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Official Description

Compression burn garment, glove to elbow, custom fabricated
Short Descr Cmprsburngarment glove-elbow
Coverage Special coverage instructions apply
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
MCM 2079
BETOS D1A – Medical/surgical supplies
TOS Code(s) S – Surgical dressings or other medical supplies
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 4
IOM 100-02, 15, 100
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RT Right side (used to identify procedures performed on the right side of the body)
A1 Dressing for one wound
LT Left side (used to identify procedures performed on the left side of the body)
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
Code
Description
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