| A4283 | Cap for breast pump bottle, replacement |
| A5113 | Leg strap; latex, replacement only, per set |
| A5114 | Leg strap; foam or fabric, replacement only, per set |
| A7031 | Face mask interface, replacement for full face mask, each |
| K0019 | Arm pad, replacement only, each |
| L4002 | Replacement strap, any orthosis, includes all components, any length, any type |
| L0861 | Addition to halo procedure, replacement liner/interface material |
| L6883 | Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power |
| K0072 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each |
| K0071 | Front caster assembly, complete, with pneumatic tire, replacement only, each |
| L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement |
| E0167 | Pail or pan for use with commode chair, replacement only |
| E2394 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
| E2383 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each |
| E2370 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
| E2386 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
| E2381 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each |
| E2382 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each |
| E2368 | Power wheelchair component, drive wheel motor, replacement only |
| E2369 | Power wheelchair component, drive wheel gear box, replacement only |
| E2388 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each |
| A4457 | Enema tube, with or without adapter, any type, replacement only, each |
| K1013 | Enema tube, with or without adapter, any type, replacement only, each |
| K0462 | Temporary replacement for patient owned equipment being repaired, any type |
| K0046 | Elevating legrest, lower extension tube, replacement only, each |
| K0043 | Footrest, lower extension tube, replacement only, each |
| K0047 | Elevating legrest, upper hanger bracket, replacement only, each |
| K0044 | Footrest, upper hanger bracket, replacement only, each |
| K0018 | Detachable, adjustable height armrest, upper portion, replacement only, each |
| A8004 | Soft interface for helmet, replacement only |
| E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement |
| E0786 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) |
| Q0487 | Leads (pneumatic/electrical) for use with any type electric/pneumatic ventricular assist device, replacement only |
| A4453 | Rectal catheter for use with the manual pump-operated enema system, replacement only |
| E2205 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each |
| A4611 | Battery, heavy duty; replacement for patient owned ventilator |
| A4257 | Replacement lens shield cartridge for use with laser skin piercing device, each |
| E1358 | Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each |
| E1354 | Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each |
| A7045 | Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
