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Medicare Part B Reimbursement Codes

EO184- Ultra-Form Therapeutic Replacement Mattress- Dry pressure mattress

                    Product #: AH961

EO199- Ultra-Form Mattress Overlay (3.5" height)

                          Product #: AH101/ AH106/ AH10680

E2601- Ultra-Form 2.5" Low Profile Cushion- General use wheelchair seat cushion, width 22" any depth                       Product #:  AH062

K0669- Ultra-Form 2.5" Low Profile Cushion- General use wheelchair seat cushion, width 22" any depth 

                       Product #: AH060/ AH061

E2601- Ultra-Form Standard 4" Cushion- General use wheelchair seat cushion, width 22" any depth 

                       Product #: AH052

K0669- Ultra-Form Standard 4" Cushion- General use wheelchair seat cushion, width 22" any depth 

                       Product #: AH050/ AH051

E2601- Ultra-Form Wedge Cushion- General use wheelchair seat cushion, width 22" any depth  

                   Product #: AH072

K0669- Ultra-Form Wedge Cushion- General use wheelchair seat cushion, width 22" any depth  

 

                        Product #: AH070/ AH071

 

E2601- Ultra-Form Plus 4" Cushion - General use wheelchair seat cushion, width 22" any depth  

 

                  Product #AH082  (for heavier patients)

 

 

   

 

K0669- Ultra-Form Plus 4" Cushion - General use wheelchair seat cushion, width 22" any depth 

                       Product #: AH080/ AH081 (for heavier patients)

 

 

 

 



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