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Try CasePilot| Short Descr | Silicone gel sheet, each | 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 | D1A – Medical/surgical supplies | TOS Code(s) | 9 – Other medical items or services | Added Date | 1/1/1997 | 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 | A1 | Dressing for one wound | AW | Item furnished in conjunction with a surgical dressing | F4 | Left hand, fifth digit | GA | Waiver of liability statement issued as required by payer policy, individual case | GO | Services delivered under an outpatient occupational therapy plan of care | GZ | Item or service expected to be denied as not reasonable and necessary | 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) |
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| 1997-01-01 | Added | Code added 1/1/1997 |
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