HCPCS Code A9901

Official Description

Dme delivery, set up, and/or dispensing service component of another hcpcs code

Short Descr	Delivery/set up/dispensing
Coverage	Carrier Priced
Pricing Indicator(s)	46 – Supplies And Surgical Dressings - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
MPI	A – Not applicable, as HCPCS priced under one methodology
BETOS	D1E – Other DME
TOS Code(s)	9 – Other medical items or services
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	Service Paid under Fee Schedule or Payment System other than OPPS
MUE	0
MUE	0
OTS Orthotic	No
CCS Clinical Classification	239 - Transportation - patient, provider, equipment

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
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)
CG	Policy criteria applied
GA	Waiver of liability statement issued as required by payer policy, individual case
GZ	Item or service expected to be denied as not reasonable and necessary
N1	Group 1 oxygen coverage criteria met
UB	Medicaid level of care 11, as defined by each state