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Try CasePilot| Short Descr | Stationary compressed gas 02 | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 33 – Supplies And Surgical Dressings - Oxygen and oxygen equipment (price subject to floors and ceilings) | MPI | A – Not applicable, as HCPCS priced under one methodology | CIM | 60-4 | MCM | 4107.9 | BETOS | D1C – Oxygen and supplies | TOS Code(s) | R – Rental of DME | Added Date | 1/1/1993 | 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 |
| RR | Rental (use the 'rr' modifier when dme is to be rented) | KX | Requirements specified in the medical policy have been met | N1 | Group 1 oxygen coverage criteria met | N3 | Group 3 oxygen coverage criteria met | QG | Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm) | GA | Waiver of liability statement issued as required by payer policy, individual case | RA | Replacement of a dme, orthotic or prosthetic item | CR | Catastrophe/disaster related | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | MS | Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty | N2 | Group 2 oxygen coverage criteria met | QE | Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm) | QF | Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed | QH | Oxygen conserving device is being used with an oxygen delivery system |
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| 1993-01-01 | Added | Code added 1/1/1993 |
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