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Official Description

Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each
Short Descr G com bandge low dn foamchnl
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 Not applicable/unspecified.
OTS Orthotic No
Date
Action
Notes
2024-01-01 Added Code added.
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