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Official Description

Supplies for maintenance of insulin infusion catheter, per week
Short Descr Supply insulin inf cath/wk
Coverage Carrier Priced
Pricing Indicator(s) 34 – Supplies And Surgical Dressings - DME supplies (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1E – Other DME
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/2017
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 0
MUE 13
OTS Orthotic No
KX Requirements specified in the medical policy have been met
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GW Service not related to the hospice patient's terminal condition
CG Policy criteria applied
GZ Item or service expected to be denied as not reasonable and necessary
KS Glucose monitor supply for diabetic beneficiary not treated with insulin
NU New equipment
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
AY Item or service furnished to an esrd patient that is not for the treatment of esrd
CE Amcc test has been ordered by an esrd facility or mcp physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity
KC Replacement of special power wheelchair interface
RA Replacement of a dme, orthotic or prosthetic item
Date
Action
Notes
2017-01-01 Added Added
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