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Official Description

Helmet, protective, soft, custom fabricated, includes all components and accessories
Short Descr Soft protect helmet custom
Coverage Carrier Priced
Pricing Indicator(s) 45 – Supplies And Surgical Dressings - Customized DME items
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 1/1/2007
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 0
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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
KX Requirements specified in the medical policy have been met
NU New equipment
Date
Action
Notes
2007-01-01 Added Code added 1/1/2007
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