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Official Description

Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard
Short Descr Packing strips, non-impreg
Coverage Carrier Priced
Pricing Indicator(s) 35 – Supplies And Surgical Dressings - Surgical dressings (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1A – Medical/surgical supplies
TOS Code(s) S – Surgical dressings or other medical supplies
Added Date 1/1/2004
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 Not applicable/unspecified.
IOM 100-02, 15, 100
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
A1 Dressing for one wound
A2 Dressing for two wounds
KX Requirements specified in the medical policy have been met
A3 Dressing for three wounds
GW Service not related to the hospice patient's terminal condition
A4 Dressing for four wounds
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
A5 Dressing for five wounds
A8 Dressing for eight wounds
GZ Item or service expected to be denied as not reasonable and necessary
RT Right side (used to identify procedures performed on the right side of the body)
A7 Dressing for seven wounds
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)
EY No physician or other licensed health care provider order for this item or service
GA Waiver of liability statement issued as required by payer policy, individual case
LT Left side (used to identify procedures performed on the left side of the body)
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2009-01-01 Changed Code description changed
2004-01-01 Added Code added 1/1/2004
Code
Description
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