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Official Description

Parenteral nutrition infusion pump, portable
Short Descr Parenteral infus pump portab
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)
KH Dmepos item, initial claim, purchase or first month rental
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KI Dmepos item, second or third month rental
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
MS Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
BR The beneficiary has been informed of the purchase and rental options and has elected to rent the item
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
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
HJ Employee assistance program
HK Specialized mental health programs for high-risk populations
NU New equipment
UE Used durable medical equipment
Date
Action
Notes
1988-01-01 Added Code added 1/1/1988
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