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Official Description

Replacement lens shield cartridge for use with laser skin piercing device, each
Short Descr Replace lensshield cartridge
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 1/1/2002
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-Covered Service, not paid under OPPS
MUE 0
MUE 0
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
GA Waiver of liability statement issued as required by payer policy, individual case
Date
Action
Notes
2002-01-01 Added Code added 1/1/2002
Code
Description
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