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Official Description

Oxygen probe for use with oximeter device, replacement
Short Descr Oxygen probe used w oximeter
Coverage Carrier Priced
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
BETOS D1E – Other DME
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2003
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 0
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
N1 Group 1 oxygen coverage criteria met
GA Waiver of liability statement issued as required by payer policy, individual case
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
N2 Group 2 oxygen coverage criteria met
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
U2 Medicaid level of care 2, as defined by each state
U3 Medicaid level of care 3, as defined by each state
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
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