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Official Description

Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each
Short Descr Pwc harness, expand control
Coverage Carrier Priced
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1D – Wheelchairs
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2008
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
KX Requirements specified in the medical policy have been met
RR Rental (use the 'rr' modifier when dme is to be rented)
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
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
KI Dmepos item, second or third month rental
KH Dmepos item, initial claim, purchase or first month rental
UE Used durable medical equipment
KY Dmepos item subject to dmepos competitive bidding program number 5
GA Waiver of liability statement issued as required by payer policy, individual case
BO Orally administered nutrition, not by feeding tube
BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item
EY No physician or other licensed health care provider order for this item or service
GZ Item or service expected to be denied as not reasonable and necessary
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KR Rental item, billing for partial month
KU Dmepos item subject to dmepos competitive bidding program number 3
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
2008-01-01 Added Code added 1/1/2008
Code
Description