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Try CasePilot| Short Descr | Ef complet w/intact nutrient | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 39 – Supplies And Surgical Dressings - Parenteral and Enteral Nutrition | MPI | A – Not applicable, as HCPCS priced under one methodology | CIM | 65-10 | MCM | 2130 | BETOS | O1C – Enteral and parenteral | TOS Code(s) | E – Enteral/parenteral nutrients/supplies | Added Date | 1/1/1986 | APC Status Indicator | Non-Implantable Durable Medical Equipment | MUE | 0 | MUE | Not applicable/unspecified. | IOM | 100-02, 15, 120 | OTS Orthotic | No | CCS Clinical Classification | 223 - Enteral and parenteral nutrition |
| 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 | BO | Orally administered nutrition, not by feeding tube | GA | Waiver of liability statement issued as required by payer policy, individual case | GL | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) | GW | Service not related to the hospice patient's terminal condition | GK | Reasonable and necessary item/service associated with a ga or gz modifier | EY | No physician or other licensed health care provider order for this item or service | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | GZ | Item or service expected to be denied as not reasonable and necessary | CR | Catastrophe/disaster related | CG | Policy criteria applied | A1 | Dressing for one wound | GX | Notice of liability issued, voluntary under payer policy | KY | Dmepos item subject to dmepos competitive bidding program number 5 | EP | Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program | JZ | Zero drug amount discarded/not administered to any patient | SC | Medically necessary service or supply | U1 | Medicaid level of care 1, as defined by each state | U9 | Medicaid level of care 9, as defined by each state |
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| 1986-01-01 | Added | Code added 1/1/1986 |
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