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Try CasePilot| Short Descr | Grad com wrap w straps bk | Coverage | Carrier Priced | Pricing Indicator(s) | 40 – | MPI | A – Not applicable, as HCPCS priced under one methodology | BETOS | O1L – | TOS Code(s) | S – Surgical dressings or other medical supplies | Added Date | 1/1/2024 | 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 | Not applicable/unspecified. | MUE | 6 | OTS Orthotic | No |
| LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | KX | Requirements specified in the medical policy have been met | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | 23 | Unusual anesthesia: occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. this circumstance may be reported by adding modifier 23 to the procedure code of the basic service. | A1 | Dressing for one wound | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GO | Services delivered under an outpatient occupational therapy plan of care | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2024-01-01 | Added | Code added. |
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