Gunnell - Seating & Positioning HCPCS Order Form

Seating & Positioning HCPCS
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Choose Your Products to Begin Customization*

Occipital CradlesHead Positioning Mounting HardwareSeating PackagesGel CushionsHip PadsAbductorsAbductor HardwareReplacements PartsPositioning AccessoriesChest StrapsH-HarnessBack Rest Packages

Symmetric-Designs APEX Head Supports

Code:E0955
Symmetric-Designs APEX Head Supports
NOTE: Requires purchase of a Head Positioning Mount Hardware separately
Select Color
Symmetric-DesignsAPEX Head Supports Total
Extension for Positive Locking Multi-Axis Headrest Hardware*
Code: E0966 - Extensions Available for Multi-axis Offset Headrest Hardware Just Ask!
Headrest Hardware Total
Occipital Cradles Without Hardware
Occipital Cradles Without Hardware*
Codes: E0955
Occipital Cradles Without Hardware Total
Symmetric-Designs Savant Head Positioning

Code:E0955
Symmetric-Designs Savant Head Positioning
Symmetric-Designs Savant Head Positioning Total

Symmetric-Designs Head Positioning Mounting Hardware

Code:E1028
NOTE: CHAL/M/S - Required for all Gunnell Wheelchairs with head positioning hardware
Select Head Positioning Mounting Hardware*
Code: E1028
Head Positioning Mounting Hardware Total

Seating Packages
ABS Seat Pan*
Code: E1028 - Required for any cushion selection
ABS Seat Pan Hardware
Choose Your Package to Begin Customization*

Solid Seat*
Code/s: E2607 or E2608 and/or K0108

Anti-Thrust Seat Cushion*
NOTE: 2” base with additional 2” thrust platform = 4”at front edge - Code/s: E2607 or E2608 and/or K0108

Wedge Seat Cushion*
Code/s: E2607 or E2608 and/or K0108

I-Modification Seat*
Code/s: E2607 or E2608 and/or K0108

Contoured Seat*
Code/s: E2607 or E2608 and/or K0108
Seat Total
NOTE: HCPCS Codes provided were determined by SADMERC and/or interpretations of the codes. Proper use of codes does not ensure coverage or payment. Please contact a Medicare professional for further assistance.
Seating Configuration Chart

A (center) = Attachment holes for an Abducter Bracket B = Attachment holes for Hip Pad Brackets and/or Lateral Support Brackets
Seating Hardware
Choose Your Seating Hardware K0108*

QRSH Quick Release Seating Hardware $222.75SAH Standard Seating Hardware $189399 Custom Seating Hardware Quote Only
Seating Hardware Total
Custom Hardware is available upon request. Please Ask!
Trays
531 Polycarbonate Tray with Black PVC Rim w/Straps*
Code/s: E0950 and/or K0108
Tray Total
Add Ons

⁫ 532 Polycarbonate Tray Trough Style Hardware $675⁫ 533 Polycarbonate Tray EZ Lock Clamp Hardware $810⁫ 534T Polycarbonate Tray with Padding $1,059.75
⁫ 532 Polycarbonate Tray Trough Style Hardware $675 Total
533 Polycarbonate Tray EZ Lock Clamp Hardware $810 Total
534T Polycarbonate Tray with Padding $1,059.75 Total
Tray Hardware
Hardware*

⁫ 532 Polycarbonate Tray Trough Style Hardware $675⁫ 533 Polycarbonate Tray EZ Lock Clamp Hardware $810⁫ 534T Polycarbonate Tray with Padding $1,059.75
⁫ 532 Polycarbonate Tray Trough Style Hardware Only $675 Total
533 Polycarbonate Tray EZ Lock Clamp Hardware Only $810 Total
534T Polycarbonate Tray with Padding $1,059.75 Total

Hip Pads and Lateral Supports
Symmetric-Designs LUB Support Systems*
Code: E0956
Symmetric-Designs LUB Support Systems Total

Hip Pad Dimensions*

Rows	Dimensions
H
L

656XN Hip Pads without Hardware $202.50/pair Total
⁫656X Hip Pads with Hardware $151.20/pair
NOTE: HCPCS Codes provided were determined by SADMERC and/or interpretations of the codes. Proper use of codes does not ensure coverage or payment. Please contact a Medicare professional for further assistance.
Hip Pad Hardware*
Code: E0956
⁫656X Hip Pads with Hardware Only $151.20/pair

Abductors

(All Abduction Systems Use ¼-20 Bolts & Nuts)
Choose Your Package*
Code/s: E0957 and E1028
Flip Down Abduction System with Depth Adjustment*
Code/s: E0957 and E1028
Regular Abduction System with Depth Adjustment*
Code/s: E0957 and E1028
Laterally Adjustable Regular Abduction System with Depth Adjustment*
Code/s: E0957 and E1028
Regular Scissor Board Abduction System with Depth Adjustment*
Code/s: E0957 and E1028
Regular Adduction System with Depth Adjustment*
Code/s: E0957 and E1028
Laterally Adjustable Regular Adduction System with Depth Adjustment*
Code/s: E0957 and E1028
NOTE: HCPCS Codes provided were determined by SADMERC and/or interpretations of the codes. Proper use of codes does not ensure coverage or payment. Please contact a Medicare professional for further assistance.
Abductor Total

Regular Scissor Board Abduction System with Depth Adjustment*
Code/s: E0957 and E1028
Abductor Hardware Total

Choose Abductor Replacement Parts*

S067 Abductor/Adductor Fleece Cover $50.42S072 Scissor Board Fleece Cover $50.42S068 Abductor/Adductor Dartex Cover $102.40S070 Scissor Board Dartex Cover $102.40SPU102 Med. Abductor Pad $104.36
S067 Abductor/Adductor Fleece Cover Quantity*
S072 Scissor Board Fleece Cover Quantity*
S068 Abductor/Adductor Dartex Cover Quantity*
S070 Scissor Board Dartex Cover Quantity*
SPU102 Med. Abductor Pad Quantity*
S067 Abductor/Adductor Fleece Cover $50.42 Total
S072 Scissor Board Fleece Cover $50.42 Total
S068 Abductor/Adductor Dartex Cover $102.40 Total
S070 Scissor Board Dartex Cover $102.40 Total
SPU102 Med. Abductor Pad $104.36 Total

Lap Belts

All positioning belts shown with pads andattach to chair with grommets (All Lap Belts attached using¼-20 Bolts, Nuts, and/or T-Nuts)
Choose Your Lap Belt Package to Customize Option*
651 & 652 Single Closure Lap Belts - 600 (not pictured)*
Code: E0960
601 & 602 4 Point Single Closure Lap Belts*
Code: E0960
Add-ons

337 Add Hip Belt Pad $40.50LH600L Bodypoint Padded Leg Harness $312.15
Hip Belt Total
Hip Belt Add-on Total
Bodypoint Add-on Total

Chest Straps

D-Ring used with Chest Strap Ring Styleand 1/2” Pad and each can be made tocustom lengths.
Chest Straps
Chest Strap Total

H-Harness
H-Harness
S035
H-Harness Total
NOTE: HCPCS Codes provided were determined by SADMERC and/or interpretations of the codes. Proper use of codes does not ensure coverage or payment. Please contact a Medicare professional for further assistance.

Back Rest Packages
ABS Back Rest Pan
Required for any Solid Flat Back Rest selection
ABS Back Rest Pan Total
Choose Your Package to Begin Customization*
Solid Flat Back Rests
Code/s: E2613 or 2614 and/or K0108

Symmetric-Designs Freeform Custom Contour Seating
Code: E2617 Complete Kits include mounting hardware, cover, and adjustment tooling
Bi-Angular Back*
Code/s: E2613 or 2614 and/or K0108

Curved Back*
Code/s: E2613 or 2614 and/or K0108

I-Modification Back*
Code/s: E2613 or 2614 and/or K0108

Back Rest Total
Planar Back Configuration Chart

B = Attachment holes for Torso/Lateral Pad Brackets 10-32 T-NutsC = Attachment holes for an Occipital Head Cradle Bracket
Planar Hardware
Choose Planar Hardware*
Code: K0108
Planar Hardware Total
NOTE: HCPCS Codes provided were determined by SADMERC and/or interpretations of the codes. Proper use of codes does not ensure coverage or payment. Please contact a Medicare professional for further assistance.
Planar Hardware
Choose Planar Hardware Code: K0108

QRBH Quick Release Back Hardware $330.75BAH Standard Back Hardware $220.59399 Custom Seating Hardware Quote Only
Custom Hardware is available upon request. Please Ask!
Planar Hardware Only Total
NOTE: HCPCS Codes provided were determined by SADMERC and/or interpretations of the codes. Proper use of codes does not ensure coverage or payment. Please contact a Medicare professional for further assistance.

Footnotes
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Email: support@gunnell-inc.com • Tel: 800-551-0055 • Fax: 800-794-5483

Specifications and prices are subject to change without notice.
Should be Empty:

Rows	Dimensions
Width
Depth

Rows	Dimensions
Width
Depth

Rows	Dimensions
Width
Height

Seating & Positioning HCPCS

Symmetric-Designs APEX Head Supports

Occipital Cradles Without Hardware

Symmetric-Designs Savant Head Positioning

Symmetric-Designs Head Positioning Mounting Hardware

Seating Packages

Seating Configuration Chart

Seating Hardware

Trays

Tray Hardware

Gel Cushions

Hip Pads and Lateral Supports

Abductors

Lap Belts

Chest Straps

H-Harness

Back Rest Packages

Planar Back Configuration Chart

Planar Hardware

Planar Hardware

Footnotes