| Short Descr | Urine ost pouch w faucet/tap |
| Coverage | Carrier Priced |
| 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 |
| BETOS | D1F – Prosthetic/Orthotic devices |
| TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics |
| Added Date | 1/1/2004 |
| 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 | 1 |
| MUE | Not applicable/unspecified. |
| 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 |
| GA | Waiver of liability statement issued as required by payer policy, individual case |
| CR | Catastrophe/disaster related |
| CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) |
| EY | No physician or other licensed health care provider order for this item or service |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit |
| GZ | Item or service expected to be denied as not reasonable and necessary |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2004-01-01 | Added | Code added 1/1/2004 |