QUICKIE P222 SE BD/SD Solid Seat (No Power or Single Power Seating Options) EIPW2 - Effective July 2014

Transcription

1 QUICKIE P222 SE BD/SD Solid Seat (No Power or Single Power Seating Options) EIPW2 - Effective July 2014 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions. The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy. Option # HCPCS Definition Price Option # HCPCS Definition Price 1. QUICKIE P222 SE GROUP 4 CATEGORY Quickie P222 SE 116PC19 K0877 Quickie P222 SE BD $8, (Solid Seat - No Power) 116PC1 K0877 Quickie P222 SE SD $8, (solid seat/single power seat option) 116PC3 K0877 Quickie P222 SE (Base Only) $8, PF8 Performance Package 8.5 (8.5 mph / 350 LB Capacity) (Max. Wt. cap. For CG Tilt 250lbs) 116ST2 116LB3 116LB4 116LI04 Power CG Tilt (53 Tilt) See electronic section for control options E1002 P222 SE Power CG Tilt Max. Wt. capacity for CG Tilt 250lbs. Not available with base only purchase. Tilt Weight Capacity Up to 175 lb Weight Capacity 176 to 250 lb Weight Capacity LED Light Package (Rnet only) LED Light Package (NA Base only) $5, $1, FRAME COLOR OPTIONS Standard Colors 116C103 Rootbeer 116C140 Aztec Gold 116C114 Sparkle Silver 116C2 Black (Not avail as base w/zebra) 116C145 Sunrise Orange 116C141 Black Cherry 116C113 Titanium Color Paint 116C10 Black Opal 116C8 Yellow 116C38 Blue Opal Standard Matte Colors 116C36 Candy Blue 116C116 Matte Black 116C14 Candy Purple 116C151 Matte Black Cherry 116C35 Candy Red 116C152 Matte Purple 116C142 Electric Blue 116C150 Matte Electric Blue 116C143 Evergreen 116C149 Matte Evergreen 116C126 Glow Custom Colors 116C144 Green Apple 116C43 Mossy Oak Camouflage $ C147 Hot Sparkle Pink 116C42 Stars and Stripes $ C148 Mauve Pink 116C108 Zebra (Choose base color above: White Std, n/a black) $ BATTERIES and CHARGERS Batteries (Gel Cells) Battery Charger 116AG03 E2363 GP24 Std Post Pair w/strap $ BJ19-8A Dual Mode (Compact) CTE Omit batteries Includes harness & straps for 116AG05-116BJ3 - standard post batteries Omit Charger -$40.00 Page 1

2 4. SEATING 116S5 14" (not avail. w/ 19" & 20" seat depths) 116S6 116S7 Seat Width 15" (not avail. w/ 19" & 20" seat depths) 16" (not avail. w/19" & 20" seat depths and dual post arms ) 116HT10 116HT12 Seat Height 18" (not avail. w/long ext. tubes; add 1.75" for CG Tilt) 19" ( add 1.75" for CG Tilt) 116S8 116S9 116S10 116S11 116S27 116S28 17" 18" 19" 20" 22" (not avail. w/cg Power Tilt; Base width is 26.5" w/ 12"x4" tires) 24" (not avail. w/cg Power Tilt; Base width is 26.5" w/ 12"x4" tires) 116HT14 116SL2 116SL5 116SL6 20" ( add 1.75" for CG Tilt) Seat Base Type Seat Sling Parapak (n/a w/cg Power Tilt) Seat Pan Aluminum Omit Seat Sling -$15.00 Seat Depth 116SD7 14" 116SD8 15" 116SD9 16" 116SD10 17" 116SD11 18" 116SD12 19" 116SD73 20" 5. SEAT CUSHIONS Standard Cushion 116CU1 2" Cushion. $ JAY Cushions (Optional) To order any JAY cushions on-chair, please see the JAY price list. Cushion name or part number must be filled out w/ desired width & depth JAY Bundled Cushion 116JC20 Cushion Name or Part # Price List Width: Depth: 6. BACKS 116BT3 116BU27 K0669 Backrest Type 116BT74 Folding Angle Adj. Backrest $ BU26 Non-Folding Angle Adj. Backrest Back Upholstery Parapak Upholstery (select back height) Jay Solid Backrest (select back height; Decrease seat depth by 1") 116BP1 Straight Back Post 116B41 21" 116BP41 8 Bend Back Post - Not avail. w/ Jay $ B42 22" Solid backrest 116B43 23" Jay 3 Option 116JB01 - Jay J3 (select OMIT Back Uph above) 116BU14 Omit Back Upholstery -$15.00 Back Post Type See J3 OF 116B4 116B8 116B13 116B36 116B37 116B38 116B39 116B40 116B44 Medium 17.5" 17" 18" 19" 20" 24" Back Height (Upholstery) Low 15.5" Tall 19.5" Jay Solid Backrest Back Height 16" Page 2

3 7. POSTURAL SUPPORTS Headrest (Incl. on Specified Specialty Controls) JAY Solid Backrest Only Headrest (8" x 4.5") 116HE65 E0955 Curved Headrest 8" x 4.5") $ Pad Style JAY Solid Backrest Only Lateral Pads Curved 116KE1 E0956 Lateral Pad Curved Pair $ $ MH1 Headrest (9" x 4.5") Removable Mount $ HE66 E0955 Curved Headrest 9" x 4.5") 116LM1 Swing Away Mount Pair Lateral Pads Straight 116KE2 E0956 Lateral Pad Straight Pair $ $ $ MH1 Removable Mount 116LM1 Swing Away Mount Pair $ Pad Size 116KD1 Lateral Support 3" x 6" (pr) 116KD2 Lateral Support 4" x 5" (pr) 116KD3 Lateral Support 4" x 6" (pr) 116KD4 Omit Lateral Support -$ ARMRESTS Armpads (Pair) Desk Length Waterfall (10") (n/a. w/ sgl. post Armrest w/jay Solid Backrest) Armrest (Pair) Single Post Height Adj. Armrests are on Power CG Tilt 116AM7 116AA131 Dual Post Flip Back Short (14-16in) 116AA132 Dual Post Flip Back Long (16-20in) 116AM8 116AA51 E0973 Dual Post Hgt Adj - Short (14-16 in) $ AA52 E0973 Dual Post Hgt Adj - Long (16-20 in) $ AA8 E0973 Single Post Height Adjustable $ AA14 Omit Armrests and mounts 116AM1 Desk Length Standard (10") Full Length Waterfall (14") (n/a. w/ sgl. post Armrest w/jay Solid Backrest) 116AM2 Full Length Standard (14") 9. FOOTRESTS 116H12 116H2 116H13 116H37 116H16 116H32 116E1 116E2 116E5 E0990 Hanger (Pair) 70 Fixed Straight (only avail. w/ solid 1-piece footplate.; n/a. w/ CG Power Tilt) 70 Swing Away Hanger (Not. Avail w/ solid 1- piece footplate.) 80 Fixed Tapered (only avail. w/ solid 1- piece footplate.; n/a. w/ CG Power Tilt) 90 Swing Away (Only available with kids angle adjustable footplates) Elevating Hanger (Req. aluminum footplate or angle adj.) Omit Hangers Extension Tube Not available with 90 hangers. Short (13" - 15") Medium (15" - 18") Not available with multi-position footplate. Long (18" - 20") Not available with 70 or 80 hangers. $ $15.00 Footrest (Pair) Composite w/ Heel Loops Not Avail. w/ fixed hangers 116F1 116HL1 - - Composite Footplate Heel Loop $30.00 Adult Angle Adjust. w/ heel loop $ Not Avail. w/ fixed hangers 116F282 K0040 Adult Angle Adj. Footplate $ HL10 Heel Loops Kids Angle Adjust. w/ heel loop Only avail. w/ 90 hangers 116F283 K0040 Kids Angle Adj. Footplate 116LS13 116F287 K0042 Aluminum (Only avail. with ELRs) 116F60 Solid One Piece not avail. w/power CG Tilt 116F58 116HL10 116F47 116HL10 116F6 Two-piece Locking w/heel Loop K0040 Two-piece Locking Footplate Multi-Positional w/heel Loop Not Avail. w/ fixed hangers K0040 Leg Straps Heel Loop Multi-Positional Footplate Heel Loop Omit Foot Plate w/heel Loop $ $ $ $ $ $ LS3 K0038 Footrest Accessories Extra Leg Strap, Black Page 3

4 10. ELECTRONICS 116ER04 R-Net Non-Expandable Drive Control (120A) R-Net Expandable Drive Control Upgrade (120A) $ EM02 116EX03 116EX04 Drive Control Options E2377 Expandable 120AController - R-net $ EM03 E2313 Harnessing for 120A Expandable Controller $ R-net Joystick (for expandable electronics) 116J70 - Std LED Joystick for Expandable Ctrls 116J108 Joystick w/stereo Jacks & Color Display $ EM01 Requires expandable controls and OMNI. All packages must be added to the specialty control on-chair package. Not available with Upholstered backs. Quickie Sip n' Puff System 116ID34 E2325 Switch Mount Bracket Single Switch Mount Bracket Dual toggle switch mount bracket 4-way toggle switch mount bracket. Specialty Driver Control Options $2, Sip N' Puff Kit $1, J88 116JM10-116II01 116IH1 ASL Head Array Package (Adult) 116II02 ASL Head Array Package (Ped) 116II03 Height Adjustable. Switch-It Head Array Package (Adult) 116HM1 - Right Side Mount 116II04 E2330 Switch-it Proximity Head Array $3, JH1 Switch-It Head Array Package (Pediatric) Joystick Handle (Optional) 116II05 E2330 Switch-it Proximity Head Array $3, JH2 E2323 Foam Ball Handle $80.00 Quickie Proportional Chin Control Package $4, JH4 - E2323 Joystick W/Toggle, Spd Pot, Stereo Jacks & Color Display Joystick Mount (Fixed or Swing Away) Fixed Mount Joystick Mount (Location) $ J95 - Omit JS for use with OMNI 116JM11 Swing Away Mount $ HM2 - Left Side Mount Ball Handle $80.00 E2323 T-Handle $ ID45 E0955 E2330 E2330 Headrest Headrest Removable Mount ASL Proximity Head Array (Ped) Headrest Removable Mount Headrest Removable Mount Headrest Removable Mount E2326 Sip n' Puff Tubing and Hardware $ ASL Proximity Head Array (Adult) $3, $3, Headrest Removable Mount E2312 Proportional Joystick $4, JH6 E2323 Goalpost $ IJ03 ASL Proportonal S/A Joystick Mount 116ON1 - R-net OMNI and Output Options (For expandable controls, choose all that apply) Rnet OMNI Input Control Module and display with built in Infrared and armrest mount. Choose mount below. (required for Specialty Input Devices.) $1, SW1 Buddy Button Switch $ DN2 Mounting Location: Left Back Cane 116SW4 Micro Light Switch $ PR5 R-net PC Programmer with Dongle 116DS03 116DS04 116SW22 116SW6 116SW2 116SW9 116SW24 116SW21 116SW23 Swing Away Left Side OMNI Mount $ Swing Away Right Side OMNI Mount $ Attendant Control Switch inputs for Joysticks or OMNI Drive or Mode / Profile Control Stereo to 2 Mono Splitter Ribbon Switch Disc Switch OMNI Mount (If used with Joystick must be mounted opposite side) Wobble Switch $ Egg Switch-Black Dual toggle switch only 4-way toggle switch w/5th button DB9 Connector. $65.00 $ $ $ $ $ A02 116DN1 116PR6 E2331 Attendant Control for R-net $1, Attendant Mounting location Mounting location: Right Back Cane Electronic Programmers DTT Rnet cables included. $ $1, Page 4

5 11. POWERED SEATING Powered Seating Control Method (TILT) (For use with power seating actuators. Switch activation is stand-alone and does not require expandable or thru-drive electronics. 116EO10 116EO11 Switch Mount (for use with switch control powered seating) 116EY01 - Switch Mount Right 116EY02 - Switch Mount Left Switch Control 1 actuator w/dual toggle and mount. (For operating Tilt) Switch Control 1 actuator w/buddy button & mount. (For operating Tilt) Powered Seating Thru-drive Control Method. "Assignable Button" feature listed below (available on Rnet Systems) allows for direct "shortcut" access to various seating functions via joystick buttons. Functions accessed by depressing the button for more than 1 second. By selecting the thru-drive w/assignable button the chair will be pre-programmed with seating functions assigned to buttons on the joystick. Assignments can be changed via PC Dongle. 116EO15 116EO13 E2310 E2310 Thru-Drive 1 Actuator options. Thru Drive 1 Actuator w/out assignable buttons. For use with R-net (For operating Tilt thru Joystick.) Thru Drive 1 Actuator with assignable buttons. (For operating Tilt thru Joystick and/or Joystick. Requires R-net.) $1, $1, WHEELS 116DW5 116DW6 116DW27 116DW28 116DT1 116DT2 Drive Wheel Type 12" x 4" Pneumatic Tire 12" x 4" Pneumatic w/ins. 12" x 3" Pneumatic Tire 12" x 3" Pneumatic w/ins. The 12" x 3" wheel size reduces the overall width specifiation by approx. 2" and also alters the overall appearance of the chair. Knobby Tire Drive Wheel Tire V Groove Tire (n/a with 12"x3" tires) Wheel Lock 116WL26 Push to Lock $ WC1 Do Not Mount Wheel Lock Extension Handle Wheel-lock extensions handles are not available with 22" & 24" seats 116EH1 E0961 Extension Handle 6" $ CASTERS Front Caster Wheel 116CW17 116CW20 8" Pneumatic 8" Airless with Insert 116CW29 9" Pneumatic (not avail. With Suspension $90.00 Fork) 116CW28 9" Pneumatic w/insert (not avail. With Suspension Fork) $ CF31 116CF35 116CF36 Suspension Fork Options are only available with 8" casters. E1016 E1016 Caster Fork Solid Caster Fork Suspension Fork Med lbs. (Only avail. w/ 8" front casters) Suspension Fork Heavy lbs. (Only avail. w/ 8" front casters) $ $ Page 5

6 116CV2 116AX1 116AX11 116RW1 116RW2 116RW7 14. MANUAL CONVERSION KIT Manual Wheelchair Conversion Kit $1, Axle 116HR1 116HR4 Quick Release 116HR7 Quad Quick Release $95.00 Wheel Rim/Size 116HR8 24" Mag 24" Spoke (not avail w/14" seat width) Omit Manual Rear Wheel -$55.00 Hand Rim Aluminum Anodized Plastic Coated Omit handrim Projections 8 Oblique $ $ RT1 E2211 E RT2 116RT3 116RT4 116RT6 E2211 E2213 E2218 E2211 E2212 Rear Wheel Tire Pneumatic Pneumatic Airless Insert Full Polyurethane Low Polyurethane High Pressure Clincher (not available with mag wheels) $85.00 $ WC2 116WC1 116ET1 E0961 Wheel Locks Push to Lock Wheel Lock $45.00 Do not mount 6" Extension Handles $ ACCESSORIES Backpack 116A1 Black Utility Backpack 116A2 Black/Charcoal Kids Seat Pouch 116A8 Black/Charcoal Positioning Belt 116A13 E0978 2" Aircraft Buckle Padded 116A12 E0978 2" Aircraft Buckle 116A142 E " Auto Buckle $ $ $ A32 116A82105A1 116A33 116A114 E0950 E0950 Wheel Chair Tray Table $55.00 Requires standard armpads to mount. 116A31 E0950 Medium Tuffak (15"-17") Requires std. $ armpads to mount tray Large Tuffak (18"-20") Requires std. armpads to mount tray X-Large Tuffak (21"-22") Requires std. armpads to mount tray Miscellaneous Caddy Dual Post Armrest Pouch $ $ $25.00 Weight: Overall Width Overall Length: Range: Top Speed: Additional Specifications 115 lbs (without batteries) Using 12" x 4" Drive Tire: 24.5" using 14"-20" Seat Width 26.5" using 22" and 24" Seat Width 31.5" (Without Footrests) Deduct 2" if using 12" x 3" Tire As far as 30 miles (With Group 24 batteries depending on conditions and user environment) Up to 8.5 mph Page 6