Product

Description

Model

Number

HCPCS/

Medicare Code

PUMPS

Sequential/Gradient 4 Chamber Pump

SC-2004

E0651

Sequential/Gradient/Calibrated

4 Chamber Pump

SC-3004

E0652

Sequential/Gradient/Calibrated

8 Chamber Pump

SC-3008

E0652

GARMENTS

4 Chamber

Pneumatic Appliance - Standard 4 Chamber Arm with Shoulder

GS-3035-SH

E0668

Pneumatic Appliance - Standard 4 Chamber Arm - Small, Medium or Large

GS-3035-S, M or L

E0668

Pneumatic Appliance - Standard 4 Chamber Half Leg

GS-3045-H

E0669

Pneumatic Appliance - Standard 4 Chamber Leg - Small, Medium or Large

GS-3045-S, M or L

E0667

Pneumatic Appliance - Adjustable 4 Chamber Half Leg

GA-3045-H

E0669

Pneumatic Appliance - Adjustable 4 Chamber Small, Medium or Large 

GA-3045-S, M or L

E0667

Pneumatic Appliance - Custom 4 Chamber Arm

CG-3035-C

E0667

Pneumatic Appliance - Custom 4 Chamber Leg

CG-3045-C

E0667

8 Chamber

Pneumatic Appliance - Standard 8 Chamber Arm w/Shoulder

G8-3035-SH

E0668

Pneumatic Appliance - Standard 8 Chamber Arm 

G8-3035-S, M or L

E0668

Pneumatic Appliance - Standard 8 Chamber Leg 

G8-3045-S, M or L

E0667

Pneumatic Appliance - Adjustable 8 Chamber Small, Medium or Large 

A8-3045-S, M or L

E0667

Pneumatic Appliance - Custom 8 Chamber Arm

C8-3035-C

E0667

Pneumatic Appliance - Custom 8 Chamber Leg

C8-3045C

E0668