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Official Description

Pump for water circulating pad
Short Descr Pump for water circulating p
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 1/1/1986
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 0
IOM 100-03, 4, 280.1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
RR Rental (use the 'rr' modifier when dme is to be rented)
KI Dmepos item, second or third month rental
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
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
NU New equipment
RT Right side (used to identify procedures performed on the right side of the body)
Date
Action
Notes
1986-01-01 Added Code added 1/1/1986
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