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Official Description

High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each
Short Descr Replace chest compress vest
Coverage Carrier Priced
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental 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 1/1/2003
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 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KX Requirements specified in the medical policy have been met
NU New equipment
RR Rental (use the 'rr' modifier when dme is to be rented)
Date
Action
Notes
2003-01-01 Added Code added 1/1/2003
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