This is a quick reference for the HCPCS codes and initial authorization quantities for the durable medical equipment we supply. Home Medix NPI: 1851399844
For the most current and complete list, use our covered items lookup at hcpcs.homemedix.com. Codes and coverage criteria change, so please verify there before submitting an order.
"Units/Qty" below refers to the quantity for initial authorization. LON = Length of Need.
Wheelchairs
HCPCS | Qty | Item |
K0001 | 1 | Standard (K1, 16" / 18" / 20"), up to 250 lbs |
K0003 | 1 | Lightweight (K3, 16" / 18" / 20"), up to 250 lbs |
K0007 | 1 | Extra Heavy Duty (K7, 22" / 24" / 28" / 30"), 300-500 lbs |
Contact us | 1 | Reclining Wheelchair (16" / 18" / 20") |
E1038 | 1 | Transport Chair (19"), up to 250 lbs |
E1039 | 1 | Bariatric Transport Chair (22"), up to 500 lbs |
Wheelchair Accessories
HCPCS | Qty | Item |
K0195 | 1 | Elevated Leg Rests (ELR) |
E0978 | 1 | Seat Belt for Wheelchair (6") |
E2209 | 1 | Arm Trough |
E2603 | 1 | Gel Cushion (20" / 22" / 24") |
E2601 | 1 | Foam Cushion (16" / 18" / 20") |
E2602 | 1 | Foam Cushion (22" / 24" / 28" / 30") |
E0971 | 1 | Anti-Tippers |
E0705 | 1 | Transfer Board |
Power Chairs & Scooters
HCPCS | Qty | Item | Battery Code |
K0823 | 1 | Power Chair, Group 2, up to 300 lbs & 3 mph | E2365 x2 |
K0825 | 1 | Power Chair, Group 2, 301-450 lbs & 3 mph | E2361 x2 |
E0827 | 1 | Power Chair, Group 2, 451-600 lbs & 3 mph | — |
K0800 | 1 | Power Scooter, Group 1 | — |
K0806 | 1 | Power Scooter, Group 2, up to 300 lbs & 3 mph | — |
K0807 | 1 | Power Scooter, Group 2, 301-450 lbs & 3 mph | — |
Group 2 codes above apply to minimal surface irregularity. For standard power chair codes not listed here, contact us to confirm.
Walking Aids
HCPCS | Qty | Item |
E0143 | 1 | Standard Front Wheel Walker |
E0143 | 1 | Junior Front Wheel Walker |
E0149 | 1 | Bariatric Front Wheel Walker, 600 lbs |
E0135 | 1 | Hemi Walker (Side Stepper) |
E0143 & E0156 | 1 | Rollator, 300 lbs |
E0147 | 1 | Bariatric Rollator, 500 lbs |
E1399 & E0118 | 1 | Knee Scooter |
E0158 | 1 | Walker Extensions / Leg Extenders |
E0154 | 1 | Walker Platform Attachment |
E0114 | 1 | Adult Crutches |
E0110 | 1 | Forearm Crutches |
E0100 | 1 | Single Point Cane |
E0105 | 1 | Aluminum Quad Cane (Small / Large) |
L4360 | 1 | Walking Boot |
Bathroom Equipment
HCPCS | Qty | Item |
E0245 | 1 | Shower Chair with or without back (Standard), up to 400 lbs |
E0240 | 1 | Shower Chair with or without back (Heavy Duty), up to 550 lbs |
E0247 | 1 | Transfer Bench, up to 400 lbs |
E0248 | 1 | Bariatric Transfer Bench, up to 550 lbs |
E0241 | 1 | Grab Bar (16" / 18") |
E0163 | 1 | Standard Commode, up to 350 lbs |
E0165 | 1 | Drop Arm Commode, up to 300 lbs |
E0168 | 1 | Bariatric Commode (22" extra wide), up to 650 lbs |
E0244 | 1 | Raised Toilet Seat, up to 350 lbs |
Bedroom
HCPCS | Qty | Item |
E0295 | 1 | Hospital Bed (Semi-Electric) |
E0297 | 1 | Hospital Bed (Full Electric) |
E0260 | 1 | Hospital Bed Bundle (Semi-Electric) — Medicare |
E0303 | 1 | Bariatric Hospital Bed (Full Electric) |
E0271 | 1 | Innerspring Mattress |
E0277 | 1 | Low Air Loss Mattress |
E0185 | 1 | Mattress Gel Overlay |
E0181 | 1 | Alternating Pressure Pad |
E0305 | 1 | Half Length Bed Rail |
E0310 | 1 | Full Length Bed Rail |
E0630 | 1 | Manual Patient Lift (with sling) |
E0635 | 1 | Electric Patient Lift (with sling) |
PAP Devices & Accessories
HCPCS | Qty | Item |
E0601 | 3 | CPAP |
E0471 | 6 | BiPAP 10 ST |
E0470 | 6 | BiPAP 10 VAUTO |
E0466 | 1 | Non-Invasive Ventilator (Breas Vivo45) |
A7037 | 1 | 6' CPAP Tubing |
A4604 | 1 | Heated Tubing |
A7038 | 6 | Disposable Filters |
A7039 | 1 | Non-Disposable Filters |
A7034 | 1 | Nasal CPAP Mask (S / M / L) or Nasal Pillows |
A7030 | 1 | Full Face Mask (S / M / L / XL) |
A7031 | 3 | Full Face Cushion Insert |
A7032 | 6 | Nasal Mask Cushion Insert |
A7033 | 6 | Nasal Pillow Cushion Insert |
A7035 | 1 | Headgear |
E0562 | 1 | Humidifier |
A7046 | 1 | Replacement Water Chamber |
For resupply quantity intervals, see our CPAP & BiPAP Resupply Guidelines article.
Oxygen
HCPCS | Qty | Item |
E0431 | 1 | Oxygen Portable "E" Setup |
E1390 | 1 | Oxygen Concentrator (5L or 10L) |
E1392 | 1 | Portable Oxygen Concentrator (pulse or continuous) |
N/A | 1 | Oxygen Cart |
N/A | 1 | Oxygen Regulator |
— | 1 | Cannula (7' or 24') |
Nebulizers
HCPCS | Qty | Item |
E0570 | 1 | Nebulizer Compressor |
A7005 | 1 | Nebulizer Kits |
A7015 | 1 | Mask (S / M / L) |
Suction
HCPCS | Qty | Item |
E0600 | 1 | Heavy Duty Suction Machine or Portable AC/DC Suction Pump |
A7002 | 2 | Non-Conductive Connecting Tubing |
A4628 | 2 | Yankauer with Bulb Tip |
A7001 | 1 | Suction Collection Jar |
Wound Care
HCPCS | Qty | Item |
E2402 | 180 | Wound Pump / Wound Vac |
A7000 | 10 | 250 or 500 Canister |
A6550 | 15 | Medium or Large Wound Kit |
Incontinence
HCPCS | Qty | Item |
T4521 | 160 | Diapers (Small) |
T4522 | 192 (2 cases) | Diapers (Medium), 32-44 |
T4523 | 144 (2 cases) | Diapers (Large), 45-58 |
T4524 | 120 (2 cases) | Diapers (Extra Large), 59-64 |
T4525 | Contact us | Pull Ups (Small) |
T4526 | 160 (2 cases) | Pull Ups (Medium), 28-40 |
T4527 | 160 (2 cases) | Pull Ups (Large), 40-56 |
T4528 | 160 (2 cases) | Pull Ups (Extra Large) |
T4541 | 100 | Underpads |
T4535 | 168 (1 case) | Bladder Control Pads |
A4927 | 200 (2 boxes) | Powder-Free Gloves (Latex) |
A4649 | 2 | No Rinse Wash Spray |
A6250 | 2 | Skin Cream |
A9286 | Contact us | Wipes |
Urological
HCPCS | Item |
A4351 | Straight Uncoated Catheter, male or female (12fr / 14fr / 16fr); Straight Hydrophilic Male (14fr / 16fr) |
A4352 | Coude Uncoated Male (12fr / 14fr / 16fr); Coude Hydrophilic Male (12fr / 14fr / 16fr) |
A4353 | Closed System Catheter (12fr / 14fr / 16fr) |
A4349 | Condom Catheter, standard or clear (Small through XLarge) |
A4358 | Leg Bag with straps & extension tubing (600mL / 900mL) |
A4357 | 2000mL Drainage Bag (Qty 2) |
A4332 | Surgical Lubricant, 3g packet |
A4402 | Lubricant, 2oz or 4-1/4oz |
Quantities for urological supplies vary by plan and utilization. Contact us to confirm.
Ostomy
HCPCS | Qty | Item |
A5063 | 40 | Clear Cut-to-Fit Pouch up to 2-1/2" (64mm) |
A4414 | Contact us | Sur-Fit Cut-to-Fit 45mm Flange |
A4416 | Contact us | Cut-to-Fit 57mm Flange |
A4333 | Contact us | Opaque Pouch, 45mm Flange |
A4334 | Contact us | Clear Pouch, 57mm Flange |
A6227 | 2 | Stomahesive Paste, 2oz |
A6228 | Contact us | Skin Barrier Paste, 2oz |
Orthotics
HCPCS | Qty | Item |
L1820 | 1 | Knee Brace |
L0625 | 1 | Back Brace or Abdominal Binder |
L3908 | 1 | Wrist Brace |
L3809 | 1 | Wrist Brace with thumb attachment |
L0120 | 1 | Cervical Collar |
L1906 | 1 | Ankle Brace |
L4360 | 1 | Walking Boot |
A5500 | 1 | Diabetic Shoes |
A5512 | 1 | Diabetic Shoe Inserts |
TENS
HCPCS | Item |
E0720 | TENS Unit |
A4595 | TENS Pads |
A4557 | TENS Wires |
TENS quantities are based on the quantity listed on the order.
Questions
To verify a code or check coverage for an item not listed here, visit hcpcs.homemedix.com or contact us at (800) 403-1010 or [email protected], Monday to Friday, 8:30am to 5pm Pacific.
To report an error in this list, email [email protected].
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