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Try CasePilot| Short Descr | Walker folding wheeled w/o s | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 32 – Supplies And Surgical Dressings - Inexpensive & routinely purchased DME (price subject to floors and ceilings) | MPI | A – Not applicable, as HCPCS priced under one methodology | CIM | 60-9 | MCM | 2100.1 | BETOS | D1E – Other DME | TOS Code(s) | A – Used durable medical equipment (DME) | Added Date | 1/1/1986 | APC Status Indicator | Non-Implantable Durable Medical Equipment | MUE | 0 | MUE | 1 | IOM | 100-02, 15, 110.1 | OTS Orthotic | No | CCS Clinical Classification | 243 - DME and supplies |
| NU | New equipment | KX | Requirements specified in the medical policy have been met | RR | Rental (use the 'rr' modifier when dme is to be rented) | 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 | KV | Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service | LT | Left side (used to identify procedures performed on the left side of the body) | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GK | Reasonable and necessary item/service associated with a ga or gz modifier | CR | Catastrophe/disaster related | 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 | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | CG | Policy criteria applied | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | EY | No physician or other licensed health care provider order for this item or service | GC | This service has been performed in part by a resident under the direction of a teaching physician | GL | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) | 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 | GX | Notice of liability issued, voluntary under payer policy | HA | Child/adolescent program | K4 | Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete. | KG | Dmepos item subject to dmepos competitive bidding program number 1 | 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 | KK | Dmepos item subject to dmepos competitive bidding program number 2 | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | KY | Dmepos item subject to dmepos competitive bidding program number 5 | KZ | New coverage not implemented by managed care | N1 | Group 1 oxygen coverage criteria met | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RB | Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair | ST | Related to trauma or injury | TW | Back-up equipment | U1 | Medicaid level of care 1, as defined by each state | UE | Used durable medical equipment | VP | Aphakic patient |
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| 1986-01-01 | Added | Code added 1/1/1986 |
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