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Official Description

Ostomy pouch, drainable, with faceplate attached, plastic, each
Short Descr Drainable plastic pch w fcpl
Coverage Special coverage instructions apply
Pricing Indicator(s) 37 – Supplies And Surgical Dressings - Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
MCM 2130
BETOS D1F – Prosthetic/Orthotic devices
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/2000
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Packaged into APC Rates
MUE 2
MUE Not applicable/unspecified.
IOM 100-02, 15, 120
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
GW Service not related to the hospice patient's terminal condition
NU New equipment
Date
Action
Notes
2000-01-01 Added Code added 1/1/2000