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Official Description

Enteral nutrition infusion pump, any type
Short Descr Enter nutr inf pump any type
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) A – Used durable medical equipment (DME)
Added Date 1/1/1988
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-02, 15, 120
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KH Dmepos item, initial claim, purchase or first month rental
KI Dmepos item, second or third month rental
KX Requirements specified in the medical policy have been met
MS Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
NU New equipment
BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item
GA Waiver of liability statement issued as required by payer policy, individual case
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
GW Service not related to the hospice patient's terminal condition
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
GZ Item or service expected to be denied as not reasonable and necessary
BU The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
KT Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
RA Replacement of a dme, orthotic or prosthetic item
UE Used durable medical equipment
Date
Action
Notes
2017-01-01 Changed Description Changed
1988-01-01 Added Code added 1/1/1988
Code
Description
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