Transcript
Quickie 7RS
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October 2015 EIR11 Mark For:
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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.
a
Option #
HCPCS
Definition
Price
a
Option #
HCPCS
Definition
Price
1. FRAME
o
o
o
132WM89
K0005
Base Model Quickie 7RS - Welded (265 lbs) Use E1235 for sizes 14" or less
$2,795.00
Performance Package (No substitutions, discount given on separate line) 132QD01 Single Sided Fork $125.00 Ultra Lightweight Wheel $250.00 Schwalbe Marathon Plus Evolution $125.00 Compact Wheel Lock $125.00 Retail Value $625.00 Package Price $535.00 Ultra Lite Package (No substitutions, discount given on separate line) 132QD02 Ultra Lite Seat Sling $100.00 Ultra Lightweight Wheel $250.00 Schwalbe Speed Run Tire $125.00 Compact Wheel Lock $125.00 Retail Value $600.00 Package Price $510.00
Frame Angle See FIGURE 1. Measure from front frame to floor. 132FA1 75° o 132FA8 80° o 132FA2 85° o
Figure 1
Frame Inset Per Side See FIGURE 2. Frame Inset is the distance from the outside of the seat tube to the outside of the footrest. 132FF1 0" NC o 132FF2 1" (NA w/ 12" wide) NC o 132FF3 2" (NA with 12" & 13" wide) NC o Frame Style See FIGURE 3 . Measurement for set up. 132FS9 Standard NC o 132FS34 Classic NC o * Standard Frame - Seat Sling to front frame bend angle is 1.5" shorter than the classic position. Classic Frame - Traditional seat sling to front frame bend angle dimensions. Front of back cane post to front edge of seat sling will remain the same for both Standard and Classic.
Frame - Direct Mount Wheel Lock (Optional) No mounting clamp hardware. Only available with Compact Wheel Lock and 0° & 3° Camber. Not available with mountain tires or rear suspension. 132WH13 Direct Mount Wheel Lock o
NC NC NC
Figure 2
Figure 3
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 1
NC
2. SIZE / SEATING Seat Width See FIGURE 4 Measure from outside of seat tube to the outside of opposite seat tube.
o o o o o
132S3 132S4 132S5 132S6 132S7
12" 13" 14" 15" 16"
NC NC NC NC NC
o o o
132S8 132S9 132S10
o
132S48
17" 18" 19" 20"
NC NC NC
(E2201)
$500.00
Seating Systems Standard Seat Sling
o
132OP01
NC
o
132OP02
Available 14" to 18" Widths and Depths. Ultra Seat Sling will be ~1/4" less than requested seat height value.
o
132OP04
Omit Seat Sling
NC
o
132CU1
Cushion K0669 2" Cushion
$120.00
Ultra Seat Sling
$100.00
Seat Depth See FIGURE 5 Measure from front of back post to front edge of seat sling. Seat sling is 1" shorter than depth ordered, but actual seat depth will remain the same as ordered.
o o o o o
132SD5 132SD6 132SD7 132SD8 132SD9
12" 13" 14" 15" 16"
NC NC NC NC NC
o o o
132SD10 132SD11 132SD12
o
132SD13
Figure 5
17" 18" 19" 20"
NC NC NC
(E2203)
$550.00
Figure 6
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 with desired width and depth JAY Bundled Cushion o 132JC20 Cushion Name or Part # Price List Width: Depth:
3. CASTERS / SEAT HEIGHT Front Seat Height See FIGURE 6 Measure from the front of the seat rail to the floor. 132SH14 16.0" 132SH20 18.5" o o NC 132SH15 16.5" 132SH21 19.0" o o NC 132SH16 17.0" 132SH23 19.5" o o NC 132SH17 17.5" 132SH24 20.0" o o NC 132SH18 18.0" 132SH26 20.5" o o NC 132SH27 21.0" o
NC NC NC NC NC NC
Figure 7
o o o o o o
132CF74 132CF65 132CF69 132CF53 132CF54 132CF55
Caster Fork and Suspension Carbotecture Forks Multiple Position Multiple Position Single Sided Fork E1015 Frog Legs 0 weight to 100 lbs. E1015 Frog Legs 101 lbs. weight to 190 lbs. E1015 Frog Legs 191 lbs. weight to 265 lbs.
o o o o o o o o o o o o o
132CW1 132CW3 132CW31 132CW72 132CW44 132CW64 132CW5 132CW51 132CW6 132CW65 132CW7 132CW66 132CW34
o
132CW33
o o
132CW35 132CW68
Caster Wheels 3" Micro 4" Low Profile Polyurethane 4" Micro Lighted 4" x 1" Aluminum Poly 4" x 1.25 Semi Pneumatic 4" x 1.5" Aluminum Soft Roll 5" Low Profile Polyurethane 5" Micro Lighted 5" Soft Roll (Grey) -NA w/Frog Legs 5" x 1" Aluminum Poly 5" x 1.5" Semi Pneumatic 5" x 1.5" Aluminum Soft Roll 6" Poly E2214 6" Pneumatic E2215 6" x 1.5" Semi Pneumatic 6" x 1.5" Aluminum Soft Roll
NC NC $70.00 $100.00 $55.00 $175.00 NC $85.00 $85.00 $110.00 $85.00 $185.00 NC $75.00 $85.00 $195.00
Caster Housing Position NC NC $150.00 $425.00 $425.00 $425.00
See FIGURE 7 o
132LH01
o o
132LH02 132LH03
Setting 1 Suggested for 3" & 4" casters. For 2" Inset NA w/ setting 1
Setting 2 Suggested for 5" & 6" casters. Setting 3 NA w/ 6" casters Figure 7
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 2
NC NC NC
4. REAR WHEELS / SEAT HEIGHT Rear Seat Height
Rear Wheel Tire
RSH 13"-15.5" only w/ 20" Rear Wheel. RSH 15"-15.5" Only w/ 20, 22 or 24" w/HP Clincher Rear Wheel. RSH 16"-16.5" NA w/ 24, 25 & 26" Rear Wheels and Rear Suspension
o o o o o o o o o o o o o o o
132RH11 132RH12 132RH13 132RH14 132RH15 132RH16 132RH17 132RH18 132RH19 132RH26 132RH20 132RH27 132RH21 132RH37 132RH22
13.0" (NA w/ Rear Suspension) 13.5" (NA w/ Rear Suspension) 14.0" 14.5" 15.0" 15.5" 16.0" 16.5" 17.0" 17.5" 18.0" 18.5" 19.0" 19.5" 20.0" ( NA w/ Rear Suspension)
NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC
Front to Rear Seat Height Matrix 12" Seat Depth 2.5" Max Front to Rear Seat Hgt. 13", 14" Seat Depth 3.0" Max Front to Rear Seat Hgt. 15", 16" Seat Depth 3.5" Max Front to Rear Seat Hgt. 17", 18" Seat Depth 4.0" Max Front to Rear Seat Hgt. 19", 20" Seat Depth 4.5" Max Front to Rear Seat Hgt. Camber See FIGURE 8 o 132CI1 o 132CI2 o 132CI4
0° 3° 6º (NA w/ 5 spk MAG Wheels )
NC NC NC
Rear Wheel Ultra Lightweight only available w/ Aluminum Handrim. Contact Built 4 Me for Spinergy color options. NC o 132RW103 20" Mag Wheel 5 Spoke NC o 132RW104 22" Mag Wheel 5 Spoke NC o 132RW102 24" Mag Wheel 5 Spoke 20" Lite Spoke $200.00 o 132RW90 22" Lite Spoke $200.00 o 132RW91 24" Lite Spoke NC o 132RW92 25" Lite Spoke NC o 132RW93 26" Lite Spoke $80.00 o 132RW94 22" Ultra Lightweight Spoke Wheel $250.00 o 132RW06 24" Ultra Lightweight Spoke Wheel $250.00 o 132RW10 25" Ultra Lightweight Spoke Wheel $250.00 o 132RW16 22" Spinergy SPOX Black Spokes $795.00 o 132RW28 24" Spinergy SPOX Black Spokes $795.00 o 132RW95 25" Spinergy SPOX Black Spokes $795.00 o 132RW96 26" Spinergy SPOX Black Spokes $795.00 o 132RW97 22" Spinergy LX Black Spokes $995.00 o 132RW32 24" Spinergy LX Black Spokes $995.00 o 132RW98 25" Spinergy LX Black Spokes $995.00 o 132RW99 26" Spinergy LX Black Spokes $995.00 o 132RW40 24" Mountain $250.00 o 132RW50 24" Topolino Carbon Red Spk Whl $1,195.00 o 132RW107 24" Topolino Carbon Yellow Spk Whl $1,195.00 o 132RW108 25" Topolino Carbon Red Spk Whl $1,195.00 o 132RW109 25" Topolino Carbon Yellow Spk Whl $1,195.00 o 132RW110
o
132RT1
o
132RT2
o o
132RT3 132RT38
o
132RT39
o
132RT21
o
132RT27
o
132RT12
o
132RT28
E2211 E2212 E2211 E2213 E2218 E2218 E2211 E2212 E2211 E2212 E2211 E2212 E2211 E2212 E2211 E2212
Pneumatic
NC
Pneumatic Airless Insert
$80.00
Full Poly Tire SHOX Performance Poly
NC $95.00
High-Pressure Clincher Black
$95.00
Schwalbe Marathon Plus Evolution
$125.00
Knobby V-TRAK by Kenda
$95.00
Mountain Only available in 24"
$95.00
Schwalbe Speed Run Tire
$125.00
Handrim Natural Fit Handrims only available in 22", 24", & 25" Natural Fit w/ 5 spoke MAG only available in 24". See APPENDIX 11 for matrix Aluminum Anodized NC o 132HR1 Plastic Coated NA w/ 25" & 26" o 132HR4 $95.00 Lite Spoke Wheels Natural Fit Standard Grip $375.00 o 132HR22 Natural Fit - Super Grip $410.00 o 132HR23 Natural Fit - No Thumb Grip $375.00 o 132HR25 Natural Fit LT - Standard Grip $375.00 o 132HR30 $410.00 o 132HR31 Natural Fit LT - Super Grip Natural Fit LT - No Thumb Grip $375.00 o 132HR32 The Surge - Oval w/Gription Strip $375.00 o 132HR26 The Surge LT - Oval w/Gription Strip $395.00 o 132HR27 Q-Grip Neoprene Coated $315.00 o 132HR28 o Spinergy Flex Rim Only available 132HR24 $525.00 on Spinergy LX wheels 24" & 25" o Omit Handrim 132HR7 NC NA w/ Ultra Lightweight Wheels
o
132AX1
o
132AX13
Axle Quick Release Steel Quad Quick Release Steel Only available with Mountain Whls
NC $125.00
Axle Plate Active Rigid (.5" to 4") Adjustment range 1/2" o
132AL57
before and after in 1/4" increments except the .5" and 4" positions which are maxed
NC
Center of Gravity Preset Measure from front of back post to the center of rear axle. No additional rearward adjustment when .5" chosen. No additional forward adjustment when 4" chosen.
o o o o o o o o
132CC1 132CC2 132CC3 132CC4 132CC5 132CC6 132CC7 132CC8
.5" 1.0" 1.5" 2.0" 2.5" 3.0" 3.5" 4.0"
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 3
NC NC NC NC NC NC NC NC
4. REAR WHEELS / SEAT HEIGHT (CONT) Figure 8
5. WHEEL LOCKS Wheel Lock Not all wheel locks available in all seat depths, wheel size, or COG 132WL1 High Mount Push o 132WL2 High Mount Pull o 132WL45 Ergo Scissor o 132WL30 Compact o 132WL10 Omit Wheel Lock o
o NC NC NC $125.00 NC
Wheel Lock Options Do Not Mount
132WL12
Extension Handle Ext. handles only available with high mount push or pull wheel locks E0961 Extension Handle (Pair) o 132EH7
NC
$65.00
6. FOOTREST OPTIONS
o o o o o
132F229 132F274 132F276 132F325 132F51
Footrest Aluminum Tubular Aluminum Tubular w/ Snap On Cover K0040 Angle Adjustable Flip Back Angle Adjustable FB Carbon Fiber K0040 Platform Footrest
NC $30.00 $185.00 $185.00 $95.00
o
132F111
Ultra Lite Platform Footrest K0040 NA w/ 14" wide and 2" inset, NA w/ 19-20
$115.00
wide w/ 0" inset
o
132F323
Platform Carbon Fiber footrest Not available on 19"-20" W
$135.00
Adaptive Platform Spacer NA with Aluminum Tubular or Ultra Lite Platform. 132AD1 Adaptive Platform 2" Spacer o 132AD2 Adaptive Platform 4" Spacer o 132AD3 Adaptive Platform 6" Spacer o
o
132DI08
o o o o o o
132DI03 132DI04 132DI05 132DI07 132DI02 132DI06
Footrest Options High Mount Ext Tubes (NA w/ K0037 Tubular footrest) K0038 Leg Strap K0038 Extra Leg Strap Gel Hanger Cover Neoprene Impact Guards Wear Pads Position Plates NA for Tubular Footrest
$95.00 $95.00 $95.00
$55.00 $35.00 $35.00 $105.00 $85.00 $50.00 $50.00
7. BACKREST Back Type See FIGURE 9 Choose backrest position. 0° Equal is perpindicular to floor, + means forward NC Active Fixed Backrest o 132BT97 Setting o -4 o -2 o 0 o +2 o +4 Ultra Lightweight Aluminum Fixed Backrest Select back height. 8", 9", or 10" only available with omit push handles. 17", 18", or 19" only available with fold down push handles 132BB21 8" $75.00 132BB17 14" o o 132BB20 9" $75.00 132BB18 15" o o 132BB13 10" $75.00 132BB19 16" o o 132BB14 11" $75.00 132BB10 17" o o 132BB15 12" $75.00 132BB11 18" o o 132BB16 13" $75.00 132BB12 19" o o
o o
132QT01 132QT02
Towel Bar Standard Style - 4" Offset Low Profile - 2" Offset Limited w/Solid Backs, Not suggested with 19" & 20" wide
$75.00 $75.00 $75.00 $75.00 $75.00 $75.00
Figure 9
Push Handles Fold Down Push Handles NA w/ 8"10" fixed height NA w/ standard upholstery Omit Push Handles
o
132PH5
o
132PH2
o
132BU1
o
132BU70
E2611
o
132BU71
E2611
o
132BU14
NC $50.00
Backrest Upholstery Standard Upholstery Backrest Tension Adj Ballistic Nylon *Reference 186BU70 for billing
Backrest Tension Adj 3DX Vented *Reference 186BU71 for billing
Omit Back Upholstery
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 4
$100.00 NC
NC $315.00 $330.00 -$15.00
7. BACKREST (CONT) JAY J3 Back J3 Back o
To order a J3 Back please select Omit Back Upholstery. See J3 Back Order Form for Part #'s.
132JB01
Price List
Military Service Patches Only available on tension adjustable upholstery and when ordered separate through JAY J3 Back OF 132VU1 US Marines Patch o 132VU2 US Army Patch o 132VU3 US Navy Patch o 132VU4 US Air Force Patch o 132VU12 Coast Guard Patch o 132VU5 Purple Heart Patch o 132VU8 Purple Heart with Marines Patch o 132VU9 Purple Heart with Army Patch o 132VU10 Purple Heart with Navy Patch o 132VU11 Purple Heart with Air Force Patch o 132VU13 Purple Heart with Coast Guard Patch o
$90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $145.00 $145.00 $145.00 $145.00 $145.00
8. ARMREST / SIDEGUARDS
o
132AA11
Armrest - Height Adjustable Single Post Height Adjustable - Std E0973
o
132AA29
E0973
Range 8" - 13". Adjust in 1" increments
Single Post Height Adjustable - Low Range 6.5" - 10.5". Adjust in 1" increments
$285.00 $285.00
Side Guards Increases overall width of chair. Some interferance may exist w/ padded SA arms at lowest settings Not available w/Height Adjustable Arms 132SG33 K0108 Plastic Standard $125.00 o 132SG29 K0108 Plastic Low $125.00 o Aluminum NA w/High Push or Pull o 132SG35 K0108 $235.00 Wheel Locks
o o o o
132AM23 132AM21 132AM24 132AM22
Armpad - For Height Adjustable Desk Length (10") Classic Desk Length (10") Contour Full Length (14") Classic Full Length (14") Contour
NC NC NC NC
o
132SG36
K0108 Aluminum w/ Fender NA w/ High Push
o
132SG12
K0108
o
132SG41
K0108
or Pull Wheel Locks
Carbon Fiber NA w/ High Push or Pull Wheel Locks
Carbon Fiber Long w/LG Fender NA w/High Push or Pull Wheel Locks
$245.00 $450.00 $495.00
Side Guard - Color Option Available with Aluminum or Aluminum with Fender. Not applicable to carbon fiber options 132GE01 Black NC o 132GE02 Matching Frame- Standard Colors NC o 132GE03 Matching Frame- Custom Color $50.00 o
9. KEY OPTIONS AND ACCESSORIES
o
132AT37
Anti Tips E0971 Anti Tips (Pair)
Additional Pack Accessories Backpack - Adult Backpack - Kids Seat Pouch Black
$140.00
o o o
132A1 132A2 1321A01
$55.00 $50.00 $45.00
o
132A824
Positioning Belt E0978 Belt 2" Aircraft Buckle
$110.00
o
132A825
E0978 Belt 2" Aircraft Buckle Padded
$120.00
o
132A826
E0978 Belt 1.5" Auto Buckle Universal
$70.00
o
132A804
K0108 Positioning Belt Clamps Only
$50.00
Spoke Guards Only available with Lite spoke 1324A01 K0065 Quickie Black Spoke Guard o 1324A02 K0065 Quickie Clear Spoke Guard o
o o
132A2100 1328A21
Miscellaneous E2207 Crutch Holder Tool Kit
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 5
$115.00 $115.00
$195.00 $45.00
10. COLOR
o o o o o o o o o o o o o o o o o o o o o
132C140 132C118 132C2 132C141 132C10 132C38 132C36 132C14 132C35 132C142 132C143 132C44 132C126 132C144 132C147 132C148 132C103 132C114 132C145 132C113 132C8
Standard Frame Color Aztec Gold Bead Blast Black (Not avail as base w/Zebra) Black Cherry Black Opal Blue Opal Candy Blue Candy Purple Candy Red Electric Blue Evergreen Glossy White - Limited Edition Glow Green Apple Hot Sparkle Pink Mauve Pink Rootbeer Sparkle Silver Sunrise Orange Titanium Color Paint Yellow
NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC
o o o o o
132C116 132C151 132C150 132C149 132C152
Matte Frame Colors Matte Black Matte Black Cherry Matte Electric Blue Matte Evergreen Matte Purple
NC NC NC NC NC
Frame Graphics Graphic designs on front frame tubes. NA with transit & Matte Black Cherry. NA w short height frames 1328A24 $295.00 o Bloom 1328A25 $295.00 o Dragon 1328A26 $295.00 o Ghost Flames 1328A27 $295.00 o Retro Squares 1328A28 $295.00 o Tribal Bloom design
Dragon design
Ghost Flames design
Retro Squares design
o o o
132C112 132C43 132C42
Custom Frame Color Desert Camouflage Mossy Oak Camouflage Stars & Stripes Zebra (Choose above base color) Std
$295.00 $295.00 $295.00
o
132C108
with White unless above base paint is chosen NA w/ Blk, Matte Black, Blk Opal, Titanium or Bead Blast)
$295.00
Anodized Color Package Forks, Backcane Bracket, Rear Axle Clamp. NA w/ Frog Legs and Carbotecture forks 132EB07 Black o 132EB08 Blue o 132EB09 Lime Green o 132EB10 Purple o 132EB11 Red o 132EB12 Ti Grey o 132EB13 Gold o Built For Me To inquire about any unique customization for Quickie products, contact: Phone: (800) 333 - 4000, Option #3, Fax: (800) 333 9011
Commonly Requested Options Include: Swing Away Knee Adductors for Oval Tubing One Arm Drive Unilateral Wheel Locks Seat Pan Caster Pin Lock Grade Aids Active Rigid w/Folding Back Spinergy Color Spokes Custom color casters (Alum sofroll only) 24",25" Glance wheels Lifestyle custom paint package (see website)
Tribal design
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 6
NC $150.00 $150.00 $150.00 $150.00 $150.00 $150.00
11. APPENDIX
Handrim & Wheel Matrix
Wheels Handrims Aluminum Anodized Plastic Coat Natural Fit - Standard Grip Natural Fit - No Thumb Grip Natural Fit - Super Grip Natural Fit LT - Std Grip Natural Fit LT - Super Grip Natural Fit LT - No Thumb Grip Surge - Oval w/Gription Strip Surge LT - Oval w/Gription Strip Q Grip Neoprene Coated Spinergy Flex Rim Omit Handrim
5 Spoke Mag
Lite Spoke
Ultra Lightweight
Spinergy
Mountain
Topolino
20,22,24 20,22,24 24 24 24 24 24 24 24 24 N/A N/A 20,22,24
20,22,24,26 22,24 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 24,25 N/A N/A
22,24,25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 22,24,25,26 24,25 24,25 22,24,25,26
24 24 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 24
24,25 24,25 24,25 24,25 24,25 24,25 24,25 24,25 24,25 24,25 24,25 N/A 24,25
Customer Service: 800-333-4000 Fax: 800-300-7502 Email:
[email protected] www.sunrisemedical.com Specifications are subject to change without notice. Copyright © 2011 Sunrise Medical (US) LLC. 7RS, MK-100205 REV A Page 7
