| 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 |
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Date
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Action
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Notes
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| 2006-10-01 | Added | Code added 10/1/2006 |