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Official Description

Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each
Short Descr Compress stking bk40-50 surg
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
Processing Note COMPRESSION LEVELS FOR PRODUCTS IDENTIFIED BY THESE CODES (
BETOS D1A – Medical/surgical supplies
TOS Code(s) P – Lump sum purchase of DME, prosthetics, orthotics
Added Date 1/1/2006
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 Service Paid under Fee Schedule or Payment System other than OPPS
MUE 0
MUE 4
IOM 100-02, 15, 100
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
AW Item furnished in conjunction with a surgical dressing
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
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
A1 Dressing for one wound
KX Requirements specified in the medical policy have been met
Date
Action
Notes
2024-01-01 Changed Long description changed
2006-01-01 Added Code added 1/1/2006
Code
Description
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