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Try CasePilot| Short Descr | Portable 02 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 | 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 | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | QH | Oxygen conserving device is being used with an oxygen delivery system | SC | Medically necessary service or supply | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | N2 | Group 2 oxygen coverage criteria met | N3 | Group 3 oxygen coverage criteria met | RA | Replacement of a dme, orthotic or prosthetic item | BP | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | EY | No physician or other licensed health care provider order for this item or service | GR | This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy | GZ | Item or service expected to be denied as not reasonable and necessary | KK | Dmepos item subject to dmepos competitive bidding program number 2 | KS | Glucose monitor supply for diabetic beneficiary not treated with insulin | NU | New equipment | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | QB | Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed | QF | Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed | QG | Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm) | QR | Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (lpm) |
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| 2010-01-01 | Changed | Code description changed |
| 1993-01-01 | Added | Code added 1/1/1993 |
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