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Official Description

Lancets, per box of 100
Short Descr Lancets per box
Coverage Special coverage instructions apply
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
CIM 60-11
BETOS D1E – Other DME
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/1985
Status Code Bundled/Excluded Code
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 1
IOM 100-03, 1, 40.2
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KS Glucose monitor supply for diabetic beneficiary not treated with insulin
KX Requirements specified in the medical policy have been met
KL Dmepos item delivered via mail
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)
GA Waiver of liability statement issued as required by payer policy, individual case
GW Service not related to the hospice patient's terminal condition
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
CG Policy criteria applied
CO Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
EY No physician or other licensed health care provider order for this item or service
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GZ Item or service expected to be denied as not reasonable and necessary
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
LT Left side (used to identify procedures performed on the left side of the body)
NU New equipment
RA Replacement of a dme, orthotic or prosthetic item
RT Right side (used to identify procedures performed on the right side of the body)
U1 Medicaid level of care 1, as defined by each state
Date
Action
Notes
1985-01-01 Added Code added 1/1/1985
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