Ultimex cushions available based upon specific HCPCS code

The following are the current SADMERC Product Classifications and corresponding Medicare Allowables for ULTIMEX cushions:

HCPCS
Codes
01/01/07

Wheelchair Cushion Descriptor

Ultimex Product Assignments

New Purchase
Allowable
01-01-07

E2601

 General Use Wheelchair Seat Cushion, width less than 22 inches, any depth COMFORT Cushion

GEL THIN Cushion

$61.16

E2602

 General Use Wheelchair Seat Cushion, width 22 inches or greater, any depth COMFORT Cushion

GEL THIN Cushion

$119.40

E2611

 General Use Back Cushion, width less then 22 inches BACK SUPPORT Cushion

$312.35

E2612

 General Use Back Cushion, width 22 inches or greater BACK SUPPORT Cushion

$422.54

E2603

 Skin Protection Wheelchair Cushion, width less than 22 inches, any depth DURO-GEL Cushion

DURO-GEL-THIN Cushion

SOFLEX Cushion

$151.59

K0734

 Adjustable Skin Protection Wheelchair Cushion, width less than 22 inches AIR-CELL DUAL Cushion (down-coded)

AIR-FOAM Cushion (down-coded)

$331.47

E2604

 Skin Protection Wheelchair Cushion, width 22 inches or greater, any depth DURO-GEL, DURO-GEL-THIN,

and SOFLEX Cushion

$188.41

K0735

 Adjustable Skin Protection Wheelchair Cushion, width 22" or greater, any depth AIR-CELL Cushion

AIR-FOAM Cushion (combo)

$421.78

E2605

 Positioning Wheelchair Seat Cushion, width less than 22 inches, any depth DURO-GEL, DURO-GEL-THIN,

and SOFLEX Cushion

$269.17

E2606

 Positioning Wheelchair Seat Cushion, width 22 inches or greater, any depth DURO-GEL, DURO-GEL-THIN,

and SOFLEX Cushion

$419.93

E2607

 Skin Protection and Positioning Wheelchair Cushion, width less than 22" DURO-GEL, DURO-GEL-THIN,

and SOFLEX Cushion

$289.85

K0736

Adjustable Skin Protection and Positioning Wheelchair Cushion, width less than 22" AIR-CELL DUAL Cushion

$334.19

E2608

 Skin Protection and Positioning Wheelchair Cushion, width 22" or greater DURO-GEL, DURO-GEL-THIN,

and SOFLEX Cushion

$348.09

K0737

 Adjustable Skin Protection and Positioning Wheelchair Cushion, width 22" or greater AIR-CELL DUAL Cushion

$423.06

K0019

 Armpad (each) ARMREST Cushion

$17.24

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