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Official Description

Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
Short Descr Synthetic drsg <= 16 sq in
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 1/1/2019
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 1
MUE 1
OTS Orthotic No
Date
Action
Notes
2019-01-01 Added Added
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