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Official Description

Gel pressure mattress
Short Descr Gel pressure mattress
Coverage Special coverage instructions apply
Pricing Indicator(s) 36 – Supplies And Surgical Dressings - Capped rental DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 60-9
BETOS D1E – Other DME
TOS Code(s) R – Rental of DME
Added Date 1/1/1991
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
IOM 100-03, 4, 280.1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KJ Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
RR Rental (use the 'rr' modifier when dme is to be rented)
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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
NU New equipment
Date
Action
Notes
1991-01-01 Added Code added 1/1/1991
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