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Try CasePilot| Short Descr | Adju cgm supply allowance | 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) | 9 – Other medical items or services | Added Date | 4/1/2022 | 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 | Non-Implantable Durable Medical Equipment | MUE | 3 | MUE | 3 | OTS Orthotic | No |
| KF | Item designated by fda as class iii device | KX | Requirements specified in the medical policy have been met | CG | Policy criteria applied | GA | Waiver of liability statement issued as required by payer policy, individual case | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | 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 | CR | Catastrophe/disaster related | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GS | Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | SC | Medically necessary service or supply |
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| 2023-01-01 | Changed | Long Description Change |
| 2022-04-01 | Added | Code added. |
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