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Official Description

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress
Short Descr Hosp bed semi-electr w/o mat
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 60-18
MCM 2100.1
BETOS D1B – Hospital beds
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 100-02, 15, 110.1
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
KI Dmepos item, second or third month rental
KH Dmepos item, initial claim, purchase or first month rental
KX Requirements specified in the medical policy have been met
GL Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
NU New equipment
CR Catastrophe/disaster related
GA Waiver of liability statement issued as required by payer policy, individual case
GK Reasonable and necessary item/service associated with a ga or gz modifier
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
MS Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
RB Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
Date
Action
Notes
1991-01-01 Added Code added 1/1/1991
Code
Description
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