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Official Description

Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds
Short Descr Pwc gp 2 hd seat/back
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 10/1/2006
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
RR Rental (use the 'rr' modifier when dme is to be rented)
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
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KX Requirements specified in the medical policy have been met
NU New equipment
Date
Action
Notes
2006-10-01 Added Code added 10/1/2006