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Official Description

Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard
Short Descr Conform band s w >=5"/yd
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.
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
A1 Dressing for one wound
A2 Dressing for two wounds
A3 Dressing for three wounds
KX Requirements specified in the medical policy have been met
A4 Dressing for four wounds
GW Service not related to the hospice patient's terminal condition
A5 Dressing for five wounds
A7 Dressing for seven wounds
A9 Dressing for nine or more wounds
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
A6 Dressing for six wounds
EY No physician or other licensed health care provider order for this item or service
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)
Date
Action
Notes
2004-01-01 Added Code added 1/1/2004
Code
Description
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