| 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 |