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Try CasePilot| Short Descr | Dme supply or accessory, nos | 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 | D1F – Prosthetic/Orthotic devices | TOS Code(s) | 9 – Other medical items or services | Added Date | 1/1/2004 | 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 | 1 | MUE | Not applicable/unspecified. | 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 | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | UB | Medicaid level of care 11, as defined by each state | GA | Waiver of liability statement issued as required by payer policy, individual case | RT | Right side (used to identify procedures performed on the right side of the body) | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | SH | Second concurrently administered infusion therapy | RB | Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair | LT | Left side (used to identify procedures performed on the left side of the body) | A1 | Dressing for one wound | SC | Medically necessary service or supply | CG | Policy criteria applied | CR | Catastrophe/disaster related | GO | Services delivered under an outpatient occupational therapy plan of care | GT | Via interactive audio and video telecommunication systems | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | N1 | Group 1 oxygen coverage criteria met | RA | Replacement of a dme, orthotic or prosthetic item | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services |
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| 2004-01-01 | Added | Code added 1/1/2004 |
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