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Try CasePilot| Short Descr | Tens suppl 2 lead per month | 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 | 45-25 | BETOS | D1E – Other DME | TOS Code(s) | P – Lump sum purchase of DME, prosthetics, orthotics | Added Date | 1/1/1996 | 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 | 6 | IOM | 100-03, 2, 160.13 | OTS Orthotic | No | CCS Clinical Classification | 243 - DME and supplies |
| KX | Requirements specified in the medical policy have been met | 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 | GP | Services delivered under an outpatient physical therapy plan of care | KG | Dmepos item subject to dmepos competitive bidding program number 1 | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | NU | New equipment | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GX | Notice of liability issued, voluntary under payer policy | GA | Waiver of liability statement issued as required by payer policy, individual case | GZ | Item or service expected to be denied as not reasonable and necessary | CG | Policy criteria applied | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | GW | Service not related to the hospice patient's terminal condition | CR | Catastrophe/disaster related | RA | Replacement of a dme, orthotic or prosthetic item | 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. | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | GO | Services delivered under an outpatient occupational therapy plan of care | KF | Item designated by fda as class iii device | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RR | Rental (use the 'rr' modifier when dme is to be rented) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1996-01-01 | Added | Code added 1/1/1996 |
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