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Official Description

External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories
Short Descr Ext amb insulin delivery sys
Coverage Non-covered by Medicare statute
Pricing Indicator(s) 00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI 9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
Statute 1861(n)
BETOS D1A – Medical/surgical supplies
TOS Code(s) 9 – Other medical items or services
Added Date 1/1/2008
Status Code Not Valid for Medicare Purposes
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-Covered Service, not paid under OPPS
MUE 0
MUE 0
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
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
GA Waiver of liability statement issued as required by payer policy, individual case
CG Policy criteria applied
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
SC Medically necessary service or supply
Date
Action
Notes
2008-01-01 Added Code added 1/1/2008
Code
Description
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