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Official Description

Stationary oxygen contents, gaseous, 1 month's supply = 1 unit
Short Descr Stationary o2 contents, gas
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) P – Lump sum purchase of DME, prosthetics, orthotics
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
KX Requirements specified in the medical policy have been met
CR Catastrophe/disaster related
N1 Group 1 oxygen coverage criteria met
N3 Group 3 oxygen coverage criteria met
Date
Action
Notes
2010-01-01 Changed Code description changed
1993-01-01 Added Code added 1/1/1993
Code
Description
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