators, the WF categories for HP code E0760 Osteogenesis stimulator, low intensity ultrasound, non-invasive are being revised to add WF category (59), N required, effective 1/1/07.. BUNE EQUEENT TBLE Use hall" to denote a mandatory requirement Number equirement esponsibility (place an in each applicable column) / B D E F H H hared- ystem aintainers OTHE

7 The DE s, /B s and carriers shall retrieve the DEPO fee schedule file (filename: U00.@BF12393.DEPO.T V1107) as soon as possible. The file is available for download on or after November 07, Notification of successful receipt shall be sent via e- mail to price_file_receipt@cms.hhs.gov stating the name of the file received and the entity for which they were received (e.g., DE name and number) The /B s, Fs and HHs shall retrieve the DEPO fee schedule file (filename: U00.@BF12393.DEPO.T V1114.F) as soon as possible. The file is available for download on or after November 14, Notification of successful receipt shall be sent via e- mail to price_file_receipt@cms.hhs.gov stating the name of the file received and the entity for which they were received (e.g., F name and number) The DE s shall retrieve the PEN fee schedule file (filename: U00.@BF12393.PEN.Y09.V1107) as soon as possible. The file is available for download on or after November 7, ontractors shall use the 2009 DEPO fee schedule payment amounts to pay claims for items furnished from January 1, 2009 through December 31, The DE s shall use the 2009 PEN fee schedule payment amounts to pay claims for items furnished from January 1, 2009 through December 31, The HP codes listed below are being added to the HP on January 1, 2009, and shall be added to the WF categories (in parentheses) as follows: Payment ategory 6545 (21,60) D 9284 (60) N/ E0487 (60) N/ E0656 (04,59,60) N E0657 (04,59,60) N E0770 (60) N/ E1354 (60) N/ E1356 (60) N/ E1357 (60) N/ E1358 (60) N/ E2230 (60) N/ F V W F

8 Number equirement esponsibility (place an in each applicable column) / B D E F hared- ystem aintainers E2231 (04,60) N E2295 (04,60) N L0113 (03, 60) PO L6711 (03,60) PO L6712 (03,60) PO L6713 (03,60) PO L6714 (03,60) PO L6721 (03,60) PO L6722 (03,60) PO L8604 (67) N/ ontractors shall establish local fee schedule amounts, when applicable, to pay claims for the codes listed in , from January 1, 2009 through June 30, f pricing information is not readily available for one or more codes and the DE s are not able to establish base local fees for the codes listed in , the DE s shall consult with central office to determine how pricing should be established for these codes The DE s shall instruct suppliers to use HP code E2313, effective January 1, 2008, for billing the electronics necessary to upgrade from a non-expandable to expandable controller at initial issue The DE s shall deny claims, for claims with dates of service on or after January 1, 2008, that are submitted for the electronics necessary to upgrade from a non-expandable controller to an expandable controller using HP code E The DE s shall use the following messages when denying a claim per requirement : 20: issing/incomplete/invalid HP 189: Not otherwise classified or unlisted procedure code (PT/HP) was billed when there is a specific procedure code for this procedure/service. N211: lert: You may not appeal this decision. 13: You may be subject to penalties if you bill the patient for amount not reported with the P (patient responsibility) group code. E H H F V W F OTHE

9 Number equirement esponsibility (place an in each applicable column) / B D E F hared- ystem aintainers N 16.36: f you have already paid it, you are entitled to a refund from this provider N 16.36: i usted ya lo ha pagado, tiene derecho a un reembolso de su proveedor The DE s shall deny claims specified in as a O-ontractual Obligation denial The DE s shall instruct suppliers to submit claims for competitively bid PD accessory codes used with non-competitively bid manual or miscellaneous power wheelchairs base codes (for a complete list of base codes, see column of ttachment B) using the KE pricing modifier, as appropriate The PD accessory codes subject to requirement are: E0950, E0951, E0952, E0955, E0956, E0957, E0960, E0973, E0978, E0981, E0982,E0990, E0995, E1016, E1020, E1028, E2208, E2209, E2210, E2361, E2363, E2365,E2366, E2367, E2368, E2369, E2370, E2371, E2381, E2382, E2383, E2384, E2385,E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, E2601,E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2611, E2612, E2613, E2614,E2615,E2616, E2619, E2620, E2621, K0015, K0017, K0018, K0019, K0020,K0037,K0038, K0039, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050,K0051, K0052, K0053, K0098, K0195, K0733, K0734, K0735, K0736, K The DE s shall instruct suppliers to submit claims for PD accessories, referenced in requirement , used with competitively bid standard PD (K0813 thru K0829) or complex rehabilitative PD base codes (K0835 thru K0864) without the KE modifier ontractors shall reject claims for PD accessories, referenced in requirement , used with competitively bid standard (K0813 thru K0829) or complex rehab PD (K0835 thru K0864) base codes when they are accompanied by the KE modifier The DE s shall instruct suppliers to submit claims for competitively bid complex rehabilitative only PD accessory codes used with competitively bid complex rehabilitative PD base codes (K0835 E H H F V W F OTHE

10 Number equirement esponsibility (place an in each applicable column) / B D E F hared- ystem aintainers thru K0864) without the KE pricing modifier The PD accessory codes subject to requirement are: E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1010, E1029, E1030, E2310, E2311, E2321, E2322,E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2351, E2373K, E2374, E2375, E2376, E The DE s shall instruct suppliers to submit claims for competitively bid complex rehabilitative only PD accessories, referenced in requirement , used with non-competitively bid manual or miscellaneous power wheelchairs base codes (for a complete list of base codes, see column of ttachment B) using the KE pricing modifier, as appropriate ontractors shall reject claims for complex rehabilitative only PD accessories, referenced in requirement , used with competitively bid complex rehab PD base codes (K0835 thru K0864) when they are accompanied by the KE modifier The DE s shall use the following messages when rejecting a claim per requirements or : 78: issing/incomplete/invalid HP modifier 125: ubmission/billing error (s) N 17.11: This item or service cannot be paid as billed N 17.11: Este servicio no se puede pagar según facturado The DE s shall instruct suppliers to submit claims for codes 4636, 4637, 7000 and E0776, when used with a competitively bid walker (E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, and E0149), negative pressure wound therapy pump (E2402) and enteral nutrient base codes (B4149, B4150, and B4152 thru B4155), respectively, without using the KE pricing modifier The DE s shall instruct suppliers to submit claims for codes 4636, 4637, 7000 and E0776, when used with a non-competitively bid cane or crutch (E0100, E0105, E0110, E0111, E0112, E0114, E0116, E0117, and E0118), respiratory or gastric E H H F V W F OTHE

11 Number equirement esponsibility (place an in each applicable column) / B D E F hared- ystem aintainers suction pump (E0600, E2000) and parenteral nutrient base codes (B4164, B4168, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, and B5200), respectively, using the KE pricing modifier The DE s shall instruct suppliers to submit claims for diabetic supply codes 4233, 4234, 4235, 4236, 4253, 4256, 4258, and 4259 with the KL modifier when these items are furnished via mail order The KL modifier shall be considered a pricing modifier for all diabetic supplies furnished on a mailorder basis, effective January 1, The WF shall add the WF category (59), N required, to HP code E The DE s shall update any user-controlled edits so that E0760 requires a N ontractors shall establish local fee schedule amounts to pay claims for HP code E2295, effective January 1, ontractors shall allow payment for HP code L5940 only when the claim is billed with one of the following endoskeletal system or socket HP codes: L5301, L5311, L5321, L5531, L5341, L5700, L5701, L5702 or L ontractors shall not adjust previously processed claims for codes L3905, L3808 and L3806 with dates of service on or after July 1, 2008 through December 31, 2008 if they are resubmitted for adjustments n accordance with the schedule noted below, base fees for the following codes must be submitted to DD/ by pril 10, 2009 for inclusion in the July DEPO fee schedule update: nexpensive and outinely Purchased DE (N) E0656 E0657 urgical Dressings (D) 6545 Prosthetics and Orthotics (PO) L The DE s, /B s, arriers and Fs shall implement changes to the 2009 DEPO fee schedules in accordance with the schedule outlined E H H F V W F OTHE

12 Number equirement esponsibility (place an in each applicable column) / B D E F hared- ystem aintainers below. E H H F V W F OTHE chedule for changes for 2009 DEPO Fees (Local arriers or DE s) or PEN Fees (DE s) hanges to DD*(arynne tevenson) DD Transmit Files ontractors mplement pril 10 ay 6 July 1, 2009 eptember 16 November 7 January 1, 2010 *DE s or local carriers will forward changes to Os. Os will forward requests to DD/arynne tevenson.. POVDE EDUTON TBLE Number equirement esponsibility (place an in each applicable column) provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. / B D E F E H H hared-ystem aintainers V F W F OTHE V. UPPOTNG NFOTON ection : For any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation.

13 -ef ecommendations or other supporting information: equirement Number Gap-filled base fees should be submitted using the record format described in section 60.1 of chapter 23 of the edicare laims Processing anual. Base fee schedule amounts submitted to shall not be updated by any update factors other than the 1.7% (1989) update factor , , for DE and prosthetics and orthotics. nstructions for gap-filling DEPO fees are located in section 60.3 of chapter 23 of the edicare laims Processing anual. ection B: For all other recommendations and supporting information, use this space: V. ONTT Pre-mplementation ontact(s): Karen Jacobs (410) and nita Greenberg (410) for general issues and hris olling (410) for oxygen and update factor issues Post-mplementation ontact(s): Karen Jacobs (410) and nita Greenberg (410) for general issues and hris olling (410) for oxygen and update factor issues V. FUNDNG ection : For Fiscal ntermediaries (Fs), egional Home Health ntermediaries (HHs), and/or arriers, use only one of the following statements: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: For edicare dministrative ontractors (s), include the following statement: The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

14 ttachment HP odes elected for ompetitive Bidding in 2008 eceiving a 9.5% eduction in 2009 PODUT TEGOY 1 Oxygen upplies and Equipment E1390 E1391 E0424 E0439 E0431 OYGEN ONENTTO, NGLE DELVEY POT, PBLE OF DELVENG 85 PEENT O GETE OYGEN ONENTTON T THE PEBED FLOW TE OYGEN ONENTTO, DUL DELVEY POT, PBLE OF DELVENG 85 PEENT O GETE OYGEN ONENTTON T THE PEBED FLOW TE, EH TTONY OPEED GEOU OYGEN YTE, ENTL; NLUDE ONTNE, ONTENT, EGULTO, FLOWETE, HUDFE, NEBULZE, NNUL O K, ND TUBNG TTONY LQUD OYGEN YTE, ENTL; NLUDE ONTNE, ONTENT, EGULTO, FLOWETE, HUDFE, NEBULZE, NNUL O K, & TUBNG E E0560 E0580 E1353 E1355 POTBLE GEOU OYGEN YTE, ENTL; NLUDE POTBLE ONTNE, EGULTO, FLOWETE, HUDFE, NNUL O K, ND TUBNG POTBLE LQUD OYGEN YTE, ENTL; NLUDE POTBLE ONTNE, UPPLY EEVO, HUDFE, FLOWETE, EFLL DPTO, ONTENT GUGE, NNUL O K, ND TUBNG TNTHEL OYGEN THETE, EH NNUL, NL TUBNG (OYGEN), PE FOOT OUTH PEE VBLE ONENTTON K HUDFE, DUBLE FO UPPLEENTL HUDFTON DUNG PPB TETENT O OYGEN DELVEY NEBULZE, DUBLE, GL O UTOLVBLE PLT, BOTTLE TYPE, FO UE WTH EGULTO O FLOWETE EGULTO TND/K PODUT TEGOY 2 tandard Power Wheelchairs, cooters, and elated ccessories E0950 WHEELH EOY, TY, EH E0951 HEEL LOOP/HOLDE, NY TYPE, WTH O WTHOUT NKLE TP, EH 1

15 E0952 E0955 E0956 E0957 E0960 E0973 E0978 E0981 E0982 E0990 E0995 E1016 E1020 E1028 E2208 E2209 E2210 E2361 E2363 E2365 E2366 TOE LOOP/HOLDE, NY TYPE, EH WHEELH EOY, HEDET, UHONED, NY TYPE, NLUDNG FED OUNTNG HDWE, EH WHEELH EOY, LTEL TUNK O HP UPPOT, NY TYPE, NLUDNG FED OUNTNG HDWE, EH WHEELH EOY, EDL THGH UPPOT, NY TYPE, NLUDNG FED OUNTNG HDWE, EH WHEELH EOY, HOULDE HNE/TP O HET TP, NLUDNG NY TYPE OUNTNG HDWE WHEELH EOY, DJUTBLE HEGHT, DETHBLE ET, OPLETE EBLY, EH WHEELH EOY, POTONNG BELT/FETY BELT/PELV TP, EH WHEELH EOY, ET UPHOLTEY, EPLEENT ONLY, EH WHEELH EOY, BK UPHOLTEY, EPLEENT ONLY, EH WHEELH EOY, ELEVTNG LEG ET, OPLETE EBLY, EH WHEELH EOY, LF ET/PD, EH HOK BOBE FO POWE WHEELH, EH EDUL LB UPPOT YTE FO WHEELH WHEELH EOY, NUL WNGWY, ETTBLE O EOVBLE OUNTNG HDWE FO JOYTK, OTHE ONTOL NTEFE O POTONNG EOY WHEELH EOY, YLNDE TNK E, EH EOY, TOUGH, WTH O WTHOUT HND UPPOT, EH WHEELH EOY, BENG, NY TYPE, EPLEENT ONLY, EH POWE WHEELH EOY, 22NF ELED LED D BTTEY, EH, (E.G. GEL ELL, BOBED GLT) POWE WHEELH EOY, GOUP 24 ELED LED D BTTEY, EH (E.G. GEL ELL, BOBED GLT) POWE WHEELH EOY, U-1 ELED LED D BTTEY, EH (E.G. GEL ELL, BOBED GLT) POWE WHEELH EOY, BTTEY HGE, NGLE ODE, FO UE WTH ONLY ONE BTTEY TYPE, ELED O NON-ELED, EH 2

16 E2367 E2368 E2369 E2370 E2371 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2394 E2395 E2396 E2601 POWE WHEELH EOY, BTTEY HGE, DUL ODE, FO UE WTH ETHE BTTEY TYPE, ELED O NON-ELED, EH POWE WHEELH OPONENT, OTO, EPLEENT ONLY POWE WHEELH OPONENT, GE BO, EPLEENT ONLY POWE WHEELH OPONENT, OTO ND GE BO OBNTON, EPLEENT ONLY POWE WHEELH EOY, GOUP 27 ELED LED D BTTEY, (E.G. GEL ELL, BOBED GLT), EH POWE WHEELH EOY, PNEUT DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TUBE FO PNEUT DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, NET FO PNEUT DVE WHEEL TE (EOVBLE), NY TYPE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, PNEUT TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TUBE FO PNEUT TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO FLLED DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO FLLED TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, OLD (UBBE/PLT) DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, OLD (UBBE/PLT) TE TE (EOVBLE), NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, OLD (UBBE/PLT) TE TE WTH NTEGTED WHEEL, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, DVE WHEEL ELUDE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TE WHEEL ELUDE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TE FOK, NY ZE, EPLEENT ONLY, EH GENEL UE WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH 3

17 E2602 E2603 E2604 E2605 E2606 E2607 E2608 E2611 E2612 E2613 E2614 E2615 E2616 E2619 E2620 E2621 K0015 K0017 K0018 K0019 K0020 GENEL UE WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH KN POTETON WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH KN POTETON WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH POTONNG WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH POTONNG WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH GENEL UE WHEELH BK UHON, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE GENEL UE WHEELH BK UHON, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO- LTEL, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO- LTEL, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE EPLEENT OVE FO WHEELH ET UHON O BK UHON, EH POTONNG WHEELH BK UHON, PLN BK WTH LTEL UPPOT, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, PLN BK WTH LTEL UPPOT, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE DETHBLE, NON-DJUTBLE HEGHT ET, EH DETHBLE, DJUTBLE HEGHT ET, BE, EH DETHBLE, DJUTBLE HEGHT ET, UPPE POTON, EH PD, EH FED, DJUTBLE HEGHT ET, P 4

18 K0037 K0038 K0039 K0040 K0041 K0042 K0043 K0044 K0045 K0046 K0047 K0050 K0051 K0052 K0053 K0098 K0195 K0733 K0734 K0735 K0736 K0737 K0800 K0801 K0802 K0806 K0807 K0808 K0813 K0814 K0815 K0816 K0820 K0821 HGH OUNT FLP-UP FOOTET, EH LEG TP, EH LEG TP, H TYLE, EH DJUTBLE NGLE FOOTPLTE, EH LGE ZE FOOTPLTE, EH TNDD ZE FOOTPLTE, EH FOOTET, LOWE ETENON TUBE, EH FOOTET, UPPE HNGE BKET, EH FOOTET, OPLETE EBLY ELEVTNG LEGET, LOWE ETENON TUBE, EH ELEVTNG LEGET, UPPE HNGE BKET, EH THET EBLY ELEE EBLY, FOOTET O LEGET, EH WNGWY, DETHBLE FOOTET, EH ELEVTNG FOOTET, TULTNG (TELEOPNG), EH DVE BELT FO POWE WHEELH ELEVTNG LEG ET, P (FO UE WTH PPED ENTL WHEELH BE) POWE WHEELH EOY, 12 TO 24 P HOU ELED LED D BTTEY, EH (E.G., GEL ELL, BOBED GLT) KN POTETON WHEELH ET UHON, DJUTBLE, WDTH LE THN 22 NHE, NY DEPTH KN POTETON WHEELH ET UHON, DJUTBLE, WDTH 22 NHE O GETE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, DJUTBLE, WDTH LE THN 22 NHE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, DJUTBLE, WDTH 22 NHE O GETE, NY DEPTH POWE OPETED VEHLE, GOUP 1 TNDD POWE OPETED VEHLE, GOUP 1 HEVY DUTY POWE OPETED VEHLE, GOUP 1 VEY HEVY DUTY POWE OPETED VEHLE, GOUP 2 TNDD POWE OPETED VEHLE, GOUP 2 HEVY DUTY POWE OPETED VEHLE, GOUP 2 VEY HEVY DUTY POWE WHEELH, GOUP 1 TNDD, POTBLE, LNG/OLD ET ND BK POWE WHEELH, GOUP 1 TNDD, POTBLE, PTN H POWE WHEELH, GOUP 1 TNDD, LNG/OLD ET ND BK POWE WHEELH, GOUP 1 TNDD, PTN H POWE WHEELH, GOUP 2 TNDD, POTBLE, LNG/OLD ET/BK POWE WHEELH, GOUP 2 TNDD, POTBLE, PTN H 5

19 K0822 K0823 K0824 K0825 K0826 K0827 K0828 K0829 POWE WHEELH, GOUP 2 TNDD, LNG/OLD ET/BK POWE WHEELH, GOUP 2 TNDD, PTN H POWE WHEELH, GOUP 2 HEVY DUTY, LNG/OLD ET/BK POWE WHEELH, GOUP 2 HEVY DUTY, PTN H POWE WHEELH, GOUP 2 VEY HEVY DUTY, LNG/OLD ET/BK POWE WHEELH, GOUP 2 VEY HEVY DUTY, PTN H POWE WHEELH, GOUP 2 ET HEVY DUTY, LNG/OLD ET/BK POWE WHEELH, GOUP 2 ET HEVY DUTY, PTN H PODUT TEGOY 3 omplex ehabilitative Power Wheelchairs and elated ccessories E0950 WHEELH EOY, TY, EH E0951 HEEL LOOP/HOLDE, NY TYPE, WTH O WTHOUT NKLE TP, EH E0952 E0955 E0956 E0957 E0960 E0973 E0978 E0981 E0982 E0990 E0995 E1002 E1003 E1004 TOE LOOP/HOLDE, NY TYPE, EH WHEELH EOY, HEDET, UHONED, NY TYPE, NLUDNG FED OUNTNG HDWE, EH WHEELH EOY, LTEL TUNK O HP UPPOT, NY TYPE, NLUDNG FED OUNTNG HDWE, EH WHEELH EOY, EDL THGH UPPOT, NY TYPE, NLUDNG FED OUNTNG HDWE, EH WHEELH EOY, HOULDE HNE/TP O HET TP, NLUDNG NY TYPE OUNTNG HDWE WHEELH EOY, DJUTBLE HEGHT, DETHBLE ET, OPLETE EBLY, EH WHEELH EOY, POTONNG BELT/FETY BELT/PELV TP, EH WHEELH EOY, ET UPHOLTEY, EPLEENT ONLY, EH WHEELH EOY, BK UPHOLTEY, EPLEENT ONLY, EH WHEELH EOY, ELEVTNG LEG ET, OPLETE EBLY, EH WHEELH EOY, LF ET/PD, EH WHEELH EOY, POWE ETNG YTE, TLT ONLY WHEELH EOY, POWE ETNG YTE, ELNE ONLY, WTHOUT HE EDUTON WHEELH EOY, POWE ETNG YTE, ELNE ONLY, WTH EHNL HE EDUTON 6

20 E1005 E1006 E1007 E1008 E1010 E1016 E1020 E1028 E1029 E1030 E2208 E2209 E2210 E2310 E2311 E2321 E2322 E2323 WHEELH EOY, POWE ETNG YTE, ELNE ONLY, WTH POWE HE EDUTON WHEELH EOY, POWE ETNG YTE, OBNTON TLT ND ELNE, WTHOUT HE EDUTON WHEELH EOY, POWE ETNG YTE, OBNTON TLT ND ELNE, WTH EHNL HE EDUTON WHEELH EOY, POWE ETNG YTE, OBNTON TLT ND ELNE, WTH POWE HE EDUTON WHEELH EOY, DDTON TO POWE ETNG YTE, POWE LEG ELEVTON YTE, NLUDNG LEG ET, P HOK BOBE FO POWE WHEELH, EH EDUL LB UPPOT YTE FO WHEELH WHEELH EOY, NUL WNGWY, ETTBLE O EOVBLE OUNTNG HDWE FO JOYTK, OTHE ONTOL NTEFE O POTONNG EOY WHEELH EOY, VENTLTO TY, FED WHEELH EOY, VENTLTO TY, GBLED WHEELH EOY, YLNDE TNK E, EH EOY, TOUGH, WTH O WTHOUT HND UPPOT, EH WHEELH EOY, BENG, NY TYPE, EPLEENT ONLY, EH POWE WHEELH EOY, ELETON ONNETON BETWEEN WHEELH ONTOLLE ND ONE POWE ETNG YTE OTO, NLUDNG LL ELTED ELETON, NDTO FETUE, EHNL FUNTON ELETON WTH, ND FED OUNTNG HDWE POWE WHEELH EOY, ELETON ONNETON BETWEEN WHEELH ONTOLLE ND TWO O OE POWE ETNG YTE OTO, NLUDNG LL ELTED ELETON, NDTO FETUE, EHNL FUNTON ELETON WTH, ND FED OUNTNG HDWE POWE WHEELH EOY, HND ONTOL NTEFE, EOTE JOYTK, NONPOPOTONL, NLUDNG LL ELTED ELETON, EHNL TOP WTH, ND FED OUNTNG HDWE POWE WHEELH EOY, HND ONTOL NTEFE, ULTPLE EHNL WTHE, NONPOPOTONL, NLUDNG LL ELTED ELETON, EHNL TOP WTH, ND FED OUNTNG HDWE POWE WHEELH EOY, PELTY JOYTK HNDLE FO HND ONTOL NTEFE, PEFBTED 7

21 E2324 E2325 E2326 E2327 E2328 E2329 E2330 E2351 E2361 E2363 E2365 E2366 E2367 E2368 E2369 E2370 POWE WHEELH EOY, HN UP FO HN ONTOL NTEFE POWE WHEELH EOY, P ND PUFF NTEFE, NONPOPOTONL, NLUDNG LL ELTED ELETON, EHNL TOP WTH, ND NUL WNGWY OUNTNG HDWE POWE WHEELH EOY, BETH TUBE KT FO P ND PUFF NTEFE POWE WHEELH EOY, HED ONTOL NTEFE, EHNL, POPOTONL, NLUDNG LL ELTED ELETON, EHNL DETON HNGE WTH, ND FED OUNTNG HDWE POWE WHEELH EOY, HED ONTOL O ETETY ONTOL NTEFE, ELETON, POPOTONL, NLUDNG LL ELTED ELETON ND FED OUNTNG HDWE POWE WHEELH EOY, HED ONTOL NTEFE, ONTT WTH EHN, NONPOPOTONL, NLUDNG LL ELTED ELETON, EHNL TOP WTH, EHNL DETON HNGE WTH, HED Y, ND FED OUNTNG HDWE POWE WHEELH EOY, HED ONTOL NTEFE, POTY WTH EHN, NONPOPOTONL, NLUDNG LL ELTED ELETON, EHNL TOP WTH, EHNL DETON HNGE WTH, HED Y, ND FED OUNTNG HDWE POWE WHEELH EOY, ELETON NTEFE TO OPETE PEEH GENETNG DEVE UNG POWE WHEELH ONTOL NTEFE POWE WHEELH EOY, 22NF ELED LED D BTTEY, EH, (E.G. GEL ELL, BOBED GLT) POWE WHEELH EOY, GOUP 24 ELED LED D BTTEY, EH (E.G. GEL ELL, BOBED GLT) POWE WHEELH EOY, U-1 ELED LED D BTTEY, EH (E.G. GEL ELL, BOBED GLT) POWE WHEELH EOY, BTTEY HGE, NGLE ODE, FO UE WTH ONLY ONE BTTEY TYPE, ELED O NON-ELED, EH POWE WHEELH EOY, BTTEY HGE, DUL ODE, FO UE WTH ETHE BTTEY TYPE, ELED O NON-ELED, EH POWE WHEELH OPONENT, OTO, EPLEENT ONLY POWE WHEELH OPONENT, GE BO, EPLEENT ONLY POWE WHEELH OPONENT, OTO ND GE BO OBNTON, EPLEENT ONLY 8

22 E2371 E2373 K E2374 E2375 E2376 E2377 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 POWE WHEELH EOY, GOUP 27 ELED LED D BTTEY, (E.G. GEL ELL, BOBED GLT), EH POWE WHEELH EOY, HND O HN ONTOL NTEFE, OPT EOTE JOYTK, POPOTONL, NLUDNG FED OUNTNG HDWE POWE WHEELH EOY, HND O HN ONTOL NTEFE, TNDD EOTE JOYTK (NOT NLUDNG ONTOLLE), POPOTONL, NLUDNG LL ELTED ELETON ND FED OUNTNG HDWE, EPLEENT ONLY POWE WHEELH EOY, NON-EPNDBLE ONTOLLE, NLUDNG LL ELTED ELETON ND OUNTNG HDWE, EPLEENT ONLY POWE WHEELH EOY, EPNDBLE ONTOLLE, NLUDNG LL ELTED ELETON ND OUNTNG HDWE, EPLEENT ONLY POWE WHEELH EOY, EPNDBLE ONTOLLE, NLUDNG LL ELTED ELETON ND OUNTNG HDWE, UPGDE POVDED T NTL UE POWE WHEELH EOY, PNEUT DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TUBE FO PNEUT DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, NET FO PNEUT DVE WHEEL TE (EOVBLE), NY TYPE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, PNEUT TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TUBE FO PNEUT TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO FLLED DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO FLLED TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, FO TE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, OLD (UBBE/PLT) DVE WHEEL TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, OLD (UBBE/PLT) TE TE (EOVBLE), NY ZE, EPLEENT ONLY, EH 9

23 E2392 E2394 E2395 E2396 E2601 E2602 E2603 E2604 E2605 E2606 E2607 E2608 E2611 E2612 E2613 E2614 E2615 E2616 E2619 E2620 POWE WHEELH EOY, OLD (UBBE/PLT) TE TE WTH NTEGTED WHEEL, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, DVE WHEEL ELUDE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TE WHEEL ELUDE TE, NY ZE, EPLEENT ONLY, EH POWE WHEELH EOY, TE FOK, NY ZE, EPLEENT ONLY, EH GENEL UE WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH GENEL UE WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH KN POTETON WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH KN POTETON WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH POTONNG WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH POTONNG WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, WDTH LE THN 22 NHE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, WDTH 22 NHE O GETE, NY DEPTH GENEL UE WHEELH BK UHON, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE GENEL UE WHEELH BK UHON, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO- LTEL, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE POTONNG WHEELH BK UHON, POTEO- LTEL, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE EPLEENT OVE FO WHEELH ET UHON O BK UHON, EH POTONNG WHEELH BK UHON, PLN BK WTH LTEL UPPOT, WDTH LE THN 22 NHE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE 10

24 E2621 K0015 K0017 K0018 K0019 K0020 K0037 K0038 K0039 K0040 K0041 K0042 K0043 K0044 K0045 K0046 K0047 K0050 K0051 K0052 K0053 K0098 K0195 K0733 K0734 K0735 K0736 K0737 K0835 POTONNG WHEELH BK UHON, PLN BK WTH LTEL UPPOT, WDTH 22 NHE O GETE, NY HEGHT, NLUDNG NY TYPE OUNTNG HDWE DETHBLE, NON-DJUTBLE HEGHT ET, EH DETHBLE, DJUTBLE HEGHT ET, BE, EH DETHBLE, DJUTBLE HEGHT ET, UPPE POTON, EH PD, EH FED, DJUTBLE HEGHT ET, P HGH OUNT FLP-UP FOOTET, EH LEG TP, EH LEG TP, H TYLE, EH DJUTBLE NGLE FOOTPLTE, EH LGE ZE FOOTPLTE, EH TNDD ZE FOOTPLTE, EH FOOTET, LOWE ETENON TUBE, EH FOOTET, UPPE HNGE BKET, EH FOOTET, OPLETE EBLY ELEVTNG LEGET, LOWE ETENON TUBE, EH ELEVTNG LEGET, UPPE HNGE BKET, EH THET EBLY ELEE EBLY, FOOTET O LEGET, EH WNGWY, DETHBLE FOOTET, EH ELEVTNG FOOTET, TULTNG (TELEOPNG), EH DVE BELT FO POWE WHEELH ELEVTNG LEG ET, P (FO UE WTH PPED ENTL WHEELH BE) POWE WHEELH EOY, 12 TO 24 P HOU ELED LED D BTTEY, EH (E.G., GEL ELL, BOBED GLT) KN POTETON WHEELH ET UHON, DJUTBLE, WDTH LE THN 22 NHE, NY DEPTH KN POTETON WHEELH ET UHON, DJUTBLE, WDTH 22 NHE O GETE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, DJUTBLE, WDTH LE THN 22 NHE, NY DEPTH KN POTETON ND POTONNG WHEELH ET UHON, DJUTBLE, WDTH 22 NHE O GETE, NY DEPTH POWE WHEELH, GOUP 2 TNDD, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND 11

25 K0836 K0837 K0838 K0839 K0840 K0841 K0842 K0843 K0848 K0849 K0850 K0851 K0852 K0853 K0854 K0855 K0856 POWE WHEELH, GOUP 2 TNDD, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 2 HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 2 HEVY DUTY, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 2 VEY HEVY DUTY, NGLE POWE OPTON LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND POWE WHEELH, GOUP 2 ET HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE POWE WHEELH, GOUP 2 TNDD, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 2 TNDD, ULTPLE POWE OPTON, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 2 HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 3 TNDD, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 3 TNDD, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 3 HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 3 HEVY DUTY, PTN H, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 3 VEY HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND POWE WHEELH, GOUP 3 VEY HEVY DUTY, PTN H, PTENT WEGHT PTY 451 TO 600 POUND POWE WHEELH, GOUP 3 ET HEVY DUTY, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE POWE WHEELH, GOUP 3 ET HEVY DUTY, PTN H, PTENT WEGHT PTY 601 POUND O OE POWE WHEELH, GOUP 3 TNDD, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND 12

26 K0857 K0858 K0859 K0860 K0861 K0862 K0863 K0864 PODUT TEGOY 4 POWE WHEELH, GOUP 3 TNDD, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 3 HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT 301 TO 450 POUND POWE WHEELH, GOUP 3 HEVY DUTY, NGLE POWE OPTON, PTN H, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 3 VEY HEVY DUTY, NGLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND POWE WHEELH, GOUP 3 TNDD, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY UP TO ND NLUDNG 300 POUND POWE WHEELH, GOUP 3 HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 301 TO 450 POUND POWE WHEELH, GOUP 3 VEY HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 451 TO 600 POUND POWE WHEELH, GOUP 3 ET HEVY DUTY, ULTPLE POWE OPTON, LNG/OLD ET/BK, PTENT WEGHT PTY 601 POUND O OE ail-order Diabetic upplies 4233 KL EPLEENT BTTEY, LKLNE (OTHE THN J ELL), FO UE WTH EDLLY NEEY HOE BLOOD GLUOE ONTO OWNED BY PTENT, EH 4234 KL EPLEENT BTTEY, LKLNE, J ELL, FO UE WTH EDLLY NEEY HOE BLOOD GLUOE ONTO OWNED BY PTENT, EH 4235 KL EPLEENT BTTEY, LTHU, FO UE WTH EDLLY NEEY HOE BLOOD GLUOE ONTO OWNED BY PTENT, EH 4236 KL EPLEENT BTTEY, LVE ODE, FO UE WTH EDLLY NEEY HOE BLOOD GLUOE ONTO OWNED BY PTENT, EH 4253 KL BLOOD GLUOE TET O EGENT TP FO HOE BLOOD GLUOE ONTO, PE 50 TP 4256 KL NOL, LOW ND HGH LBTO OLUTON / HP 4258 KL PNG-POWEED DEVE FO LNET, EH 4259 KL LNET, PE BO OF 100 PODUT TEGOY 5 Enteral Nutrients, Equipment, and upplies B4034 ENTEL FEEDNG UPPLY KT; YNGE FED, PE DY B4035 ENTEL FEEDNG UPPLY KT; PUP FED, PE DY B4036 ENTEL FEEDNG UPPLY KT; GVTY FED, PE DY 13

27 B4081 B4082 B4083 B4087 B4088 B4149 NOGT TUBNG WTH TYLET NOGT TUBNG WTHOUT TYLET TOH TUBE - LEVNE TYPE GTOTOY / JEJUNOTOY TUBE, NY TEL, NY TYPE, (TNDD), EH GTOTOY / JEJUNOTOY TUBE, NY TEL, NY TYPE, (LOW POFLE), EH B4150 B4152 B4153 ENTEL FOUL, NUFTUED BLENDEZED NTUL FOOD WTH NTT NUTENT, NLUDE POTEN, FT, BOHYDTE, VTN ND NEL, Y NLUDE FBE, DNTEED THOUGH N ENTEL FEEDNG TUBE, 100 LOE = 1 UNT ENTEL FOUL, NUTTONLLY OPLETE WTH NTT NUTENT, NLUDE POTEN, FT, BOHYDTE, VTN ND NEL, Y NLUDE FBE, DNTEED THOUGH N ENTEL FEEDNG TUBE, 100 LOE = 1 UNT ENTEL FOUL, NUTTONLLY OPLETE, LOLLY DENE (EQUL TO O GETE THN 1.5 KL/L) WTH NTT NUTENT, NLUDE POTEN, FT, BOHYDTE, VTN ND NEL, Y NLUDE FBE, DNTEED THOUGH N ENTEL FEEDNG TUBE, 100 LOE = 1 UNT B4154 ENTEL FOUL, NUTTONLLY OPLETE, HYDOLYZED POTEN (NO D ND PEPTDE HN), NLUDE FT, BOHYDTE, VTN ND NEL, Y NLUDE FBE, DNTEED THOUGH N ENTEL FEEDNG TUBE, 100 LOE = 1 UNT B4155 ENTEL FOUL, NUTTONLLY OPLETE, FO PEL ETBOL NEED, ELUDE NHETED DEE OF ETBOL, NLUDE LTEED OPOTON OF POTEN, FT, BOHYDTE, VTN ND/O NEL, Y NLUDE FBE, DNTEED THOUGH N ENTEL FEEDNG TUBE, 100 LOE = 1 UNT B9000 B9002 E0776 ENTEL FOUL, NUTTONLLY NOPLETE/ODUL NUTENT, NLUDE PEF NUTENT, BOHYDTE (E.G. GLUOE POLYE), POTEN/NO D (E.G. GLUTNE, GNNE), FT (E.G. EDU HN TGLYEDE) O OBNTON, DNTEED THOUGH N ENTEL FEEDNG TUBE, 100 LOE = 1 UNT NOTE: (EE J7060, J7070, J7042 FO OLUTON ODE FO OTHE THN PENTEL NUTTON THEPY UE) ENTEL NUTTON NFUON PUP - WTHOUT L ENTEL NUTTON NFUON PUP - WTH L V POLE 14

28 PODUT TEGOY 6 ontinuous Positive irway Pressure Devices, espiratory ssist Devices, and elated upplies and ccessories 4604 TUBNG WTH NTEGTED HETNG ELEENT FO UE WTH POTVE WY PEUE DEVE 7030 FULL FE K UED WTH POTVE WY PEUE DEVE, EH 7031 FE K NTEFE, EPLEENT FO FULL FE K, EH 7032 UHON FO UE ON NL K NTEFE, EPLEENT ONLY, EH 7033 PLLOW FO UE ON NL NNUL TYPE NTEFE, EPLEENT ONLY, P 7034 NL NTEFE (K O NNUL TYPE) UED WTH POTVE WY PEUE DEVE, WTH O WTHOUT HED TP E0470 E0471 E0472 E0561 HEDGE UED WTH POTVE WY PEUE DEVE HNTP UED WTH POTVE WY PEUE DEVE TUBNG UED WTH POTVE WY PEUE DEVE FLTE, DPOBLE, UED WTH POTVE WY PEUE DEVE FLTE, NON DPOBLE, UED WTH POTVE WY PEUE DEVE OL NTEFE UED WTH POTVE WY PEUE DEVE, EH EHLTON POT WTH O WTHOUT WVEL UED WTH EOE FO POTVE WY DEVE, EPLEENT ONLY WTE HBE FO HUDFE, UED WTH POTVE WY PEUE DEVE, EPLEENT, EH EPTOY T DEVE, B-LEVEL PEUE PBLTY, WTHOUT BKUP TE FETUE, UED WTH NONNVVE NTEFE, E.G., NL O FL K (NTETTENT T DEVE WTH ONTNUOU POTVE WY PEUE DEVE) EPTOY T DEVE, B-LEVEL PEUE PBLTY, WTH BK-UP TE FETUE, UED WTH NONNVVE NTEFE, E.G., NL O FL K (NTETTENT T DEVE WTH ONTNUOU POTVE WY PEUE DEVE) EPTOY T DEVE, B-LEVEL PEUE PBLTY, WTH BKUP TE FETUE, UED WTH NVVE NTEFE, E.G., THEOTOY TUBE (NTETTENT T DEVE WTH ONTNUOU POTVE WY PEUE DEVE) HUDFE, NON-HETED, UED WTH POTVE WY PEUE DEVE 15