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Official Description

Tubing, used with suction pump, each
Short Descr Tubing used w suction pump
Coverage Carrier Priced
Pricing Indicator(s) 32 – Supplies And Surgical Dressings - Inexpensive & routinely purchased DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS D1E – Other DME
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2000
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 Non-Implantable Durable Medical Equipment
MUE 0
MUE 30
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
NU New equipment
KX Requirements specified in the medical policy have been met
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
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
GW Service not related to the hospice patient's terminal condition
EP Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program
GZ Item or service expected to be denied as not reasonable and necessary
KE Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply
EY No physician or other licensed health care provider order for this item or service
RR Rental (use the 'rr' modifier when dme is to be rented)
Date
Action
Notes
2000-01-01 Added Code added 1/1/2000
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