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Official Description

Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge
Short Descr Portable liquid oxygen sys
Coverage Carrier Priced
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
BETOS D1C – Oxygen and supplies
TOS Code(s) A – Used durable medical equipment (DME)
Added Date 1/1/2010
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 1
OTS Orthotic No
CCS Clinical Classification 243 - DME and supplies
KX Requirements specified in the medical policy have been met
RR Rental (use the 'rr' modifier when dme is to be rented)
N1 Group 1 oxygen coverage criteria met
NU New equipment
QF Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed
Date
Action
Notes
2010-01-01 Added -
Code
Description
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