Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot| Short Descr | Incontinence supply | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 46 – Supplies And Surgical Dressings - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 2130 | BETOS | D1F – Prosthetic/Orthotic devices | TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 1/1/1990 | 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 | Not applicable/unspecified. | IOM | 100-02, 15, 120 | OTS Orthotic | No | CCS Clinical Classification | 243 - DME and supplies |
| 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 | KX | Requirements specified in the medical policy have been met | SC | Medically necessary service or supply | GA | Waiver of liability statement issued as required by payer policy, individual case | U8 | Medicaid level of care 8, as defined by each state | GZ | Item or service expected to be denied as not reasonable and necessary | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | EY | No physician or other licensed health care provider order for this item or service | GP | Services delivered under an outpatient physical therapy plan of care | U9 | Medicaid level of care 9, as defined by each state | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | BP | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item | CG | Policy criteria applied | CR | Catastrophe/disaster related | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | KK | Dmepos item subject to dmepos competitive bidding program number 2 | RA | Replacement of a dme, orthotic or prosthetic item |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 1990-01-01 | Added | Code added 1/1/1990 |
Get instant expert-level medical coding assistance.