HCPCS Code B4087

Official Description

Gastrostomy/jejunostomy tube, standard, any material, any type, each

Short Descr	Gastro/jejuno tube, std
Coverage	Carrier Priced
Pricing Indicator(s)	39 – Supplies And Surgical Dressings - Parenteral and Enteral Nutrition
MPI	A – Not applicable, as HCPCS priced under one methodology
BETOS	O1C – Enteral and parenteral
TOS Code(s)	E – Enteral/parenteral nutrients/supplies
Added Date	1/1/2008
APC Status Indicator	Non-Implantable Durable Medical Equipment
MUE	0
MUE	Not applicable/unspecified.
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

KX	Requirements specified in the medical policy have been met
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
GA	Waiver of liability statement issued as required by payer policy, individual case
CR	Catastrophe/disaster related
BO	Orally administered nutrition, not by feeding tube
BP	The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
EY	No physician or other licensed health care provider order for this item or service
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
GW	Service not related to the hospice patient's terminal condition
GZ	Item or service expected to be denied as not reasonable and necessary
KT	Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
NU	New equipment
U3	Medicaid level of care 3, as defined by each state
UB	Medicaid level of care 11, as defined by each state